Healthcare Innovation - A Case Study in Scalability and Sustainability

January 2018 | By Assistant Professor Wiljeana Glover, TOIM, Schlesinger Fund for Global Healthcare Entrepreneurship

Estimated reading time: 4 minutes

Key Takeaways

  1. An entrepreneurial mindset and the willingness to pilot a program with nothing more than the resources at hand can be an important first step, and will help define additional phases of the project.
  2. Community building is an essential precursor to any systems change or innovation, and ensures that the needs of the community are heard and the right problem is being addressed.
  3. Sound strategy comes alive when the implementation team is collaborative, enthusiastic, and has a strong sense of mutual respect.
  4. Simplify in order to scale. The easier it is to develop and implement a global healthcare project or solution, the easier it will be to put it into the hands of more communities in need.

As populations increase, health resources shrink, and quality of life equity differences widen, the clarion call for innovation in healthcare is growing louder around the world. According to the World Health Organization, healthcare innovation “identifies new or improved health policies, systems, products and technologies, and services and delivery methods that improve people’s health and wellbeing.” We see this in the U.S., where healthcare organizations such as Atrius Heath work to replace processes and create brand new care models. In the global health community, both technological innovations (exemplified by public-private product development partnerships) and social innovations (for example system solutions, new programs, and policy) are equally valued and encouraged

Many health innovators have set high goals but have experienced limited implementation success or never scaled to serve a wider population. In my role as faculty director of the Schlesinger Fund for Global Healthcare Entrepreneurship within the Lewis Institute at Babson College, I have observed numerous product, service, and systems innovations in multiple geographies including Haiti, Ghana, Mongolia, Mozambique, and Uganda. Through our engagements, we look for common themes across innovators that may enhance or limit success.

Dr. Stephen Ttendo, director of anesthesia for Mbarara Regional Referral Hospital (MRRH) in Mbarara, Uganda, Dr. Paul Firth, anesthesiologist at Massachusetts General Hospital and MRRH visiting anesthesiologist, and their team created the surgical quality assurance database (SQUAD), a database that they are now attempting to scale to other hospitals in the region and throughout the continent . Their story illustrates four major themes that we’ve seen in our global healthcare innovation work so far:

Embrace an Entrepreneurial Mindset

Ttendo and Firth identified a clear need for tracking patient data to improve health outcomes. Their predecessor, Dr. Gerald Tumusiime, a former MRRH surgeon, already had implemented a no-cost Excel file to track patient data. MRRH needed to expand this effort and track patient data across a larger population for informed decision making. Ttendo and Firth leveraged low-cost resources to implement SQUAD, using Open Medical Record System (OpenMRS), open-source software platform that allowed them to build an electronic medical record for surgery, obstetrics, gynecology, and intensive care. SQUAD also is now being used to provide quantitative information needed to publish academic research and attract funding for long-term financial support.

Know Your Adoptive Community

Firth, as the U.S. partner on the SQUAD team, recognized the need to deeply understand the needs of Ttendo and the MRRH environment and patients before lending assistance. Of his trips to Uganda, Firth noted, “It’s the human interactions with people that matter most. It’s the people in the system who are running the system, so engaging first and foremost with people and determining what they want to do is essential.” Firth set up biweekly anesthesia training calls not just to train the MRRH staff, but to also build community and better understand the needs of the community before attempting any changes.

Strengthen Your Implementation Team

Well-functioning teams value the contributions of all team members and work in collaboration. High performance often is paired with a strong team leader with considerable experience who can leverage the skills and resources of those on the team. For SQUAD, Firth and Ttendo respected each other and also were respected by the rest of the team of six Ugandan employees (four data clerks to collect and record patient records, one data quality assurance monitor, and one IT specialist to manage the database and create monthly reports). There was enthusiasm for the project among all team members. I met one of the data clerks, Manfred, and was extremely impressed by his depth of knowledge on how SQUAD impacted other parts of the hospital and how it might be used to improve other processes, including the hospital supply chain.

Measure and Scale Your Operational Approach

Because it is a process-oriented innovation, its overarching goal is continuously improving accurate and reliable metrics that correlate with improved patient outcomes. The challenge now is to simplify the development and implementation of SQUAD for other regional hospitals. In April 2017, The Lewis Institute and GHE hosted Firth for the Babson Social Innovation Summit. At the event, a group of Babson students, staff, and faculty brainstormed new models to scale SQUAD. The new models centered on continued collaboration with local hospitals and universities, and the potential monetization of research findings based on the data.

Scaling and sustaining global healthcare innovation is both an art and a science, much like medicine itself. Knowing how and when to deploy a technological resource, social innovation, or systems solution can make a big difference in the ultimate success of the project.

Selected Sources:

The SQUAD story is captured in more detail in the teaching case, “SQUAD IN UGANDA: SURGICAL QUALITY ASSURANCE DATABASE (A)” by James Quinn and Genevieve Barnard under the direction of Kate McKone-Sweet, John Meara, Sarah L.M. Greenberg, Johanna Riesel, and Leonard Schlesinger.