technology: the glamorous and the grinding

by Anjali Sastry on December 4, 2010

Can we make process, management, and systems a bit less dreary and a bit more glam?

So, we’re at MIT, where technology is in the air, and I have my own personal obsessions with technology–witness my (often flawed) forays into twitter, delicious, and too many mobile phones, along with plenty of other tech tools.


Working on the delivery of health care in global settings from MIT, I’m often asked about technology: what do we make of the potential for electronic medical records? Point-of-care diagnostics? Labs-in-a-box? Mobile phones and SMS? Telemedicine? Bar codes? Dual-market pharmaceuticals?

I’ve come to think that things–devices, pills, machines–exert an allure that the other things that are needed simply can’t match. Process improvement? Enterprise solutions? Strategic planning? Internal review processes? Cost accounting? Utilization tracking? All these things, and more, are much needed in health care delivery, but they are so difficult to observe and describe. Photo-ops are few, and the entire effort that managerial improvement entails seems slow, grinding, and maybe even uninspired. Definitely not cool the way a solar-powered, IDEO-designed thing is.

Here’s an example: MIT graduate Saul Griffith is much admired for his inventions and recognized with a MacArthur Fellowship. Earlier this year an engaging story in the New Yorker told of what Griffith learned after he invented a device to rapidly custom-manufacture low-cost eyeglass lenses, primarily for people in impoverished countries:

… winning the [MacArthur] prize turned out to be easier than changing the world, and Griffith’s lens printer has never found a market. The real problem with eyeglasses in the developing world isn’t making lenses, it’s testing eyes and writing accurate prescriptions. Griffith is an invention engine. His many current projects include an electricity-assisted cargo-carrying tricycle, an inexpensive form of insulation inspired by origami, and an unconventional method of generating power with wind. But his thinking has been deeply influenced by what might be thought of as the cheap-glasses conundrum: the inadequacy of addressing complex societal issues with technological ingenuity alone.

Read more: source.

I’ve come to feel that we need to give more attention and respect to the task of sorting out how to actually deliver the good stuff–whether this good stuff is evidence-based medical knowledge or the medicines, bednets, water filters, and eyeglasses that would immeasurably improve the quality of life for low-income populations. Reporters do not breathlessly describe improvements in inventory turns or patient loss to followup (each of these indicate how well the organizational system is meeting its constituents’ needs). At least not the same way that a clever new water pump or incubator is described, or even the way that social entrepreneurs are themselves described. Is the problem our culture’s obsession with novelty, which results in our dismissing the earnest and quotidien efforts required to make existing ideas better? Is the problem that management and systems thinking generate few photo-ops? Is it that we’ve failed to make the case for why  process, logistics, and leadership matter? Perhaps we need to frame the management innovations that are emerging as social and information technologies and hitch the cause to the technology bandwagon.

I guess I am tipping my hand here: I do think there is a cause, not only in the activist, health-is-a-human right sense (which seems to me a personal and political issue), but also in an academic sense. If health care is a large component of our economy (17% and counting of US GDP), a big chunk of foreign aid (the second five year authorization of PEPFAR, from 2009-2013, will require some $58 billion from US taxpayers), and has a huge impact on development, competitiveness, and even global political stability, then we need to attend to health care delivery as a domain of activity, asking what makes for good performance. Dartmouth President Jim Kim tells us, we can’t wait for a new science of global health delivery–there’s a pressing need for a new, practical, academic field.

What’s the link to technology? If the social technologies of management and systems are key to the new science of health care delivery, then delivery can join discovery and development as areas of focus. And I don’t mean to dismiss the more traditional forms of technology. There are amazing physical and biological technologies out there. For instance, we’re working with an entrepreneur and academic expert whose devices could help treat AIDS patients in the most remote and resource-limited settings by measuring their need for medication far more cheaply than ever before possible. If we can help their team to get the technology to the market, we’ll help the device to have the impact it promises. And we learn of new technologies every day. Modern science, for instance, can now breed rats who sniff tuberculosis, detecting the devastating disease at what could be a far lower cost than the alternatives.

At the same time, in existing organizations all over the world, there are innovations in management systems, operations, processes, and collaborations that could help others, if only they could learn from them. There are also plenty of opportunities to apply known approaches to improve organizational performance. Management really does matter (learn about this recent widely-cited study on the value of management techniques in Indian manufacturing: start with this story ; then the full research paper.)

What do you think? Do we need to glamorize the work that’s entailed with getting things done, and with getting things done better?

One of our steps in this direction is to build a dialog within our classrooms and with the experts in the field, who include people in front-line health care delivery enterprises themselves, to understand what works, what seems not to, and how things can be improved in the most practical sense. In the coming weeks, we’ll share what we’ve been uncovering in our new class on global health delivery and management and look forward to continuing the conversation. We’ll share nine mini case studies along with some reflections on what else we need to know in order to draw out our insights on the business models. And our spring projects class will put our management toolkit to the test in some 11 efforts carefully designed in collaboration with front-line health enterprises in South Africa, India, Kenya, and Uganda.

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Perspective seeking in global health | MethodLogical
March 3, 2011 at 11:47 pm

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Anonymous December 6, 2010 at 4:30 pm

I think what needs to be done is to establish some broad measures and agency for researching and reporting effectiveness and impact of these organizations and efforts.
Aid and donations has enjoyed a pretty good run as the developed world economies boomed. Going forward through, if we assume foreign aid as a percentage of GDP does not increase (if anything I would expect it to decrease), foreign aid might increase by 3% a year (which I think is an aggressive estimate). The demand for aid will far outpace supply, at which point aid becomes a zero sum game in which an increase in funds to one cause decreases those available to another.
If there is not an established and transparent set of measures for efficiency and impact, growth will be a function of marketing and fundraising, which entails higher costs. What is to stop the competition to out-fundraise to the point where 90% of donations go to fundraising, leaving only 10% to deliver on the mission?
If you look to examples of establishments that have developed to efficiently allocate resources, one of the best examples is the stock market. The driving idea of the stock market is that it is efficient because all available information is reflected in the price of the stock. The way it maintains this efficiency is through accepted metrics of success (Profit, ROI , etc.) and transparent information flows through disclosures and financial statements. It also has a governing body, the SEC, which (in theory) maintains this transparency.
The challenge is that the stock market has investors and agents who can sort through this data and make sense of it. If Global Health can leverage technology to collect, analyze, and report data of the effectiveness of an organization this will promote an allocation of resources based on data and not photo-op generated sentiment. Moving towards this should come from three directions.
First, we need an agency to organize the data coming in from the field and present this information in a way that can be easily interpreted. This organization can also set standards for what information should be reported and in which format it should be reported.
Second, the health delivery organizations should be collecting data at their level, which will then be reported up. If they know that this data and not their fundraising efforts will drive donations this will be an incentive to collect and report this data.
Thirdly, end users should take a more active role in serving as a feedback mechanism. Similar to the way that e-bay generates information on its sellers from customer feedback, the broad agency could generate feedback on organizations through end users. The wide availability of cell phones could be leveraged to allow end users a voice in how future funds are allocated. For this you could even look to American Idol for inspiration. If you have multiple health care delivery organizations operating in a region, why not let people vote on which one should get more funding? Ultimately the end users will be most impacted and have the largest stake in the decision of the allocation of resources so it seems only fair that they should at least have a voice.

Jenny December 8, 2010 at 1:06 pm

Interestingly enough, a lot of the innovations in global health delivery are process oriented. Living Goods has created a pharmacy in a bag model that relies greatly on standardized guidelines of treatment. Smile Train’s core capability is its ability to monitor safety and quality of cleft operations at low cost through the use of cutting edge technology that checks for any doctored photos, re-used photos, etc. Smile Train also relies on electronic medical records.

Many of the processes that are causing the success of global health delivery firms abroad are painfully needed here in the US as well. The transition to standardized protocols and meaningful use of IT in healthcare has been slow everywhere. Perhaps there are lessons that could be learned from these global health organizations that are on the forefront of innovative operating models and processes, even in the developed world where things and cool gadgets and medicines are abounding, but efficiency is not.

T majority of the gains and cost savings in healthcare will come from efficient practices and operations. So if it takes some marketing campaigns to put the glamor in management and operations, it’s definitely worth the investment. Perhaps the creative staff at Lovelife can bring their expertise to this sales pitch?

Anonymous December 10, 2010 at 5:30 pm

In a recent debate between Peter Singer and William Easterly, Easterly brought up the issue of determining an organization’s effectiveness. (Discussion is around 12 minutes or so in.) One great example of a “watchdog” program he brings up is . It was started by a bunch of former hedge fund managers who had the expertise evaluating corporations and determining good investments. They have even developed a “Clear Fund” that allows individuals to donate through them into the recommended organizations, essentially a social giving mutual fund. Interestingly enough their most recent blog discussed effective charities that were not getting enough attention due to the logistic supply chain issues they address that didn’t generate photo-ops. Specifically it mentions the organization, Village Reach which specializes in last mile logistics in health care.

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