If we were to review the most notorious buzzwords of the past decade, “innovation” would probably be close to the top of the list. Businesses have never been more eager to stick the label in their tag lines. All over the globe technology startups and social enterprises continue to pop up, and if there’s one theme that’s common in their press kits, it is the promise that they innovate.
In practice, however, real innovation is much harder to come by. Contrary to what many seem to believe, innovation does not come in the form of a product or business model. Nor is it represented by a minor improvement in a company’s achievements. Yet, in its truest form, innovation can act as the catalyst to human progress on a global and historical level. It harnesses the power to end some of the world’s biggest problems, including poverty and disease.
How, then, can we learn to identify the processes of innovation? What are the characteristics of a truly innovative system and how can they be achieved?
As one Silicon Valley supremo famously put it, “Innovation distinguishes between a leader and a follower.” So who better to answer these questions than a healthcare leader who’s innovative solutions are changing lives: Echo Collins-Egan, London born twenty six year old and founder and director of the Moroccan branch of ACCESS Health International. Echo’s mission is to show the world that preventable blindness can be eliminated through an adaptable system of innovation — here is what she taught me.
Lessons from India
To spread her message, Echo is writing a manual on eye care that places a culture of innovation into the heart of its purpose. The book is informed by lessons learned from the pioneer of affordable eye care innovation: a private hospital called Aravind based in Madurai, a small city in the south of India.
“We know that there’s a solution to curing blindness, but that’s often not the problem,” begins Echo. “Malaria can be cured, but why does a baby die every minute in the world from malaria? Because we can’t spread that solution. That’s the big challenge within global health.”
Aravind exists as the spearhead of the innovation processes that are enabling the elimination of preventable blindness. Without any public funding, the private clinic has managed to cure blindness in more than three million disadvantaged patients over its thirty year existence. Aravind originated as a clinic comprising of eleven beds, with the aim of providing care for patients who could not afford to pay. It was set up in the 1970s by the late leader of the movement, a man locally known as Dr. V . Fast forward to 2015 and the hospital has expanded into six vision centers around the country. Currently, Aravind’s vision centers collectively continue to provide over half (fifty five percent) of their care for free, while maintaining lower infection rates than in the United Kingdom.
What is perhaps even more impressive than Aravind’s track record is its contribution to global eye care reform. To date, Aravind Eye Care Systems have been successfully implemented in a whopping two hundred hospitals in India, and in various other low income countries across Africa and South America. The common link between these private clinics inspired by Aravind is their provision of high quality, high volume eye care at affordable rates. But the main point of emphasis is that they’re entirely financially self sufficient.
“That’s partly what’s amazing about them, and partly why they work so well,” declares Echo. “Without government funding, they have to be constantly resourceful in the way that they design, adapt and react to their systems.”
Leadership and Ignorance
In Morocco, where Echo is working, there has been incremental progress in government healthcare reform since the country’s independence in 1956. But there remain huge obstacles to overcome. Like in most other countries, hospital places are limited, and care for low income patients is poor and basic due to the lack of financial and human resources. Moreover, low national levels of literacy and staggeringly low health insurance adoption among the general population means patients are often ill informed, and not necessarily inclined to seek medical care when they need it — making it that much harder for solutions to reach them.
“There’s a huge amount of power in not knowing, not coming with the idea that you are selling a solution.”
Echo’s first lesson on tackling those problems is to remember that focusing on those problems does absolutely nothing for the innovation process.
“It’s not about the resources you have,” she asserts. “It’s about how you use them.”
She also recommends a healthy dose of curiosity, communicativeness and, well, ignorance: “There’s a huge amount of power in not knowing, not coming with the idea that you are selling a solution,” she says.
This perspective underpins one of the many qualities necessary for positive changes to materialise on a large scale and, crucially, to endure the test of time. In this way, small enterprises like ACCESS Health are trying to bridge the gap between public policymakers and the private health sector. The idea is to get them to understand that public funding is not always the end goal — it’s about reinventing the approach by getting both sides to work together.
This approach seems to be working.
In her three years leading the project in Morocco, Echo has already managed to form the first ever government partnership enabling free eye tests and follow up care for all schoolchildren. What’s more, thanks to her work, by 2016 eye glasses should be available to all schoolchildren in need. The sustainable aspect of Echo’s approach means that, even if she were to leave the organisation tomorrow, she will have set up the foundation for an innovation mechanism that will last.
The functional capacity of a certain mechanism and the strength of a leader’s vision are only small parts of the process of innovation. Above all, innovation is a culture. Like any culture, it involves a group of people linked by a set of clear and common values. Those values are founded on a constantly self questioning mindset, and they require extremely dedicated people who will toil to uphold them.
Aravind Eye Care Systems serves as a perfect embodiment of an innovative culture. Between Aravind’s six hospitals, the organisation sees two million patients a year and performs an average of three hundred thousand cataract surgeries annually. (Cataract is the leading cause of blindness in the world.) As a point of comparison, in Morocco, there are around 1,100 ophthalmologists and clinics that are dealing with an average of forty thousand cataract surgeries a year. In statistical terms, that is 7.5 times more surgeries performed by Aravind’s six hospitals than in all of Morocco. That is not to say, of course, that Morocco as a national culture is less innovative than India.
“Without government funding, they have to be constantly resourceful in the way that they design, adapt and react to their systems.”
“When we’re talking about culture, [we mean] organisational culture,” clarifies Echo. “It is not Indian culture that is more innovative. It is these specific organisations that have built up innovative cultures. In Morocco that just hasn’t happened yet.”
That is precisely what Echo is attempting to change. Innovation, after all, is not about creating variations of a former solution — it is about completely reinventing the rules of conduct. The initial obstacle is convincing people that the old system no longer applies. In one instance, Echo went as far as to dip into her limited seed funding to take a delegation of Moroccan policymakers to the Aravind hospital in Madurai. Her intention was to show them how the path to creating impact starts with an open mind.
“There’s a moment of resistance when you come across a new model,” she observes. “But those barriers were broken down by the incredibly persistent [staff at Aravind] who said- and this is one of my favourite sentences of all time- ‘It’s complicated’ is not a good enough excuse not to try!”
As a direct result of this trip—indeed, immediately upon their return to Morocco—the Children Eye Care Partnership with the Moroccan government was made possible, enabling free vision screenings for all schoolchildren. In this case, the resources have not changed, but their impact certainly will.
“[Aravind] didn’t have many resources,” says Echo. “They had to innovate in order to achieve what they wanted to achieve.”
That sounds simple enough, but the question of how to pass that knowledge on remains complex.
The Big Challenge: Replicating Innovation
Arguably the biggest question is, how does replication come into place? How do you transfer a system that works in one country to another, given the complex cultural differences between them? These are exactly the issues that Echo addresses in her book, and in her work at large.
To tackle the question of replication, Echo embarked on a tour of multiple clinics around the world that follow the line of the Aravind system, including clinics in Kenya, Ethiopia, and Guatemala. Over many weeks of observation and analysis in these different hospitals, she was able to identify the core common challenges they face. These range from practical challenges such as funding and keeping costs down, through to the technical surgical approaches that enable high volume care against limited human resources. (She also provides detailed documentation of the trip in her blog.)
“I’m very much trying not to sell a specific model,” she emphasises. “Replication is difficult, you can’t copy paste. The book [involves] examples of challenges faced by all, from [the United States to Cameroon]. Each chapter addresses an aspect of the system and culturally appropriate changes that one has to make, including solutions that have been tried and tested. That looks a little different in each place but I want it to be fairly universal in the lessons that it has.”
At the foundation of the replication process is a concept that ACCESS Health terms ‘joint learning.’ The idea is to reform the classic ‘North-to-South’ charity practice wherein, to use an ageless example, European medics endeavour to set up their own hospitals in Africa. Instead, Echo’s organization encourages strategic partnerships between countries that face common socioeconomic challenges (like India and Morocco), given they actually have something to learn from one another.
But beyond pragmatic challenges and their solutions, in the end it all ties back to innovation resulting from people’s willingness to transform the way they think. The only way for any organization to achieve the level of impact that these hospitals have, is on the strength of each and every individual’s dedication to fulfilling the vision.
“It takes guts and it takes energy, and it’s a hard fight that you have to do in the beginning,” contends Echo. “But I find it incredibly satisfying that there are these special pockets of people who are intelligent and compassionate, with an unwavering vision of what it is they’re on this planet to do. And they’re doing it with their own resources, with their own willpower. That is the most satisfying thing to see.”