Blogger: Richard Watson
I hate putting newspapers and magazines into the green recycling bin before I've extracted every bit of written goodness from them. Unfortunately, I often have to, because my appetite for reading matter is bigger than my slice of reading time. Sometimes, though, I get to look back at a few weeks of the Economist, to make sure I've not missed something. This week my frugality was rewarded, as I came across a gem I'd missed first time around.
This article  is about lessons we can learn from India's healthcare system. The first lesson we learn is from Vivek Jawali, a heart surgeon, and his team at Bangalore's Wockhardt hospital. They have pioneered "beating heart" or open heart surgery with the patient remaining awake for procedures including complex bypasses.
Because such "beating heart" surgery causes little pain and does not require general anaesthesia or blood thinners, patients are back on their feet much faster than usual. This approach, pioneered by Wockhardt, an Indian hospital chain, has proved so safe and successful that medical tourists come to Bangalore from all over the world.
Unlike the hidebound health systems of the rich world, he says, "in our country's patient-centric health system you must innovate." This does not mean adopting every fancy new piece of equipment.
This resonates clearly with the direction of my research this year. In the reincarnation of service oriented architecture, service modeling and other concrete architecture practices are the focus, not buying shiny new equipment. Service architecture innovation involves identifying services in a rich business context to prove their value. Adhering to the proven design principles of separation of concerns, loose-coupling and service-orientation to make sure they deliver value over the longer term by being flexible and maintainable.
Just as I found value in reviewing back issues of the Economist, my advice to our clients is to look back over their application platform infrastructure to squeeze the most from it. I spent much of the winter adding to Burton Group's Reference architecture for service infrastructure. I added decision making tools for service containers, service mediation systems and middleware. The overarching recommendation in each case is to use what you already have, as it probably fulfils 80% of your requirements. This means keeping the operating theatres running more efficiently, rather than building newer gilded halls. Concentrating on patient outcomes, not polishing the marble, or buying a new machine that goes "ping".
Over the years [Dr. Jawali] has rejected surgical robots and "keyhole surgery" kit because the costs did not justify the benefits. Instead, he has looked for tools and techniques that spare resources and improve outcomes.
Shivinder Singh, head of Fortis, a rival hospital chain based in New Delhi, says that most of the new, expensive imaging machines are only a little better than older models. Meanwhile, vast markets for poorer patients go unserved. "We got out of this arms race a few years ago," he says. Fortis now promises only that its scanners are "world class", not the newest.
This is the key lesson from the Indian healthcare providers. Patient-centric and outcome-oriented innovation plays to their strengths and allows more patients to be treated at lower cost. Building our IT around patient (business-) centric treatment rather than technology is the only way enterprise IT can stay relevant, competitive, and innovative.
I like this article because it reminds us in this flat world innovation is a global two-way street. Especially in the IT industry, we tend to view India through cultural cataracts as primarily an outsourcing location, rather than a centre for business and technology innovation we can learn from.
There's another twist in the Economist article. In claiming advances in Indian care have been enabled by adopting healthcare information technology (HIT) the author is on shakier ground. A glance at the blog entries from my colleague Joe Bugajski and the comments from healthcare professionals will confirm that those advances are coincident, not causal.
 "Lessons from a frugal innovator". The Economist. 16 Apr 2009.
 Thomas L. Friedman. The World Is Flat: A Brief History of the Twenty-first Century. New York, New York: Farrar, Straus and Giroux, 2005