Innopinion 2: Make frontline innovation visible and change the system from the inside out

By Anjali Sastry

frontline innovation

Across the planet, every day, nurses, doctors and their colleagues wrestle with the challenge of delivering healthcare to those who most need it. Many agree that to enable improvement, we need to learn what works and support innovation. 

There’s wide consensus that management and business tools could help. Organisations in low-resource settings could benefit from practical assistance in marketing, operations, change-management, design, technology use, finance, strategy and systems. My own experience bears this out.

Dozens of improvement projects that my collaborators and I conducted in Africa and Asia via MIT Sloan School of Management’s GlobalHealth Lab, reveal that the right management approaches can improve efficiency and effectiveness of clinics, hospitals and programmes that serve the poor.

But my field experience reveals more than gaps in providers’ management toolkits. Collaborating closely with frontline workers has taught me much about the work of healthcare innovation. I’ve learned that frontline workers make flawed healthcare systems work for patients by improvising practical new solutions. But because this work is underappreciated, we fail to understand – and to harness – all that could enable or stymie needed change.

“If much of the work that people do to make the system better goes unrecognised, are we asking for healthcare innovation, yet failing to appreciate and support what people are already doing?”

So, with an eye to enabling us to better appreciate both needs and opportunities in frontline innovation, I’d like to share my inventory of some of the everyday invisible work involved in serving the neediest:

  • Devising creative ways to address patient needs, including leveraging or repurposing existing services or infrastructure
  • Finding and using information about patients and the community, including non-medical aspects, to enable better care
  • Gathering data from the organisation’s daily operations to find opportunities for improvement or to make the case for change
  • Designing new materials, systems, processes, and flows for patients or staff, to better manage care and operations
  • Fixing things that aren’t working and crafting work-arounds for broken or missing inputs
  • Building internal coalitions and momentum to enable change or improvement
  • Advocating for missing resources
  • Organising, rationalising and managing physical and electronic spaces
  • Building supportive external relationships
  • Learning from colleagues who are tackling similar challenges elsewhere
  • Teaching others and sharing what has been learned

If much of the work that people do to make the system better goes unrecognised, then efforts to improve performance are inherently invisible and inevitably undervalued. Are we asking for healthcare innovation, yet failing to appreciate and support what people are already doing? Are we extolling the virtues of new devices, drugs and software at the cost of overlooking every other aspect of healthcare delivery innovation?

I’ve been thinking about what it would mean to take seriously the invisible, innovative work of healthcare delivery. We’d build novel two-way collaborations with frontline workers. We’d commit resources to documenting and examining what works. More prospectively designed research is needed, for sure, but we need to first find and invent the new ideas. Let’s harness action research, collaborative action learning, natural experiments, case studies, ethnographies and more.

Videographers, journalists, writers and masters of social media could make valuable and enriching contributions to the documentation. Systems thinkers and policy visionaries could add needed contextualisation and analysis to ensure that new ideas are aligned with health and development goals.

The resulting recognition of frontline workers’ efforts could help shore up their motivation and engagement. Acknowledging local innovations could encourage new leaders and change agents to emerge.

But this new movement could do much more: It could also equip innovators – leaders, administrators, reception staff, aides, physicians – to define and label the practices they co-develop or discover. Academics, educators and professional experts could help establish results, then connect high-impact innovations to existing knowledge, management training and communities of practice. This could allow innovators to find their own improvements in a broader set of professional frameworks and methods. Innovators could tap into others’ experience and know-how, contribute to shared knowledge and help advance techniques across domains and settings.

Over the years, professional practice in software development, manufacturing and clinical care benefited from such advancement. Imagine the gains if we could do the same. Frontline healthcare workers’ innovations could be codified, disseminated and improved upon, and we could finally follow our own advice by learning from each other and facilitating innovation that is grounded in frontline realities.

THREE INNOPINIONS ON HEALTHCARE INNOVATION: One is a pharmaceutical correspondent at the Financial Times in London, another is senior lecturer at the MIT Sloan School of Management, and the third is Director at the City of Cape Town for World Design Capital 2014. These are their thoughts on healthcare innovation.

  1. → Andrew Jack: Africa’s inherent innovative potential
  2. → Anjali Sastry: Make frontline innovation visible and change the system from the inside out
  3. → Richard Perez: The role of service-design in healthcare transformation

Adapted from the 2014 Health Innovator’s Review, compiled by Inclusive Healthcare Innovation, a joint initiative between the Bertha Centre for Social Innovation & Entrepreneurship at the University of Cape Town (UCT) Graduate School of Business, and the UCT Faculty of Health Sciences.

Inside | Anjali Sastry


Anjali is a senior lecturer at the MIT Sloan School of Management and the Director of the Groundwork Initiative and GlobalHealth Lab.


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