The Doctor Weighs In

There are two interesting articles in the Sunday NY Times (Jan. 27, 2008).  One is about the failure of President Bush's Volunteerism Initiative, the other is about the rise of social entrepreneurs.  Volunteerism is usually about helping people.  Social entrepreneurism is about helping people help themselves.  I won't dwell on why the President's Volunterism Initiative is "sputtering," because the story about social entrepreneurs is so much more interesting and inspiring. 

Nicholas Kristof introduced us to social entrepreneurship in a NY Times op-ed when he wrote about Kiva, an online site where you can make microloans to entrepreneurs across the world.  In his most recent Times editorial, "The Age of Ambition," Kristof describes a number of other organizations you might want to include in your list of online favorites:

• Unite for Sight (www.uniteforsight.org) was started by Jennifer Staple, who founded the organization in her dorm room while in college.  Unite for Sight collects old reading glasses in the US and ships them to poor countries.  Last year the organization provided eye care to 200,000 people.
• Injaz (www.injaz.org.jo) trains Arab students in the fundamentals of starting a business.  It was started by Soroya Salti, a Jordanian woman.  It has spread to 12 Arab countries and has the goal of teaching one million students a year.  Per Mr. Kristof:  "My hunch is that Ms. Salti will contribute more to stability and peace in the Middle East than any numberof tanks in Iraq, UN resolutions or summit meetings."
• Orphans Against AIDS (www.orphansagainstaids.org) was founded by Andrew Klaber while he was "playing hooky" from Harvard Business School."  While traveling in Thailand, Mr. Klaber was shocked to learn that teenage girls, orphaned when their parents died of AIDS, were forced into prostitution.  Orphans Against AIDS pays school-related expenses for children  in poor countries orphaned by AIDS.
• Cinepop is one of the most interesting of the organizations described in the Kristof article.  It was founded by a 27 year old Mexican, Ariel Zylbersztejn after learning that 90% of Mexicans can't affort to go to the movies.  The company projects movies on inflatable screens and shows them for free in public parks!  The movies are paid for by advertising.  But Mr. Zylbersztejn didn't limit his focus to just movies.  He "works with micro-credit agencies and social welfare groups to engage the families that come to his moves" in order to help them start businesses or otherwise try to rise out of poverty.  Cinepop plans to take the model to other countries, such as Brazil, India, and China.

Bill Drayton, CEO of Ashoka, an organization (tagline "Everyone is a Changemaker) that supports social entrepreneurs says, "such people neither hand out fish not teach people to fish; their aim is to revolutionize the fishing industry."

It is terrific to read about a this new generation of social entrepreneurs.  Unlike some volunteer programs that falter after the volunteer goes home,this new approach raises the distinct possibility of sustainable improvements in the lives of people struggling with poverty. 

I think Nicholas Kristof sums it up nicely, particularly during this election period when almost every candidate is running on a platform of change, when he says, "Only one person can become president of the United States, but there's no limit to the number of social entrepreneurs who can make this planet a better place."

Disruptive innovations are new technologies, processes, or business models that blow status quo products out of the water and, eventually, replace them entirely. Here are some examples:

• Automobiles replaced horses

• Semiconductors replaced vacuum tubes

• Digital cameras are in the process of replacing film cameras

Lord knows we could use a big dose of disruptive innovation in health care. Most of us are still getting care in a delivery model that is more than 50 years old. And many of us would say it no longer works well.

"Minute Clinics" are often cited as an example of a disruptive innovation in health care, although these retail-based, nurse practitioner run urgent care clinics still have a long way to go before they replace the more traditional office visit, urgent care center, or emergency department as the place to get minor ailments treated.  Nevertheless, their rapid uptake are an indication that health care is ripe for change.

More and more people are unhappy with, unable to access, or can’t afford medical care as usual. That is why I was delighted to learn about a competition being sponsored by the Robert Wood Johnson Foundation and Changemakers.net, an initiative of Ashoka, an organization that describes itself as “Innovators for the Public.”

The competition is titled "Disruptive Innovations in Health and Health Care: Solutions People Want." It is  seeking “new products, technologies, services, delivery systems, business models -- or some combination thereof -- that help consumers to better manage their health and health care.” By better they mean, in ways that are more affordable, accessible, simple and convenient – all issues that sorely need addressing in the current health care “system.”

The application process, like the competition itself, is innovative. You go to a section called “Mosaic of Solutions” to determine what types of barriers to care and innovative strategies are likely to lead to disruption. The suggested barriers in the Mosaic for health care are the following:

• Health care is not consumer friendly (you can say that again!)

• Patients are not empowered • Medicine is complex and expensive

• There are monopolies of knowledge (although the internet revolution is starting to change this)

The healthcare Mosaic lists the following innovative strategies or insights:

• Democratize access

• Simplify through technologies

• Center the consumer in the business model

• Work down the chain of command (for example, help mothers of kids with cerebral palsy get licensed as in-home providers)

The application is filled out and posted online. Readers, including your competition, can then comment on and make suggestions to improve your application. After about 11 weeks, three judges will select 12 finalists. Over the ensuing 2 weeks, the Changemakers community will vote for 3 winners.

Each winner will receive $5,000 -- not much in the Trillion Dollar world of health care, but the winners will also be eligible for additional funding from Robert Wood Johnson. The Foundation has pledged to provide up to $5 million to fund disruptive innovations in health and health care in the United States that show potential to grow and make a large scale impact.

So if you have a great little idea and want to make it a great big product, think about entering this competition. If you are discouraged by the status quo in health care and  just want some inspiration, then bookmark this website and check in periodically to learn what the innovators are up to.

This competition promises to be informative and fun.

Pat Salber, MD