No matter how empathetic a delivery system, there is always a scope to do more, to do better and to think farther. During my recent visit to Postgraduate Institute of Medical Education and Research, Chandigarh for a foundation day lecture on Doctors as Designers of an inclusive healthcare system, I learnt so much about the innovations involving patients, their wards, nurses and other staff as co-creators. Somehow, the intellectuals tend to take over far too much responsibility of thinking and doing. We ignore the contribution grassroots workers within and outside an organisation can make towards a very creative and innovative ecosystem.
During the informal interaction with the Director, Dr. Yogesh Chawla, Dean, Dr. Arunaloke Chakraborti, innovative students and faculty, it was learnt that despite being a premier institute of tertiary research and practice of medical science, PGIMER received about 10000 patients every day. The more caring they were, more demands were made on them from the entire region. I was keen to know whether doctors and patients together had developed some innovative solutions.
What Dr.G.D.Puri shared is not only an inspiring one but also very relevant for all other hospitals which would wish to learn from their patients and the wards. Dr. Puri explained that while giving infusion to the patients, sometimes he needed to know when a specific volume had been delivered, say 200 ml out of 500 ml saline. The wards keep an eye and then communicate the information to the nurse and the doctor to do the needful. Dr. Puri being a surgeon had to focus on surgery rather than keeping track of every infusion to critical patients. He discussed this problem with the wards of the patients and discovered a very innovative possibility. Mr. Kalia, a technical assistant was attending on his relative who needed such monitoring. They both discussed the idea and realised that a weight based alarm system would be easiest to design and solve the problem. Dr.Kalia was working with a company, Clarity which helped him to design a small device with a hook on which bottle could be hung. At the predetermined level, the alarm would indicate the need for stopping the flow or taking the next step. When I asked this question in my SMIPR class yesterday, students came out with several ideas such as flow meter, timer and several other possibilities till one student thought about a balance to weigh and signal an alarm. Mr. Kalia was no less talented than my class at IIMA and that too with far less qualification. An invention was born [see fig].
Imagine similar opportunities for redesigning a whole range of devices, delivery systems and other patient monitoring systems in which the patients, their wards and nurses who face the constraint can contribute positively to solving the problem. These solutions when designed by materially constrained people invariably turnout to be a frugal innovation. Given the empathetic context in which such a dialogue takes place, the samvedana is inherent in the srijansheelta. Let me give you another example of Dr. Kusum Sharma who wanted to develop a quick system for identifying TB. With the help of similar discussion with affected people, staff and students, she has designed a very low cost solution. Dr. Reddy regretted that many of the terminally ill patients with a need to use feeding tubes could not taste the food. He wanted the evening of the life of such patients to be more meaningful. He designed a tubing with corrugated filter inserted in the oesophagus so that food after being tasted went to the inserted tube.
There was another interesting example for monitoring children who sometimes feel uncomfortable and squirm in the cradle. Generally, we take note only when the child cries. Some doctors thought about an image processing device on the top of the cradle to indicate the discomfort of the child. How nice of the doctors and the nurses to be so sensitive to the child’s needs. There were many other innovations being done at this and many other institutions. As Dr. Chawla mentioned, they were so occupied with day to day care of the patients that innovations even when tried did not often get catalogued, shared and celebrated. I requested him to start a corridor of creativity in which such innovations and even the challenges could be displayed. When patients, wards and the staff walk through the corridor, they feel envious, inspired or provoked to do something different themselves. Once the seeds of impatience with inertia are sown, the sprout of an innovative idea become inevitable. The student innovators may note that under BIRAC-SRISTI partnership, SRISTI provides fifteen fellowships of Rs 15 lac each and 100 fellowships of one lac each for grassroots innovations validated or value added by students, Apply firstname.lastname@example.org .