Really radical heart surgery

February 16, 2011 at 7:29 pm 1 comment

An NHS Review published today proposes ending child heart surgery in four or five hospitals in England.  This would almost halve the number of institutions performing child heart surgery.  That may sound like a painful cut, but even within the profession itself, the notion that this work must be done at scale is well-established.  With such a range of complex procedures, one-person operations just cannot perform as well as teams of specialists that can constantly sharpen their sills.

However, by international standards, let’s not pretend that this represents radical change.  As our research, Radical Efficiency highlighted, Narayana Hrudayalaya has not just brought scale to heart surgery but ‘walmartisation’.  Founded by Dr Devi Shetty, Narayana performs perhaps twice as many heart operations each day on adults as there are performed on children in the whole of England.  The institution boasts 1,000 beds, compared to an average of 160 in its US equivalents, as well as survival rates nearly 25% better.  We need to be very careful about identifying ‘economies of scale’ in public services – too often in the past they have been illusions.  But where benefits of scale really do exist, their implications can be very challenging, even for our largest, most prestigious teaching hospitals.


Entry filed under: Health.

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1 Comment Add your own

  • 1. Innovation in India « Disciplined Innovation  |  April 5, 2011 at 7:57 pm

    […] why two of our radical efficiency examples show ‘solutions’ based here (D.Light and Narayana Hrudayalaya), the only country that boasts more than one. And there is such incredible poverty in India, such […]


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