Quality at the Bottom of the Pyramid

Not only must a future be imagined, it must be built. …

– C. K. Prahalad and Gary Hamel

This entry is to mark my respects for Prof.C.K.Prahalad who unexpectedly passed away today  in the US. Even though his work has been an inspiration for my HealthcareProgress.org online initiative [which is not yet online but would be soon] I have included this brief post which I hope to elaborate later. If one believes in  the ideal of ‘Democratization of Excellence’ *[ which is the slogan of Healthcare Progress] , one among the many commitments it involves is to focus  quality at the bottom of the pyramid. If those sympathetic to what I am trying to do with academic blog would permit me to say so , it is towards the ‘ Democratization of Inquiry’.

C K Prahalad’s impact on the practice of medicine in the developing world is his ‘guidance’ for the development of  ‘disease specific ‘ insurance programs in India . A clear strategic and systemic dedication of healthcare towards ‘chronic care’; one may appreciate his contribution better if one realises that there is no distinction between acute and chronic care in hospital based practice  in India and other developing countries: the financial  burden of  long hospital stays in acute care hospital environments is nothing but systemic violence on society, that has received very little attention among policy makers and health service research academics alike  . His ideas may be considered as the protosystemic versions of Disease Management in the developing world .

He is well known for his many contributions to marketing and strategic management such as ‘ core competencies’.  My favourite quotes are : ‘ the future must not only be imagined but must be built’ and ‘ Not just best practices but next practices ‘.

Healthcare Improvement in developing has largely been a wholesale enterprise: International accreditations , ISO certifications etc. Healthcare in developing countries , contrary what most people think , is not provided by the hospitals but by general practioners working in the isolation of their solo clinics or from their homes. The influence of  Prahalad’s management theories is probably most visible in the retail outlets of the developing countries which began to visualise the value stream in providing daily commodities shampoos , toothpaste  etc in ultra small sachets. Retailing of improvement is a must , but only happen if the target is the individual general practioners , for whom talk about strategy and leadership is meaningless. We do have exemplars of  improvement retailing : if you haven’t guessed yet I have the IHI Model of  Save lives Campaign in mind. Wholescaling [ not wholesaling] of  change requires the retailing of improvement. But it still leaves us, in the developing countries, with the metaphorical question are you talking about the ‘quality of the car’ or the ‘quality of the road’.


* Atul Gawande  in his plenary speech at the IHI Annual forum few years back.

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