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Two weeks in China: Lessons on innovating abroad

I recently spent two weeks in Beijing as part of a program at the Stanford Center at Peking University. Led by Robert Chang, MD, a Stanford ophthalmologist and entrepreneur, the program brought together 20 students from Stanford and PKU to research problems and create digital health solutions in Chinese health care.

Aside from being an opportunity for cultural immersion, the program provided an extraordinary learning experience on innovation in an emerging market. Three lessons were particularly memorable.

1. Multifaceted barriers to care

We visited two major hospitals during the trip to gain on-the-ground insights into Chinese health care. The need for better delivery systems was immediately obvious.

Huge numbers of patients go to the public hospitals resulting in massive overcrowding. At one hospital, a junior physician's role was to physically blockade the entrance to a senior physician's office. Every time he opened the door, a crowd would push to enter. His job was to let one patient through, push the rest back, and lock the door.

A host of issues contribute to the access problem but at its core, it's a supply and demand problem. The population is enormous - there's too much demand for medical services. And there aren't nearly enough qualified physicians - a lack of supply.

The supply problem is exacerbated by the fact that medicine isn't adequately professionalized in China. Training isn't standardized, so there is high variability in what it means to be a "doctor." Pay is low as well, leading physicians to supplement their income with kickbacks from drug companies and gifts from patients.

Perhaps more significantly, it's a widespread practice for patients or their families to assault doctors if they are unhappy with an outcome. According to the Chinese Medical Doctor Association, more than 13 percent of medical staff have been attacked.

Given the prospects of low pay and physical danger, it's hard to see the appeal of becoming a doctor. Developing solutions in this context requires rethinking assumptions about how society works.

2. A risk-averse approach to innovation

Along with hospital visits, we had the opportunity to meet Chinese venture capitalists. They served as both a sounding board against which to pitch our ideas and advisors on the nuances of the Chinese market.

Among other insights, one of my takeaways was that Chinese entrepreneurs are relatively risk-averse. The culture of the Silicon Valley celebrates failure, to the point that it's almost a prerequisite for success.

But in China, there appeared to be a deep-rooted fear of failure. One advisor argued this mentality explains why so many Chinese start-ups are copies of American companies - it's less risky to start a business if the model is proven elsewhere.

These conversations frequently revolved around a desire for structured innovation, which is exactly what our program provided. Dr. Chang taught us the Biodesign Innovation Process, a system that breaks down the development of health technologies into discrete, iterative steps.

While it has been a successful model in the U.S., I believe it was even more compelling to many Chinese students. The Chinese education system emphasizes test-taking and rote memorization, which engenders anxiety with topics as amorphous as "innovation." Approaches like biodesign can help relieve that anxiety and inspire new entrepreneurs.

3. Finding similarities amidst the differences

While I spent a great deal of the trip reflecting on differences between China and the U.S., it was also interesting to think about the similarities.

Despite the economic, cultural, and demographic differences between the two countries, several principles of innovating in health care proved to be universal. Health-care systems around the world face many of the same challenges, whether it is creating insurance systems, tackling payment reform, or administering delivery networks.

Understanding the local environment is very important, but best practices often apply across borders. By taking a consistent and repeatable approach to innovation, we can develop improvements that push health care forward.

Stanford Medicine Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the Stanford Medicine Unplugged category

Akhilesh Pathipati is a fourth-year MD/MBA student at Stanford. He is interested in issues in health care delivery.

Photo courtesy of Akhilesh Pathipati

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