India and China present the largest emerging market growth opportunity for the medical device industry. The Indian surgical device market is valued at $2.75bn, with China’s market significantly larger at $8bn – and both are growing at 15% a year, with more than three-quarters of high-value surgical devices imported. But surgery in emerging markets will not share the same future as surgery in developed markets, according to the report. Different commercial, clinical, user and technical challenges will drive ‘need-based’ innovation – resulting in new products and solutions that are tailored for emerging markets.
“Emerging markets offer a unique opportunity for the surgical device industry to reinvent its role in advancing healthcare,” said report co-author Rahul Sathe, a principal mechanical engineer at Cambridge Consultants. “But the surgical device industry must alter how it innovates in order to grow, succeed and serve these new markets.”
To better understand the challenges and opportunities for surgical innovation, Cambridge Consultants sent a team of product development and human factors engineers to spend two weeks in Indian hospitals – interviewing surgeons, nurses and hospital executives, and observing a variety of surgical procedures. The hospitals ranged from top-tier multi-speciality centres to small, fast-growing village hospitals.
Only 25% of India’s population has health insurance so most Indian patients pay for their healthcare, including surgery, out of their own pockets – emphasising the importance of surgical device value when developing new products for emerging markets. Indian hospitals are generally overcrowded and understaffed, although rapid expansion is on the horizon to support the rapidly growing population. A shortage of experienced surgeons, nurses and equipment technicians highlights the need for products that enable high throughput, operational efficiency, and use by staff with a wide range of experience.
Surgeons in India are rarely employed by a single hospital – they are consultants at multiple hospitals, bringing in their own patients while hospitals provide the infrastructure and patient services. They usually rely on the surgical equipment available at the various hospitals – and may need to switch between multiple types of equipment on a day-to-day basis.
There are no standard training protocols for using new equipment – surgeons spend their own time and money on whatever training they determine to be an appropriate investment to maintain or advance their skills. For nurses and technicians, almost all training is on-the-job, especially when it comes to the use of specific equipment and surgical instruments. But language barriers can complicate the situation – surgeons in India communicate primarily in English, and most equipment manuals are in English, but the ability of nurses, technicians and support staff to read or understand English is often limited.
“The combination of the surgeon consultant model and the issues surrounding training makes it difficult to optimise the team-based surgical techniques that are essential to complex procedures,” said Leslie Johnston, a senior human factors engineer at Cambridge Consultants. “Laparoscopic surgery, for example, often requires frequent tool changes in a confined space – and proper execution of these changes can be difficult, even with a surgical team that has worked together for years.
“Future surgical tools should be designed to enable team-based surgery and reduce the physical and cognitive workload for all surgical staff. Devices that are easier to use – and easier to learn how to use – will be deployed on a greater number of cases immediately after commissioning. And equipment that has applications for more than one surgical department will be used more and potentially allow hospitals to branch out into more complex or specialised procedures – a goal that is integral to the growth plan of many hospitals in India.”
But it’s not just emerging markets that will benefit from innovation in surgical device development – the Cambridge Consultants report predicts that healthcare innovation will be a two-way street. “Products designed for emerging markets can infuse new perspectives into developed markets to improve affordability, accessibility and operational efficiency in healthcare,” said Sathe. “Ultimately, emerging markets will be the catalyst needed to ignite a new wave of surgical innovation – and will affect healthcare delivery on a global scale.”
To request a copy of the report – Emerging markets: the next frontier for surgical innovation – visit: www.cambridgeconsultants.com/2014-surgical-innovation-report