In healthcare, where every decision can mean the difference between life and death, we cannot afford to let innovation be stifled by hierarchy.
In fact, hierarchy doesn’t just stifle ideas—it kills them before they ever leave the room and often for reasons unrelated to the issue itself.
This paradox is striking. While healthcare aims to innovate and improve, it often fails to leverage the full spectrum of ideas available.
Quality improvement—a structured framework for enhancing care—provides a powerful lens to explore how inclusive innovation can transform healthcare.
The people closest to the problem are often the best equipped to find solutions.
Consider the development of Oral Rehydration Solution in the 1960s.
Amid a cholera outbreak in Bangladesh, researchers and frontline health workers, including Dr Richard A Cash and Dr David Nalin, discovered that a simple mixture of water, sugar and salt could effectively combat dehydration caused by cholera and other diarrhoeal diseases.
This low-cost intervention has since saved millions of lives worldwide. ORS didn’t originate in a boardroom or a government office—it came from the field.
Another powerful example is the introduction of kangaroo mother care in the late 1970s by pediatricians Dr Edgar Rey Sanabria and Dr Héctor Martínez Gómez in Bogotá, Colombia.
Faced with a shortage of incubators, they developed this method of placing preterm infants skin-to-skin with their mothers to regulate the baby’s temperature, promote breastfeeding and improve survival.
This low-cost intervention is now used globally and has dramatically improved outcomes for preterm and low-birth-weight infants, particularly in resource-limited settings.
These groundbreaking examples demonstrate the potential of frontline innovation, but are they the exception or the rule? In my opinion they also highlight a troubling reality: the system isn’t often designed to support innovation from the bottom.
At its core, QI is about collaboration.
It recognises that the people who work closest to the problem are often best equipped to identify solutions.
A nurse who notices bottlenecks in patient flow, a cleaner who identifies gaps in infection control, or a receptionist who sees the flaws in appointment systems—they all bring valuable perspectives.
Consider the case of community health workers.
Often the first point of contact for patients in rural areas, they have deep insights into the barriers their communities face, from access to transportation to cultural beliefs that affect care-seeking behaviour.
Yet, their voices are rarely sought in policy discussions. Imagine the potential of a national immunisation programme designed with their input—scheduling mobile clinics at times and locations they know would draw the most attendance.
Theese insights, which come at no additional cost, are often overlooked in favour of top-down directives.
QI offers a different approach.
Ideas and innovations can be tested on a small, local level to evaluate their effectiveness before scaling up— minimising the risks of traditional top-down strategies, where a single mistake can have widespread consequences.
Unfortunately, many healthcare systems aren’t built to listen.
As noted earlier, hierarchy doesn’t only suppress ideas—it can silence them entirely before they even begin to take shape.
Frontline workers, who see problems firsthand, are often silenced by rigid systems that prioritise authority over collaboration.
A lack of structured systems for feedback compounds this issue.
Without platforms for staff and patients to share insights, many promising ideas are lost.
This is particularly troubling in resource constrained settings, where innovative thinking is most needed.
Patients themselves are another overlooked source of ideas.
A patient who struggles to access medication due to poorly timed clinic hours or transport issues could suggest practical changes that improve care.
Yet, in many systems, their voices are not invited into the conversation.
