RCF Kapurthala

Brian Kenny:

Of all the weapons of war, there is one that has been called the perfect soldier. The landmine. It never sleeps, never hesitates. Introduced in the American Civil War in 1862, landmines have been a battlefield staple ever since. It’s estimated that there are 110 million in the ground right now, with more being deployed every year. According to Landmine Monitor, they kill or maim about 5,000 people a year, mostly civilians and most often in areas lacking basic human services. For those who survive a mine blast, loss of a foot or leg is almost inevitable. A life devastated. But for some of these victims, that’s not the end of the story.

Today on Cold Call, we welcome Srikant Datar, Dean of Harvard Business School, to discuss his case, BMVSS: Changing Lives, One Jaipur Limb at a Time. I’m your host, Brian Kenny, and you’re listening to Cold Call on the HBR Podcast Network. Srikant Datar is an expert in the areas of cost management and management control, strategy implementation and governance. He’s a huge advocate of design thinking, which we’re going to talk about today, and he also happens to be the Dean of Harvard Business School. Srikant, thank you for joining me on Cold Call.

Srikant Datar:

What a pleasure, Brian, to be with you again. I remember doing this podcast with you, I think at least two, three years-

Brian Kenny:

It was 2018 actually.

Srikant Datar:

2018. Five years ago, so I’m delighted to be back.

Brian Kenny:

And it’s not just any episode. This is the 200th episode of Cold Call. So we are thrilled to have you here as our guest to celebrate this milestone. It’s a big deal to us and we’re thrilled to have you here.

Srikant Datar:

It is a big deal for the School, so thank you for having me.

Brian Kenny:

I think one of the things that we’ll talk about today as well, every episode of Cold Call is predicated on a case written by a Harvard Business School faculty member. It’s in our DNA. This is the thing the School is probably best known for. And so I do want to talk a little bit about your opinion of what makes for an enduring case, and so we’ll get into that a little bit more. But why don’t we just start by having you tell us what the central issue is in the case and what your cold call is to start the discussion in class.

Srikant Datar:

The central issue in the case is, can design thinking be applied by an organization in a way that is repeatable? And so my cold call is, you read the case, there are a whole host of innovations that are described in the case. Was this really a process by which all these innovations occurred, or was it just a chance event? For instance, the case starts off by one of the people who is involved in developing these ideas, observing in a high density polyethylene (HDPE) irrigation pipe, and then suddenly thinking, geez, that could be something that could be used to actually provide the shank that is needed to attach the foot when a person is maimed or loses their limb. But is that just not a chance event or is there a process? And there are many such instances that the case goes through that forces a student to think about, was it just luck or was there something going on in this organization that allowed it to continually innovate in many different ways, which I’m sure we’ll talk about.

Brian Kenny:

Yes. How did you hear about the Jaipur Limb?

Srikant Datar:

This is one of the benefits of having research centers all over the world. So Anjali Raina, who was our director of the research center in Mumbai, who had seen the Jaipur Limb case or had heard about the Jaipur Limb situation and helped organize the writing of the case. And she knew about my interest in innovation and design thinking and she thought it would be a very good fit. So that’s how it started.

Brian Kenny:

When I asked you to be on the show today, I said pick whatever case you want to pick. Why did you decide to choose this one? And I guess this gets a little bit to the question I have about what to your mind… You’ve been teaching the case method for 25 plus years here at Harvard Business School. What makes for an enduring case and a good case discussion?

Srikant Datar:

It’s a very important question and one of course that we have thought long and hard about. Let me first say why I picked this particular case as a case that I really enjoy teaching. It sheds light in ways that you might not expect at the time that you’re reading the case. It forces you to think at a deeper level. It enables a lot of discussion and debate because you could actually make arguments on both sides in this particular case. And the depth of understanding that that allows or achieves through that process of discussion and deliberation is quite remarkable. Very often what you remember from the case and why you remember it is because you never went into the case with that particular point of view. But when you heard the discussion and it deepened your understanding, whether you changed your mind or not, at least you’re thinking about that issue in a very different way. And it’s the fact that you have thought about it differently, because the case has this richness of a decision point where reasonable people could disagree, that makes for these cases to be so enduring and memorable.

Brian Kenny:

And I like this one in particular too because this is a real human issue. So we’re focusing, and so many of our cases do this, I think they are compelling stories in and of their own right, and they do a great job of showcasing management and leadership in situations where you just might not think about it. So I liked it for that reason as well. Can you tell us a little bit about what life would be like for an amputee in one of these war torn areas of the world where landmines are so prevalent?

Srikant Datar:

It’s such a difficult situation, Brian. It happens quite unexpectedly, as you described, and you are just suddenly affected in a way that you believe will never get you out of the unfortunate situation in which you are in. So first, it’s the surprise of the event. Second, it is the fact that there isn’t really a very good solution for it. And third, it is the kind of event that if there is no solution for it, the kind of life you’d lead relative to what you thought right before that event occurred is dramatically different. So I think in any of these situations, it is really very powerful when you can think about solutions to basic human needs of a type that you never even imagined.

Brian Kenny:

Let’s talk a little bit about design thinking because that factors heavily into the theme of the case. There are insights that were gleaned through the work that they did as they thought really about this from the patient’s perspective. And so often we don’t think about it from the customer or the patient’s perspective. Tell us a little bit about design thinking, I guess from your point of view and what a couple of the insights were that led them down this path of designing the prosthesis in the way that they did.

Srikant Datar:

There are several steps that you go through when you do design thinking, Brian. The first and the most important is to have this deep empathy and understanding for user needs. In this case, the patient. But the second is, I think this belief that if you can do this and this organization’s belief that you can do this, with two assumptions that I think most of us believe are needed. First, you need a lot of money. I wanted to write a case on an organization that had no money. And yet because it believed that deep understanding of a patient could help address important problems, they were able to innovate in amazing ways. And second, that it is a process. It is something that if you are willing to practice it, and it is a doing skill, so if you’re willing to practice it and you have the right mindset, you can actually innovate in amazing ways.

Brian Kenny:

Let’s talk a little bit about BMVSS. I won’t even try to pronounce what it stands for. You might be better at that than I am, but let’s talk about that hospital. How did it come to be?

Srikant Datar:

Well, it started with this event in 1975 when Mr. D.R. Metha is in a car accident and is at risk of losing his limb. And fortunately, it gets saved, he doesn’t have to have an amputation done. He’s lying in that hospital bed thinking, what would’ve my life been like if I had this? And then begins to think about others who might have had this situation. And that’s the start of his first germ of an idea of forming BMVSS. But I think there are many times in our lives when we encounter situations like that, but it doesn’t always end up leading to this organization being created. And there, I think it was his deep empathy that he had for others. He had that already. So when an event like this occurs, he was able to see this from another person’s point of view rather than I’m done now, I don’t need to worry about it. Thank God that my leg wasn’t amputated. And a truly remarkable man, a man who believed that he could make a difference. And then with that empathy, goes and develops this amazing organization.

Brian Kenny:

What are some of the things that they do at BMVSS just to cater specifically to their patients’ needs?

Srikant Datar:

Let me give you a couple of examples, Brian, that I think will bring home the points that I was making earlier. So as I said, the first step is to develop this deep empathy and understanding. Related to that step is how do you define the problem? What is the problem you’re trying to solve? In design thinking, you really spend a lot of time thinking about the problem. Are you thinking about the right problem? What is fascinating in the case, and you can see it playing out in different ways, is students debate what problem was Mr. Metha trying to solve. And one problem that he was trying to solve was to restore someone’s mobility because after all, that’s the most important thing that you can see in front of you is a person without a limb. But this is where amazing design thinkers, when they’re thinking about problem solving, think about it much more deeply. He actually defined the problem very differently. And he said, “The goal of this organization is not just to restore someone’s mobility, it’s to restore their dignity.”

And then you go through, in the case, a number of things he does in, because basically, you can think of it as a hospital helping people fit prosthetics. So for instance, anyone who comes in can come in at any time at night, and many of the trains that would reach Jaipur would reach late at night. And so Mr. Metha would allow those patients to be admitted to the hospital at night. Not during working hours. Who’s available at night? And it’s the guard and there are some very interesting examples. We call this task unification tools that you can use to do design thinking. And the guard would admit the patient. And then where will they stay? Well, he said, “If I’m restoring their dignity, they shouldn’t be just sleeping on the pavement the night before the next day they’re coming.” So they and their families who are often accompanying them, one or two family members, get accommodation and meals while they are there.

Brian Kenny:

That’s remarkable.

Srikant Datar:

And I ask, I said, “But aren’t they short on resources? Should he be spending the resources here or should he be spending the resources somewhere else?” And we have this great discussion, depending on how you frame the problem. You would either view it as a waste of resources or you would view it as a critical thing to do because if he’s trying to restore their dignity, he wants to treat them in this very dignified way all the way through the process.

Brian Kenny:

And restoring their dignity also relates directly to the design of the limit itself. Our listeners can’t see this, but just so that they understand what I’m saying, the Jaipur foot looks like a foot. It looks like a human foot. And we’re used to seeing prosthesis in the west that have that springy action. They’re more like metal devices. Talk a little bit about why they landed on that type of a design.

Srikant Datar:

And again, it was deep understanding of customer and patient needs. And so design thinking can be applied in a wide range. In this case, the individuals he’s designing for his patients. But my next case will deal with how a company can do this and design it for customers. But in this case, there were cultural reasons because people don’t wear shoes. So how would that foot look if they were doing it? They have to walk on terrain that is undulated. So how should you design the foot so that it’s comfortable for them to walk? Most people do manual work, therefore the entire shank, which is the part that connects where the limb has been lost to the foot, has to be light, has to be durable, has to be one that they can walk on and actually do manual work. It can’t be heavy. It can’t be uncomfortable in that respect. They have to be able to squat and bend their knees in particular ways, and the foot then moves in a particular way. So the level of attention to detail on how you would design this foot to meet those particular needs are unbelievable. And even as I combine now the two things, we talked about the foot and we talked about how Mr. Metha admits patients, he also, by the way, then worries about what they’re going to do after he’s treated them. Are they going to go back to the lives like they had? He asks them questions about what they would like to do and then provides them, might give them carpentry lessons, might give them stitching lessons, might be a person who sells tea on the railway stations. And why does he do that? Because again, it’s to restore their dignity. This allows us in the class to think about this concept of journey mapping, that is, when does he start thinking about the problem? It’s at the time of the accident. When does he stop thinking about the problem? It’s when they’ve restored and gotten to a good life. Many times we define the problem very, very narrowly, when you enter the hospital and when you leave, but you don’t broaden it out. When you don’t broaden it out, you lose the opportunity for innovation because many things that you could do, you would only innovate, provided you understood the full picture.

Brian Kenny:

Yeah. I’m sure a lot of our listeners are comparing what you’re describing to their experience with the healthcare system, whether it’s in the United States or in Europe or in other parts of the world, which oftentimes is pretty unsatisfactory and you don’t feel like they care about you the way that he’s caring about his patients. How is he able to scale to extend the reach of the work so that he’s helping as many people as possible? And I guess I would start by saying how many patients are they able to care for?

Srikant Datar:

At the time of the case is written now, it’s gone above that as well, 22,000 that we did in the first. I think in the update that we are doing now, it’s more closer to over 30,000, which by the way is more than what at that time, and I believe it’s still true, the largest organization that actually fix-

Brian Kenny:

That’s amazing.

Srikant Datar:

… these kinds of limbs. And then as you know from the case, that when we get into good discussion about that as well, not all patients can come. And so then this idea of having these branches in different parts of India and then of course going abroad and running these camps so that people who would benefit from these services actually have it. And then very often, this equipment is then left in the camps so someone there can now start developing what they’re doing. By the way, which is another design principle he uses, which is how do I develop this prosthesis in a way that many others could benefit from the transfer of the technology, if you will, to other parts of the world.

Brian Kenny:

And he also was smart enough to realize that you can’t do this alone. So he was able to strike up some helpful partnerships. Some of the work they did with Stanford around the knee I think gets even back to some other examples of design thinking. Can you describe that a little bit?

Srikant Datar:

It’s a great example, Brian, and I’ll again use this example to point out how the discussion in class then unfolds. So the knees, as many parts of our body are, is an amazing organ because it has two functions. When you are standing, you want it to be completely stable. And when you are walking, you want it to be able to move in a way that allows you to walk. And this is why you have this. In the case, we go into in a single axis knee, how do you have a dual axis knee because that’s what allows you to both stand and be confident standing and then allows you to walk and be comfortable walking. The issue that comes up when they start designing it, first, of course, it’s very expensive, usually the current knee that was there. So they had a target of bringing down the cost of the knee to a very small number, as you know.

Brian Kenny:

What was it? Say the number because that blew my mind actually.

Srikant Datar:

So the original design was to be $25. It ended up being 35 overall for this full knee. As you know, it’s a polymer filled nylon knee that they eventually develop. But I think the interesting design thinking feature here was how they began thinking about this not from the functional needs of the patient, but their emotional needs. And again, when you are designing products, if you can design it both from it achieving a particular function but also satisfying some other human need, those products are always amazing products. So in the case of the Jaipur Limb, this idea that you have to be confident doing these two activities is what they paid a lot of attention to in the design. And so there’s a lot of the next stages of design thinking you can see play out here because once you’ve come up with this idea, so once you’ve got deep empathy, you’ve got this idea about defining the problem correctly that we’ve talked about, you then go into ideation and they come up with a lot of these ideas trying to think about, can I do this, can I develop this kind of knee at a low cost? But then the next ideas are terrific. Ideation is very important. Brainstorming is the one that you’re most familiar with.

Brian Kenny:

Sure.

Srikant Datar:

But there are other tools. We go through eight or nine tools in the course on how you might ideate more systematically. And then they prototype it. So here, they are now trying to understand what do these patients feel, experience, how are their emotional needs being met? Do they have this kind of confidence there? Because it might perform very well, but if you don’t feel confident about it, you’re not likely to use it in the way it should be used. So it was that prototyping that they then do before they then begin to implement.

Brian Kenny:

So you brought up finances earlier. All of this costs money. Even if they’re able to bring the unit cost down, which is again remarkable, I can’t imagine if you were to compare prosthesis in the United States to what they’re paying for it here, it’s got to be a huge difference. How are they able to sustain this business over time?

Srikant Datar:

So I think they do two things. First is on the cost side, pay great attention to materials. Always paying attention to durability and quality. Because again, if you are designing this, you don’t want people to keep coming back to you. It’s just a high cost to them, to the patients to keep coming back. So you want it to be good. So you want low cost, but you also want very good quality. And then you really work hard on the process, and then the case goes through a number of places where they substitute gauges instead of very complicated molds in order to get the correct mold so you can get the correct fitting and simplify that technology as much as possible. So that’s on the cost side. And on the revenue side, and this is a fascinating discussion that we have in the case, is should Mr. Metha start charging customers who can afford to pay in order to subsidize those who can’t? So how should he run this business, if you will, in a way that allows that to happen? He, of course, completely refuses to do that. He thinks it’ll be a mission. Changes mission will affect how they treat their patients. Again, this whole concept about will I worry about the most needy patients in the right way doesn’t do that. And then therefore relies largely on donations, then trying to build up a little bit of a corpus and trying to get to using the land and getting some revenue from it, the facilities getting some revenue from it. But the biggest question here is, should he not have charged those who could afford in order to sustain this business? But he didn’t want to do that.

Brian Kenny:

And it almost sounds like they have become kind of, and maybe they were from the start, a mission-driven organization. This deep purpose seems to define the way that they go about doing their work and the way that they make their business decisions and investments.

Srikant Datar:

That is correct. And it was interesting, Brian, when I went to write the case, Mr. Metha asked me to interview some of the patients. I wanted to do that anyway, because I wanted to get that perspective after all. Part of this thinking is to have these deep insights about patients. But he said, “It’ll be good if you can understand from them how we can do better.” And I said, “That’s an amazing question that you’re asking me to ask because they must be so grateful to you for the services you’re providing.” And he said, “Yes, and sometimes they won’t tell me how I can do better.” And he says, “As soon as this organization stops being that patient centric, stops caring for the patients in the way we always should,” back to your point around mission, “I don’t think we’ll be innovative, I don’t think we’ll be able to deliver the services in the way we should deliver.” So this is always the most important question that we should ask ourselves and ask, is how can we do better? And I thought that was such a lovely message to leave the students with at the end of the discussion.

Brian Kenny:

It really is. Did you have an opportunity to ask him what happens when he has to step down? Because so often we find in these kinds of organizations, the leader becomes the cult of personality around which everything else revolves. And finding a way to sustain their empathy and their view of what the hospital should be is a real challenge.

Srikant Datar:

It is and he fortunately still continues to be very active and so that’s great. But he has thought a lot about succession. He clearly wants this to be sustained. Fortunately, there are both members of his family and very close associates who have the same values as he does and will continue the mission in the way in which he did. But of course, we all know in these kinds of organizations, the founder plays a very important role. And much of what he’s trying to do is to set this up for long-term sustainability. But when you have somebody who is as impressive an individual as that, that’s always a question that remains to be answered.

Brian Kenny:

Srikant, this has been a fabulous conversation for our 200th episode. I have one last question for you, and that is, if you want our listeners to remember one thing about the Jaipur Limb case, what would it be?

Srikant Datar:

I would say that design thinking and innovation is a process, as we just went through, Brian, thinking about deep empathy and understanding; framing problems, ideating, prototyping, implementing, that we can all learn. And so we can all be innovative to address the problems that we have. And I would like our listeners to know that this is a learnable skill that requires the right mindset. But it is one that if you do develop it, you constantly practice it and therefore come up with new ways of doing things that you might not have done before.

Brian Kenny:

And I will tell our listeners, little inside baseball here at Harvard Business School, we use design thinking quite a bit. You’ve brought that tool to us, and I’ve used it in my work. I think it’s fabulous.

Srikant Datar:

Yeah, it’s very satisfying. It’s very inspiring, I think, and very motivating to do so.

Brian Kenny:

Srikant Datar, thanks for joining me on Cold Call.

Srikant Datar:

My great pleasure, Brian. Thank you for having me.

Brian Kenny:

If you enjoy Cold Call, you might like our other podcasts, After Hours, Climate Rising, Deep Purpose, Idea Cast, Managing the Future of Work, Skydeck, and Women at Work. Find them on Apple, Spotify, or wherever you listen. And if you could take a minute to rate and review us, we’d be grateful. If you have any suggestions or just want to say hello, we want to hear from you. Email us at coldcall@hbs.edu. Thanks again for joining us. I’m your host, Brian Kenny, and you’ve been listening to Cold Call, an official podcast of Harvard Business School and part of the HBR podcast network.