Acknowledgments

Although we’ve known each other for more than four decades, our intellectual journeys followed separate trajectories for many years. One of us (VG) was studying strategy and innovation in large US multinationals, and the other (Ravi) was doing the same with firms in emerging markets. Our paths intersected when Western multinationals became increasingly interested in emerging markets, and firms in emerging markets became increasingly interested in the rest of the world, including the United States and Europe. And so, in 2010, we began to collaborate around the topic of “reverse innovation.” We first explored reverse innovation in analytical terms, and then we zeroed in on its relevance in a very important industry—health care. We published our initial ideas in 2013 in the Harvard Business Review article, “Delivering World-Class Health Care, Affordably.”

This book is the culmination of six years of research on how the United States and other industrialized countries can benefit from innovations in health-care delivery in poor countries like India. Needless to say, those lessons are also relevant to other poor countries, where billions have no access to health care. Our research took us to more than two dozen hospitals, and we interviewed over 125 health-care executives in India and the United States.

For the first phase of our research, we are deeply indebted to the leaders of innovative Indian hospitals who threw open their doors to us. Among them are Dr. Aravind Srinivasan, Dr. R. D. Ravindran, and R. D. Thulasiraj of Aravind Eye Care System; Dr. N. Krishna Reddy and Dr. B. Soma Raju of Care Hospitals; Dr. K. S. Nayak of Deccan Hospital; Dr. B. S. Ajaikumar and Dr. Naveen Nagar of HCG Oncology; Anant Kumar and V. Srinivas of LifeSpring Hospitals; Dr. Gullapalli N. Rao of LV Prasad Eye Institute; and Dr. Devi Shetty, Dr. A. Raghuvanshi, and Viren Shetty of Narayana Health. The logistics of our field visits and research were expertly organized by Mahesh Sriram.

For the second phase of our research, in the United States, we are grateful to Dr. Anthony Tersigni, John Doyle, and Rhonda Anderson of Ascension; Dr. Rushika Fernandopulle of Iora Health; Dr. Kristi Henderson, formerly of University of Mississippi Medical Center (now with Ascension); Dr. Bruce Spivey of Pacific Vision Foundation; Liam Donohue and Payal Divakaran of .406 Ventures; Diane Daych of Apple Tree Partners; Ellen Zane of Tufts Medical Center; Dr. Gary Kaplan of Virginia Mason Medical Center; Dr. Kevin Curtis of Dartmouth-Hitchcock; Dr. Richard Friedlander of Netcare (South Africa); and Anssi Mikola of HNG (Finland).

Several colleagues gave us constructive feedback, some of them multiple times, and shaped the book in profound ways. Among them are Lisa Adams, Dr. Don Berwick, Sujana Chalsani, Dr. David Chang, Dr. Elliott Fisher, Dr. Richard Fried, Robert Hansen, Punam Keller, Karen Koh, Tim Lahey, Russ Moran, Alan Mullaly, Merritt Patridge, David Puvirajasingam, Suzie Rubin, Steve Spear, Albert Wocke, Gary Young, and Mike Zubkoff. We owe a special debt of gratitude to Eric Wadsworth of the Tuck School and Dartmouth Medical School, who educated us on the US health-care system and fundamentally shaped our research design and strategy. We cannot thank Eric enough for his deep insights and generosity.

A project of this scale and scope requires resources. VG would like to thank Tuck School’s deans—Paul Danos (former dean) and Matt Slaughter (current dean)—for their generous financial support. Ravi would like to acknowledge the support of Northeastern University’s Center for Emerging Markets and its benefactors, particularly Dave Nardone and Venkat Srinivasan.

We were lucky to have an outstanding editorial team to help us with the book. The fabulous duo of Art Jahnke and Nancy Zerbey helped recast our research in an engaging, storytelling style. And at Harvard Business Review Press, we were fortunate to have as our editor the one-and-only Melinda Merino, who helped sharpen our arguments and make the book a whole lot punchier. Jon Zobenica was a meticulous copy editor, and Jennifer Waring oversaw production.

We would like to dedicate this book to our wives, our children, and their families, whose love and support have sustained us through this and every other project we’ve undertaken. We would also like to dedicate the book to three people who left us prematurely in the recent past. Here are a few words about each of them.

VG was extremely close to his brother Rangan who, after earning his undergraduate degree in engineering, went on to get his MBA from the prestigious IIM-Ahmedabad. Rangan knew more accounting than VG did, even though VG was trained as a CPA. That is what motivated VG to pursue an MBA. Later in life, deriving inspiration from VG, Rangan completed his doctorate in strategy, then published his doctoral thesis as a book, which he dedicated to VG. It seemed as though the brothers had come full circle. When he was diagnosed with cancer, Rangan was determined to write a book on the engineering principles of cost-effective industrial construction, based on his experiences as CEO of one of India’s largest construction companies. VG and his wife, Kirthi, spent time with Rangan just before he passed away. What amazed them was how passionate Rangan was about his book project. He dictated chapter outlines to his executive assistant. He was in a race against cancer to finish it. He saw the book as his legacy. VG wishes he knew enough engineering to complete Rangan’s unfinished manuscript.

Bala, Ravi’s brother, was one of six siblings, all boys, born to middle-class parents. As the number five and number six siblings, Bala and Ravi were especially close and grew up together for their first seventeen years. When he was two years old, Bala developed a high fever that led to convulsions, which resulted in a lifelong physical disability. This disability limited Bala’s activities—but never his spirit or his determination to lead a full life. He completed college, volunteered in a village for two years, got married, had a lovely family, and pursued a career as an HR executive. Whatever fate dealt him, Bala faced with courage and good humor. He always focused on the other person, not himself, and on the good news, never the bad. His courage, positive outlook, and big heart were an inspiration to all who knew him.

Drew was the older brother of Ravi and Meena’s daughter-in-law, Paige. Drew trained as a pediatric cardiologist and married May Ling, also a cardiologist. With two-year old Claire they attended Paige and Bharat’s wedding—as groomsman and bridesmaid—even though May Ling was due to deliver their second daughter, Norah, any day. A few years later, their third daughter Caroline arrived. Drew loved baseball and hanging out with his family. Then, out of the blue, he was diagnosed with advanced cancer. Drew and his loving family lived as normal a life as possible, even as he underwent treatment. Drew is sorely missed by his family and friends.

As we conclude this book on health-care innovations, we would like to dedicate it to the fond memory of Rangan, Bala, and Drew.

Vijay Govindarajan (VG), Hanover, NH

Ravi Ramamurti, Lexington, MA