Yet over the last few decades and centuries, other industries have embraced these shifts. Take for instance the information systems of McDonald’s vs. a hospital vs. a classroom. The McDonald’s has computer-based ordering which has a workflow that guides low-expertise, task-shifted employees to run a restaurant. With this system, McDonald’s can operate thousands of restaurants. The hospital likely has paper records that require experts to write notes readable to other experts. If they happen to be using an electronic system, the workflow still doesn’t enable lesser trained non-experts to manage diabetes or follow vaccine schedules or prescribe antibiotics – the system is simply an electronic version of the same medical notes taken by paper records. And similarly in schools, how much has technology been used to enable teachers to manage self- and peer-based learning that is far more effective? Unfortunately, not so much. But these barriers to change don’t mean that if industrialized versions are built that they won’t be wildly successful.
I am happy to report that this is already where we are going. Many patient safety advocates in the US like Peter Pronovost and Atul Gawande (The Checklist) have similarly been pushing for standardization, although less so for the cost benefits and more so for the quality improvement benefits. Business strategy guru Michael Porter has built an entire literature on the healthcare delivery value chain, and he makes use of these successful examples in his case studies. In India, the Aravind Eye Hospital has built a system of eyecare services that serves a population the size of the United Kingdom, with the same quality outcomes and with over an order of magnitude less cost. And so it should go for social services. Experts make a service standardized.
Standardized means task shifting. Task shifting means scale. Scale means high volume. High volume allows unit costs to be lowered. High volume, standardized, low cost. Those concerned with social services having high quality, low cost, and equitable access should embrace these trends toward industrializing social services. Yes, there will be those that will resist these changes. Some will have reasonable complaints that industrialized services will have to deal with seriously. Many people that resist will simply have vested economic interests or old-fashioned beliefs about how medicine and education should be done. But ultimately, anyone, especially those working in developing countries, who is concerned with equity, social impact, and national financial security will be forced by these successful low-cost examples to see the way of the future.