From HQ | Lean Innovation: Doing More with Less

December, 2022

Lean Innovation: Doing More with Less

Have you ever heard of the concept of ‘Jugaad’? Neither had I, until very recently. But I have certainly encountered it in the world, and you probably have too. Jugaad is a Hindi word which can be roughly translated to mean finding a makeshift solution, an ingenious hack, improvising with limited resources or creating something useful out of adversity. You may have heard to the related term ‘frugal innovation’. Many people and organisations across the globe facing limited resources are engaging in it, seeking bold solutions to big problems, without much investment.

A few years ago, while doing research in Rwanda, I was lucky enough to see such an innovation in action. I didn’t know the term at the time, but I could see something impressive was going on. I was there to study how community health workers were operating, and what their challenges were. To overcome the difficulty in data collection and reporting due to a lack of infrastructure and a widely dispersed population, community health workers were using a simple but powerful solution; text messages. They would send updates to the Ministry of Health via SMS. This innovation was smart and certainly frugal, and it demonstrated ‘Jugaad’ because they looked at the resources they already had available (their cell phones) and devised a comms system around them. Genius.

However, an unexpected problem emerged. In some areas, there were frequent power outages. The community health workers weren’t able to charge their phones. As a result, some could face up to six-hour walks to find the nearest ‘charging station’ (often a savvy entrepreneur charging devices out of their car—another great example of ‘frugal innovation’). This meant less time serving their communities, and more frustration for the workers.

It strikes me, years later, that this notion of ‘frugal innovation’ could benefit from an innovation of its own, one which builds in a feedback and development process. For me, this is where the principles of the ‘Lean Startup’  [1] approach are the perfect fit: it is about doing more with less—and in the world of primary care and non-profits the limited resources often compel such approach—while focusing on engaging stakeholders and looking at a bottom-up approach.

So, in the interests of bringing together these ideas to help our community find creative and affordable solutions to problems they face, here are a set of principles to innovate by.

1. Keep it simple

In low resource environments, knowledge is truly the most valuable currency available. Here comes perhaps the most fundamental part of the lean approach: the concept of building a ‘minimum viable product’ to test an idea. Don’t worry – this isn’t as complicated as it might sound!

You have a hypothetical solution to a problem. The most critical step in the entire process is to get something out in front of potential users (your target audience: your patients, fellow team members or decision-makers) as quickly as possible. This means coming up with the most basic, rudimentary, low-cost version of a deliverable (a ‘product’ or ‘service’) which will still allow users to experience it, or the idea of it, enough for them to give meaningful feedback. In lean terminology, this means getting out of the planning stage and into the ‘Build Measure Learn’ circle as soon as possible.

This ‘product’ could be anything from a new website to a newsletter, to a system in place at your clinic, to a basic service. It can even be a mock-up or a prototype of the idea, not the real deal, as long as it is enough to get feedback from. Dropbox, for example, got started with a simple three-minute video from the CEO explaining the idea which, at that time, was difficult to be explained to investors. They got a hugely positive response and helpful input, which ultimately led to the success of the company.

You can follow this process and identify this kind of ‘minimum viable product’ whenever you are testing out an idea or service in your workplace, in your clinics, university departments, or even in your wider advocacy work. The key is to find the simplest version, not obsess over the details or making it ‘perfect’ and get it out there so that you can learn fast!

Involving as many stakeholders as possible in idea generation is such a critical component of this approach, crucially because it increases how much knowledge and insight you gain; the wider the net, the more feedback you receive. This means doing everything possible to engage with the users or people affected by the change you want to make. In a family practice, this can include doctors, nurses, support staff, patients, accountants, the wider community and beyond.

Key takeaway: knowledge is power; focus on feedback first, and you will reap the rewards.

2. Fail cheaply, and adapt quickly

The big draw of a ‘minimum viable product’ is that it is incredibly cheap, which suits environments with limited resources. It is quick and easy to get off the ground and if it doesn’t work, it doesn’t matter too much. The most important thing is to get something out there, and get feedback on it, so you can make changes and try again. Even a ‘failure’ is not really a failure – it’s just a form of feedback. Once you have gained this, you can adapt and improve your offer. It is all about low-cost experimentation.

At WONCA, we were exposed to a tough challenge when COVID hit, and we had to move our Council Meeting to a virtual space for the first time. The most critical thing was to get the business of the Council done, follow the relevant processes, convey key information and get the voting completed. Throughout the process, we encouraged and listened to feedback. We soon discovered that deprioritising the interactive part of the meeting was strongly criticised. As a result, a workshop—a long-standing WONCA tradition—was added during our latest hybrid Council meeting and it has been very positively received. Other small changes, like online voting, online check-in and the weekly dedicated newsletter conveying key information in advance of the meetings, received positive feedback and are here to stay.

Key takeaway: innovation is messy and iterative takes lots of attempts to make it really work. So the best way through it is to keep experimenting with the idea and adapting it often.

3. Don’t reinvent the wheel

So often, we face problems that have been faced by many before us and will continue to be tackled by many to come. Yet we tend to silo ourselves into communities, sectors or groups, and feel that we need a brand-new response to a problem, when in reality there are many out there who have already come up with great innovations. Many solutions remain ‘undiscovered’ simply because people don’t realise their solutions already exist elsewhere. A great example of this is when health care takes inspiration from the aviation sector about the way they use thorough and exhaustive checklists as a core part of their safety process [2]. When they applied similar checklists, it led to a drastic decrease in errors in performances.

Key takeaway: don’t just think outside the box, but look outside of it. Take inspiration from other working groups, other members, other countries, or even other sectors.

4. Use what is in abundance

When facing limited resources, it can feel like nothing is possible. But the concept of ‘Jugaad’ teaches us that there are always clever solutions to be found. One approach to this is by focusing instead on what resources are plentiful and available. This may be in the form of physical resources, such as in the case of ‘Conceptos Plasticos’, a Colombian company which aims to tackle the housing crisis by using what is in abundance–plastic–and turning it into durable, cheap, and brilliantly self-insulating bricks to build houses.

It also may be in the form of less obvious resources, such as people, community support, time, or expertise. On this front, we have an example from within WONCA itself. We have been facing a challenge around our website: it is difficult to navigate and use, and this has led to missed opportunities for communication with and between members as a result. However, building and migrating to a new website is very expensive, and with inflation rising, this cannot be prioritised now.

So we asked instead, what does WONCA have in abundance? One answer, aside from the enormous level of expertise, is community. This inspired us to work on the Membership Portal, which is a space for members to participate in groups and communicate easily within them. We have also chosen to launch one group at a time, as a form of ‘minimum viable product’ so that we can receive feedback, learn, and adapt for the next group. The Working Party on Research has already launched its group on the Membership Portal, and other groups are coming very soon.

The emphasis on ‘low cost’ or ‘limited resource’ innovation can lead some to believe that they are of inferior quality. This is simply not true, and it’s important to challenge these assumptions. An example of this is Safari Comm’s ‘Empesa’ business, launched in Kenya in 2007, which used the widely available cell phones to facilitate money transfers by developing a simple mobile money system. This is such a powerful example because not only was it an ingenious and low-cost innovation, but it has also been adopted globally since, including inspiring higher income countries to do the same, proving the cheap innovation doesn’t mean sub-standard innovation.
Key takeaway: focus on what is available and plentiful, and use it to help solve your biggest problems.

5. Don’t be vain!

Often, when companies and NGOs alike launch innovations and seek feedback, they do so using vanity metrics rather than meaningful measures. This means that while they can give themselves a pat on the back for a job well done, or look good to their investors and donors, they haven’t actually got useful feedback which will help improve the product or service they are providing.

To provide a different example: communication campaigns often measure the ‘reach’ (the number of users that are exposed to the message of the campaign). But wait, how much of an impact indicator is this? Does the number of users that have (passively) read a message on a newsletter or a social media platform indicate how many of them have increased their knowledge of your advocacy message or changed their behaviour?
It’s crucial to ask for feedback which is truly relevant, and which will help push forward change and new ideas, even if that feedback might be negative or hard to receive.

Key takeaway: focus on meaningful indicators to build something great.

6. Keep your eye on the prize!

This is something we have mentioned before when discussing effective communication: it is crucial to ensure that alongside the small experiments and quick adaptations, there is a long-term vision and strategy in place. It is key to have some clear goals and objectives to keep you moving towards a desired outcome, and to identify all relevant stakeholders and channels required as part of the process, and to keep checking in against this longer-term strategy. Of course, this can be adapted over time, but it is key to ensure that it doesn’t become a haphazard or random approach to trying things.

At WONCA, we are planning to start doing more fundraising in the form of crowdfunding campaigns. We are mapping out a long-term strategy, including our assets and areas of expertise, and what is already available to us. We are developing a set of clear objectives we are working to. From this place, we will start running small pilot programmes to test different ideas, experiment and learn from what does/doesn’t work.

Key takeaway: think long term, test short term.

We would love to hear from you about your experiences—good and bad—with innovation. What problems have you faced, and how have you solved them? What are you working on now which could use a little extra direction from others? How have you coped when facing limited resources in response to a challenge? Where have you failed? And succeeded? These don’t have to be big or complex, they can be small, simple and cheap changes you have made in response to problems and adapted based on need. They can be around communication, processes or systems in your practice or institution, practices you have adopted, or products you have introduced.

We want to showcase examples to our membership, highlight what works and learn from what doesn’t, and build more support across our community to step in when individuals or groups are stuck on a complex problem. We look forward to hearing from you!

Dr Harris Lygidakis

1. Ries, Eric. The Lean Startup: How Today's Entrepreneurs Use Continuous Innovation to Create Radically Successful Businesses. New York: Crown Business, 2011.
2. Clay-Williams R, Colligan L Back to basics: checklists in aviation and healthcare BMJ Quality & Safety 2015;24:428-431. Available from: