On the road in Pakistan: creating a new healthcare service
This is the first installment in a series of real-time articles about the early stages of developing a healthcare service for Pakistan. We’ll be conducting research across a variety of urban, peri-urban, rural, and feudal regions. I’ll document my own research methods and processes for product development along the way.
The team
I’m Mike LaVigne, former CD of frog design and former co-founder and CPO of Clue in Berlin. I’ve recently co-founded a new venture in Berlin, Das Dach, which creates businesses and supports teams that are socially equitable and environmentally sustainable. Through my work at Das Dach, I was introduced to Maliha Khalid in April 2018, and became her product advisor as she went through an accelerator program.
Maliha is CEO of Doctory, an early-stage healthcare startup in Pakistan. Co-founder Ayyaz Kiani has a long history of working for consumer protection in Pakistan’s healthcare space. I’ve recently joined Doctory as co-founder and CPO.
Maliha’s vision is to create a self-sustaining business that provides high-quality healthcare to all Pakistanis, regardless of income or location. Assuming Doctory achieves success in Pakistan, it will expand throughout the regions of South Asia and Middle East and North Africa (MENA).
This series of articles will chronicle how we do it.
Hypotheses for healthcare in Pakistan
The first step is generating hypotheses that can be tested using Lean Startup methods – building and testing prototypes and MVP. The traditional Lean approach to product development has some limitations. The methods for how hypotheses are chosen are not often discussed, and what’s commonly practiced is much like informed guesswork. The lack of methodology is starkly obvious when developing hypotheses for people or industries you don’t know well. For me, both Clue – a healthcare app for women – and Doctory – a healthcare service for Pakistanis – are excellent examples.
Deriving hypotheses from a clearly defined product vision eliminates the need to explore entire swaths of irrelevant hypotheses, and along the way, it allows brand positioning and principles for product development to be iterated.
The formative, generative, and evaluative research methods that I developed over years of doing product strategy at frog design and getting Clue into the market are well suited for these tasks. Some are original, and some are derivative of existing methods. As we craft Doctory’s product strategy, I’ll describe these methods along the way.
A shift in direction
Doctory’s original MVP and those of its competitors were like “Yelp for doctors,” similar in strategy to Zocdoc in the US, which is a searchable directory of doctors who are rated by patients. Zocdoc monetizes itself via a patient management service for doctors.
I questioned whether a product that’s successful in the US would also be successful in Pakistan. It makes more sense that a solution for Pakistan will be inspired by global innovations, but Pakistan will be best served by a solution that reflects local context.
By asking this question, I learned that Doctory’s brand positioning and Zocdoc-like business model that Maliha introduced to me were atrophied expressions of their original vision. The original positioning – to build a profitable healthcare business focused on consumer protection – has much more differentiation and directly addresses unmet needs in Pakistan. We reoriented toward that original positioning.
Brand execution from a single, essential attribute
After determining the brand positioning, we had a daylong discussion about Doctory’s brand execution. My branding process begins by boiling everything down to a single essential attribute that is highly differentiated, difficult for others to claim or use, and supports the business strategy and vision. It often turns out that this essential attribute can also be interpreted as the unique selling proposition. Brand attributes often become murky when they are translated into usable traits for different areas of the business (e.g. tone and voice of copy, visual look and feel, and interaction principles). Continuously orienting toward one highly focused and differentiated essential brand attribute keeps things on track.
Through this process, we found that the single most essential brand attribute of Doctory is “respect”. This means respect for everyone in the healthcare ecosystem, with highest priority given to the patients.
We then expanded the attribute of respect into experiential qualities, such as: listening carefully to each patient’s needs, not being pushy, giving patients control in a system where they’ve previously felt no agency, and giving patients unexpected value where they’ve previously felt undervalued.
Unmet needs in Pakistan’s healthcare system
Pakistan’s healthcare services are split between public, private, and military systems. The private systems are of the highest quality, but concentrated in urban areas and difficult to access by 70% of the population due to location and cost. The public system is more accessible to rural populations, but it has a very poor reputation after decades of low funding. If people can afford it, they choose the private system and avoid the public system. The military system operates similarly to the public system, but privileges people connected to the military establishment. These market dynamics have contributed to the deterioration of the public system while creating a booming private healthcare system.
There are many general practitioners (GP) in Pakistan. Unfortunately, they have a poor reputation, and people almost always start by going directly to specialists in urban areas. Accordingly, one key problem to solve for Pakistan is directing people to the correct specialist. However, an online directory of specialists – the original MVP – only solves part of that problem.
Patients are obviously neither experts at diagnosing themselves nor choosing an appropriate specialist. In the current situation, patients first pay for a visit with their best guess for a specialist, receive a referral to a new specialist, and then repeat this cycle three or four times until they reach a correct diagnosis and treatment protocol. According to Doctory’s research, patients end up wasting 80% of their time and money when seeking a new diagnosis and treatment.
The easiest MVP isn’t solving the right problem
This insight can lead to an MVP that assists patients in finding a specialist that’s the best fit for their condition – a product that’s focused on a single symptom of Pakistan’s healthcare system. But that neither satisfies the positioning of comprehensive consumer protection nor provides high-quality healthcare to all Pakistanis.
To achieve our vision, there must be one profitable healthcare service that provides high-quality healthcare to all Pakistanis, regardless of income or location, within the scope of consumer protection.
That’s our hypothesis, and that’s the starting point for the MVP we’ll develop. It’s a necessarily complex hypothesis for a complex problem, and we’ll maintain that complexity until simple MVP emerge that we believe are most likely to affect change across the healthcare system.
Startups often start with world-changing visions, but the product development process rarely addresses the vision’s complexity. When the complexity isn’t held open, those grand visions shrink to solving problems that are easy to identify and build solutions for, resulting in products that mostly only solve symptoms of systemic problems and that are only connected to the vision by rhetoric. This topic is covered in greater detail in “The Ecology of Innovation” by Keks Ackerman.
Investigating this complex hypothesis and defining Doctory’s product vision are what we’re about to do during a month of in situ research and iterative MVP testing in seven different areas across Pakistan.
We don’t yet know what Doctory’s exact product or service will be, but we aren’t seeking to replace or displace what’s already working in Pakistan’s healthcare system. Through our explorations, we expect to find missing pieces that could be new products or services, or the glue between elements of the existing healthcare system. Some combination of those will become the vision of Doctory’s offering. From that vision, we’ll begin defining small pieces suitable for MVP that will begin to navigate the complexity toward achieving Maliha’s vision.
What’s next
Upcoming articles will focus on methods I’ve developed that are uniquely suited to understanding foreign cultures, that focus on finding opportunities that unify diverse populations rather than separate them, and that benefit from maintaining the complexity of problems throughout the development process to find better solutions rather than simplifying problems to make solutions easier to find.
These methods include “market context interviews,” a formative research method for acquiring a non-superficial overview of a foreign culture.I developed this method at frog design and have used it for product development in China, South Korea, Japan, and South Africa.
I’ll also cover “spectrum research” for uncovering unmet needs that connect people with different behavioral or socioeconomic traits rather than separating them. I’ll also use systems mapping to gain greater clarity on the pressure points in Pakistan’s healthcare system.
I’ll do my best to write about our on-the-ground efforts in mostly real time as we conduct the research, prototype, and iterate product concepts and build MVP – all in the field across seven different types of communities in Pakistan, including urban, peri-urban, rural, and feudal regions.
As with any early-stage startup, the road is bound to have bumps and sharp turns, and I’m happy to have you along for the ride.
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Cofounder of Doctory and Das Dach, former cofounder and CPO of Clue, and CD of frog design. You can follow me @MikeLaVigne, find me on LinkedIn, and contact me at mike@dasdach.berlin.
