Cardiac surgery is a sophisticated, dangerous and delicate procedure; but an Indian surgeon and his hospital group have successfully transformed it into a factory style mass operation, bringing high quality care to the many millions who could never before afford it. Dr. Devi Shetty’s Bangalore based flagship, 1,000-bed Narayana Hrudayalaya Hospital, charges $2,000, on average, for open-heart surgery, compared with hospitals in the U.S. that are paid between $20,000 and $100,000, depending on the complexity of the surgery. Narayana Hrudayalaya reports a 1.4% mortality rate within 30 days of coronary artery bypass graft surgery, one of the most common procedures, compared with an average of 1.9% in the U.S. in 2008, according to data gathered by the Chicago-based Society of Thoracic Surgeons. This despite the fact that many of its patients are much higher risk– the patients often lack access to even basic health care and suffer from more advanced cardiac disease when they finally come in for surgery. How does this doctor achieve the holy grail of all products– a better quality product at a lower costs? At the heart of this lies one of the oldest business model innovations and its application to cardiac surgery.