Arvind eye care hospital

Offer quality eye care at reasonable cost.
Provide services to rich and poor alike.
Financially self supporting.
Eradication of eye diseases.

1. The Arvind Eye Hospital, Madurai, India Developing Countries Developed country Macular Degeneration Cataract (75%) Diabetic Retinopathy Glaucoma WORLD WIDE (1992) Projected- 30 Million

2. The Arvind Eye Hospital, Madurai, India WHO estimates by 2020 the number would increase by 75 million globally Reference- “Low vision assessment” - By Jane McNaughton, Jane McNaughton (MCOptom.)

3. The Arvind Eye Hospital, Madurai, India Scenario of Blindness in India (1991) Population 850 Million Blindness 20 million blind eyes (2 million being added annually) Main Cause Cataract (75-80%) uniformly distributed Ophthalmologist 8000 performing 1.2 million Cataract Operations/year Eye Hospital 42,200 Medical R and Infrastructure Two-third skewed to the Urban areas where less than one third of the nation’s population lived District Hospitals 425 offering free eye care and cataract Surgery Revenue Allocated Rs. 60 Million ($2milliion ) for blindness prevention Challenges Proper Infrastructure State of Art Equipment Training Personnel Government Initiatives

4. The Arvind Eye Hospital, Madurai, India VISION : To Mass Market Cataract Surgery on a Global perspective DREAM- “Eradication of Needless Blindness” by creating a private, non profit eye hospital that would provide quality eye care Offer quality eye care at reasonable cost Provide services to rich and poor alike Dr. G. Venkataswamy

5. The Arvind Eye Hospital, Madurai, India DEVELOPING NATIONS CHALLENGES AND ISSUES Large % of people are poor and people do not have health Insurance Government Infrastructure poor to provide adequate health Services Lack of Incentives to promote excellence and concern for the poor International and local non governmental organization depend on donations for Operating Cost they find it difficult to finance and expand services When the organization is tied into the charitable mentality for their fund raising appeals, they often lack the skill and attitude to earn money Lack of business planning skill to raise money

6. The Arvind Eye Hospital, Madurai, India Dr. V’s Approach and ‘Level 5 leadership’ concept APPROACH Carry out a high quality process at low cost Followed the idea of reproducibility Achieving High productivity by a significant process innovation driven by close analysis of value adding time Economically self sustaining Model- By generating enough Revenue from the paying Patients to recover the cost of providing eye care free of cost services to the Majority Reference: © 2005 Joe Tidd, John Bessant, Keith Pavitt www.wileyeurope.com/college/tidd

7. The Arvind Eye Hospital, Madurai, India Three Key Elements that defines the Arvind Business Model Reference: Treating Cataract In India (Case Study)

8. The Arvind Eye Hospital, Madurai, India Conceptual Foundation Level 5 Leadership Concept Cost Recovery Model

9. The Arvind Eye Hospital, Madurai, India Level 5 Leadership Concept Level 5 Leaders lead with Disciplined People, Discipline Thought and Disciplined Action Identify Discipline people, but do no manage them because they do not need to. Through these Discipline People or right people they manage the Whole System These disciplined People bring in the necessary discipline for Executing Organization strategy Finally desired or Expected results are achieved

10. The Arvind Eye Hospital, Madurai, India Journey from 1976-1981 1976 1977 1978 20 Bed Eye Hospital Goal - Providing Quality eye care at reasonable cost 30 Bed Annex Goal - To accommodate patients after surgery 70 Bed Free Hospital Goal - Providing poor with free eye care 1981 Main Hospital 250 Beds 80,000 sq. feet space 4 Major O.T. Specialty Clinics Cornea Glaucoma Squint Corrections Diabetic Retinopathy Pediatric Ophthalmology Features State of Art Equipment Standardizing and Engineering The Cataract Surgery

11. The Arvind Eye Hospital, Madurai, India HORIZON 1 HORIZON 2 HORIZON 3 “Short Jump Initiatives” (Fortify and Extend Current business) “Medium Jump Initiatives” (Leveraging existing Resources) “Long Jump Initiatives” (Sow the seeds for Growth and Businesses for the Future) Strategic Initiatives TIME Three Strategy Horizons Concept Challenges and issues Reference: Crafting & Executing Strategy: Arthur A. Thompson

12. The Arvind Eye Hospital, Madurai, India HORIZON 1 “Short Jump Initiative” Objective: Fortifying and extending the company’s objective 1984 Building up of 350 bed free Hospital 36,000 sq. feet space 2 major OT and Minor theatre for Septic care Medical Personnel from main Hospital Strategy ASSEMBLY LINE PROCESS Building of Hospitals in Tirunellvelli (1985) , Theni (1988) and other places of Tamil Nadu Eye Hospital, Since 1976 Three Strategy Horizons

13. The Arvind Eye Hospital, Madurai, India From……………………… McDonald's …………….................To…………………..Mc. Surgery " A blind person is a mouth with no hands,“ is an Indian saying that Dr. V liked to quote.

14. The Arvind Eye Hospital, Madurai, India McDonalds , has managed to spread its golden-arched empire across the planet based on Systematic high volume production of a range of meals offered at low cost Idea of reproducibility All McDonalds outlets operate on the same model Staff are trained in a core set of skills which are common to all its operations Reference: © 2005 Joe Tidd, John Bessant, Keith Pavitt www.wileyeurope.com/college/tidd

15. The Arvind Eye Hospital, Madurai, India “WHY Mc. Donald’s CONCEPT WAS SO FASCINATING ?” McDonald's success can be attributed to the following: Defining the basic premise of the service they offer Breaking up the labor into constituent parts, and then continually reassemble and fine tune the many steps System works without a hitch, to the degree that such operations maintain quality control, and cherish customer satisfaction, profits flow

16. The Arvind Eye Hospital, Madurai, India Assembly Line Model: The Main Hospital and The Free Hospital The Morning is usually heavy an people are divided into two groups for evaluation Ophthalmic Assistants Eye Doctor Senior Medical officer Final Examination Records Persons Vision Preliminary Eye Examination Records Preliminary Diagnosis of the patients Medical Record Testing the patient for Ocular Tension, Tear Duct Function and Refraction Test PHASE 1

17. The Arvind Eye Hospital, Madurai, India Final Examination (Patients Could be Sub Divided as) Patients for Corrective Actions are suggested Optometry Room for measurement and prescription of Glasses Patients referred to specialty Clinics Patients for Cataract Surgery 20 patients seated in the halfway were prepared by the Medical Staff In the O.T. there were 2 active operating table 3 rd Bed for preparing Patient Cataract Surgery took 15mins. The moment first operation completes the Next starts Assembly Line Model: The Main Hospital and The Free Hospital

18. The Arvind Eye Hospital, Madurai, India Cost Recovery is possible in Cataract Surgery Carrying Out high Quality Process at Low cost Cataract unlike most surgical procedures is the same procedure performed repetitively with Little Variation Per unit surgery cost vary very little , allowing for very accurate cost projection Same procedure performed repetitively hence facility set-up, Training procedures can be standardized Cataract is procedure oriented and curative . People are generally willing to pay for cure but unlikely to pay for preventive services Because of large number of people requiring Cataract surgery in Developing Countries , it is one of the few health care procedures that has the potential to pay for itself through user fees.

19. The Arvind Eye Hospital, Madurai, India Principles of Cost Recovery

20. The Arvind Eye Hospital, Madurai, India Source: Data supplied by Aravind Eye Care System.

21. The Arvind Eye Hospital, Madurai, India Factors assisting Arvind Eye Hospital- Eye camp Model Several facilitating factors helped AEH make its business model sustainable AEH draws its patients to eye camps through organized local Business units Organizations bear the publicity costs and other costs incurred Organizations also pay for expenses related to transportation and meals AEH gets supplies of IOL lenses and other products at a substantial discount. Reference: Bottom of Pyramid by, C.K. Prahlad

22. The Arvind Eye Hospital, Madurai, India Paying 35% Free Camp 47% Subsidized 18% Through a unique fee system & effective management, Aravind provides free eye care to 2/3 of its patients . For each $1 spent, $1.60 is earned Financial Viability

23. The Arvind Eye Hospital, Madurai, India FREE HOSPITAL and EYE CAMPS : MADURAI The outpatient facilities at the free hospital were not well organized There was a temporary shelter at the free hospital’s entrance Those who came for a return Visit were directed to different lines Less administrative assistants helping patients and guiding them sequential flow Operating theatre appeared to be more crowded and cramped Only 1 or the other operating tables was equipped with an operating Microscope Free hospital did not have “beds” in which to recuperate and recover Need of Organized Camp, Need to Create Propaganda, and Organizing of Logistics Requirement of consistent set of procedures and common set of Principles CHALLENGES AND ISSUES CONCERNED

24. The Arvind Eye Hospital, Madurai, India INITIATIVES FREE HOSPITAL and EYE CAMPS : MADURAI INITIATIVES The Government of India launched a cataract blindness control programme with World Bank funding and offered a subsidy for the camp patients. In stages, the number of beds increased to the present 1468 beds (1200 free and 268 paying) in the hospital at Madurai. Multiple "camps" were conducted every week, to propagate more and more about the services. Skilled and technically qualified personnel were brought in solve out these issues. The use of mats enabled better utilization of floor space —about 30 patients could be accommodated in one room. Establishment of complete Arvind Eye care system, helped in Eliminating the Major Issues Concerned, to provide quality eye care, Keeping in view the requirements of every patient, so as to instill a satisfaction within them as far as the services were concerned.

25. The Arvind Eye Hospital, Madurai, India INITIATIVES FREE HOSPITAL and EYE CAMPS : MADURAI INITIATIVES The Arvind Eye Hospital, had build up an excellent IT system that kept track of all the patients. The system generated daily schedules taking into account the load on that day, patients’ preferences for doctors, and the pending work. This enabled the hospital administration to keep track of the workload in different units. The Aravind management kept a very close track of the intra-operative as well as post-operative complication rates . The major complications were very much under control and were considered highly satisfactory, according to the doctors at Aravind.

26. The Arvind Eye Hospital, Madurai, India HORIZON 2: “Medium Jump” Leveraging existing resource and capabilities by entering into new areas with promising growth potential Arvind Eye Hospitals gradually shifted to become the Arvind Eye Care System. Community Outreach Programs (1500/year) Making Technology Affordable (AUROLAB) A 874 bed hospital (1997) was opened at Coimbatore & 750 bed hospital (2003) at Pondicherry Total of 3649 beds , consisting of 2850 free and 799 paying beds Three Strategy Horizons

27. The Arvind Eye Hospital, Madurai, India 20 Bed to 600 Bed Hospital – What served as the Major footsteps? Major Footsteps SEVA CIDA Sight Savers

28. The Arvind Eye Hospital, Madurai, India Word of Mouth Communication Past Experience External Communication GAP GAP GAP GAP SERVICE QUALITY MODEL

29. The Arvind Eye Hospital, Madurai, India Expected Service Doctors requirement for Long Hours of concentrated Work Dedication and Devotion to the Practice GAP Most believe they need work only for a few Hours and that too two days a weak Requirement of well trained people not fulfilled Perceived Service Lot of chaos in free hospitals Service Delivery Operating theatre appeared to be more crowded and Cramped GAP Less administrative assistants helping patients and guiding them sequential flow Translation of Perception Operating efficiently a good number of Patients ASSOCIATING DR. VENKATASWAMY CONSIDERATIONS TO SERVICE QUALITY MODEL

30. The Arvind Eye Hospital, Madurai, India

31. The Arvind Eye Hospital, Madurai, India FREE HOSPITAL : THULASI and TIRUNELVELI Less occupancy rate in the free hospital (7), (9) On Monday, Tuesday and Wednesday – Patients are Overflowing (2), (1) Repayment of Cost of Capital (7) Not Financially self Sufficient (6), (7), (8) Meeting up the salary scale as compared to Private Hospital (3),(6),(7) Getting people who are motivated towards the working philosophy of Arvind eye Centers (10) OTHER CHALLENGES OR ISSUES CONCERNED

32. The Arvind Eye Hospital, Madurai, India Reasons and Proposed Action: (Dr. V’s Insight) “Despite all our efforts, so many people with problems with their vision have still no access to hospitals. Much of the blindness can be corrected through surgery. But they are afraid of operations. So we have to increase the awareness of the causes of blindness and the need for early treatment. Even in villages where we conduct eye camps, only seven percent of people having eye problems turn up. We have to do more to create demand.” Other Initiatives Increasing community involvement Community eye health education through various programmes: Diabetic Retinopathy Management Project (2000) Community Based Rehabilitation Project (1996) Eye Screening of School Children Use of IT Kiosks for Tele advice

33. The Arvind Eye Hospital, Madurai, India Cost Provider Strategy Overall Low cost Focused Low cost Focused Differentiation Broad differentiation Best- Cost Provider Strategy Market Target Reference: Crafting & Executing Strategy: Arthur A. Thompson Lower Cost Differentiation

34. The Arvind Eye Hospital, Madurai, India Reliability: At the hospital the staff must inform patients when and where services will be run…like eye camps At the hospital the staff should be more prompt in providing services Safety: behavior of the staff should be such to reassure the patients At the hospital the team should have adequate knowledge to answer patients questions…because it instills assurance within the patients that …this hospital is good and our investment is worthwhile.

35. The Arvind Eye Hospital, Madurai, India Reliability: The hospital must operate during the times when maximum percentage of patients availability suits there time and the rest part should be shown to other activities.

36. The Arvind Eye Hospital, Madurai, India HORIZON 3 “ Long Jump Initiatives” Objective: Initiatives to sow the seed for Growth in Businesses of the future Balancing the Portfolio Establishing Lions Arvind Institute of Technology Arvind Medical Research Foundation Eye Bank- Rotatory Arvind International Eye Bank Three Strategy Horizons

37. The Arvind Eye Hospital, Madurai, India OVERVIEW (LAICO) initiated a capacity building process with other eye hospitals elsewhere based on Aravind’s experience in providing eye care service in partnership with the network of eye care NGO’s working in India and abroad . 3 Major activities in Capacity Building Process Need assessment Visit Vision Building Follow up

38. The Arvind Eye Hospital, Madurai, India THE GRAND PORTFOLIO “ARVIND EYE CARE”

39. The Arvind Eye Hospital, Madurai, India

40. The Arvind Eye Hospital, Madurai, India Eye to Future : (As per Dr. Venkataswamy) One of our key strategic future steps is to develop dual specialties among our doctors. We would like to retain and get the best out of our doctors. One way may be to provide more meaning to their work . We are trying to help doctors to develop at least one other specialty. We can then also involve them in the running of the Aravind Eye Care System. We also need to find resources to fund our research projects. We need to build more linkages with other eye care institutions all over the world. Reference: Aravind Eye Care System: Giving Them The Most Precious Gift (R1)