The Great Indian Healthcare Factories – II: Aravind Eye Care System-In service for sight

Aravind Eye Care System (AECS)- An overview

It was in the year 1976 that Late Dr G Venkataswamy established an 11-bedded Aravind Eye Hospital in a small rented house in Madurai. His mission was simple yet his vision was grand- to eliminate needless blindness by providing compassionate and high quality eye care.

Today, Aravind’s operations include a chain of seven eye hospitals with a combined strength of more than 4000 beds, a network of outreach centres in the state of Tamil Nadu and a complete integration of its processes and resources. In the year ending March 2012, over 2.8 million outpatients were treated and over 350,000 surgeries were performed, making Aravind the single largest enterprise providing eye care in the world.

Adjudged among the world’s top 100 NGOs by The Global Journal, ACES has been a subject of many international case studies, including Harvard Business School, in social entrepreneurship, public health, corporate business and academic excellence. The Conrad N Hilton Foundation awarded the $1.5 million Humanitarian Prize for the year 2010 to ACES for doing extraordinary work to alleviate human suffering. Aravind’s mission and vision statements don’t just remain on paper; they come alive in each of the organisation’s activities. Even now, 37 years after its inception, Aravind continues to be a beacon of innovative healthcare worldwide.

What makes this organisation so unique, realise its mission and vision, and reach milestones that others can only envy? To answer this question, one has to examine the Aravind Eye Care System’s visionary leadership, strategic management, organisational culture, unique business model and other key attributes.

The leadership

Gp Capt (Dr) Sanjeev Sood

Late Dr Govindappa Venkataswamy or ‘Dr V’ as he was affectionately called was the founder chairman of ACES. At one point of time, he was affected by rheumatoid arthritis, but through his hard work and determination he overcame his disability and earned his masters in Ophthalmology from Madurai Medical College. He joined as a faculty in the same College, where he was appointed head of the Department of Ophthalmology and later Vice-Dean of the College. During this period, he launched many successful programmes to reach out to the visually impaired and their rehabilitation. He has also performed over one hundred thousand successful eye surgeries.

Dr V blended his spiritual life to his daily work remarkably well. As a young man, he was highly inspired by Sri Aurobindo’s philosophy. Aravind was founded on this principle of service and continues to be guided by it.

In recognition of his remarkable work in the fight against blindness, Dr. V was honoured with the Padmashree award in 1973 and invited to deliver an address at the Harvard Divinity School on the theme of living a spiritual life in the contemporary age in 1991.

The results of putting his philosophy into action are evident in the remarkable career of Dr. V and the growth of ACES into an internationally renowned institution since its inception in 1976.

ACES will remember the day, July 7, 2006 when it lost its founder, the great visionary Dr. G. Venkataswamy. Today, the conglomerate AECS is run by a team of eminent professionals like RD Ravindran, P Namperumalsamy and RD Thulasiraj.

The strategy

There are several key attributes that define AECS’ unique strategy. A sense of compassion and commitment of employees, all activities aligned with organisational mission and values, focus on core professional competencies with no frills attached, factory like efficiency and process optimisation, practice of lean management, achieving economies of scale, complete forward and backward integration of all processes and resources are the hallmark of Aravind’s service, operations and its scintillating performance.

Exploiting economies of scale

In the year ending March 12, Aravind attended to 2.8 million eye cases in OPD, performed 350,000 surgeries, comprising 40 per cent of eye care in Tamil Nadu. Aravind Eye Banks have collected 2,800 corneas, of which 1,800 were transplanted. An average surgeon does about 25-40 procedures per day or 2600 surgeries per year in Aravind Eye Hospitals. Since 1976, Aravind has given sight to more than one million people in India. Aravind generates volumes through its outreach programmes and tele-ophthalmology enabled satellite centres, which penetrate the remotest of villages. It organised 2600 camps in the last one year to reach out to every individual needing eye care.

Complete integration of supplies and human resources

Aravind Eye Care System includes a spectrum of diverse activities. ACES is centrally governed by a Board of Directors. The Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Lions Aravind Institute of Community Ophthalmology (LAICO) and Dr G Venkataswamy Eye Research Institute are governed by the GOVEL Trust and Aurolab by the Aurolab Trust.

Recognising that the imported intra-ocular lenses constituted a major component of the total surgical costs, Aravind obtained a transfer of technology through the US-based Seva Foundation, and Combat Blindness Foundation, to permit it to manufacture these lenses and other surgical consumables at a fraction of the cost. Aurolab is one of the few device manufacturing companies that is both ISO 9001, CE and USFDA certified. The manufacturing activity has scaled up to nearly 600,000 lenses. Today, Aurolab has grown into an organisation with six product divisions (intraocular lenses, pharmaceuticals, sutures, instruments, spectacles, and hearing aids) and more than 200 employees. The affordably priced intra-ocular lenses are exported to some 120 countries around the world, providing another source of revenue for Aravind.

LAICO, established in 1992 with the support of the Lions Club International SightFirst Programme and Seva Sight Programme, is Asia’s first international training facility for blindness prevention workers from India and other parts of the world. It contributes to improving the quality of eye care services through teaching, training, research and consultancy.

Aurosiksha – is another venture of AECS to enhance the reach and quality of education drawn from the rich knowledge base that the organisation has harvested since 1976. Its four essential attributes – digitisation, immediacy, virtualisation, and globalisation – drive knowledge sharing. Aravind has trained several thousands of eye care professionals across the world over the last three decades.

Care delivered through echelon of eye centres

Aravind delivers an entire range of eye care services from primary eye care to tertiary eye care. Its vision centres provide comprehensive primary eye care including triage, referral services and also create adequate awareness in the community. This network structure, allows Aravind to reach a large rural population at their doorstep in South India.

Unique HRM Policies

The organisation follows unique HR practices by optimal use of skilled man power .It imparts in house training to mid-level ophthalmic personnel, mostly rural women, in a two-year course. These personnel never had the chance to go to college, now they get the opportunity to enter the work stream as mid-tier technicians. AECS recruits without commercial advertisements. Currently, 350 medical officers and consultants, 1,500 mid-level ophthalmic personnel and 500 administrative staff are on AECS’s rolls. Not only the attrition rates are minimal there is also a sizeable waiting list of applicants.

Practicing lean management

With efficient processes,stream lined work-flows and well designed assembly line, Aravind is able to handle high patient volumes with minimum waiting time. With less than one per cent of the country’s ophthalmic manpower, Aravind accounts for five per cent of the eye surgeries performed nationwide.

Reaching out to bottom of pyramid

Through its pioneering approach of using social science research to understand who is in need of eye care and what is needed for them to receive it, Aravind provides free transportation to bring patients to its hospitals and addresses the issue of gender inequity to provide eye care at the grass root level. Rather than thinking of poor at the bottom of pyramid as victims of fortune, Aravind looks up to them as value demanding care recipients.

Harnessing dual pricing and cross subsidisation

Almost half of the patients seen and surgeries performed at Aravind are free of cost. Aravind takes no donations or charity and yet makes a profit that is enough to fund a new hospital every three years. The organisation remains financially viable from the nominal charges collected from paying patients. The average cost of each surgery is approximately Rs 2000/- only, which is 1/10th the average cost at a private Indian hospital and 1/300th the cost in US hospital.

Achieving best outcomes

Equipped with sophisticated technology, Aravind performs the latest state of the art procedures like DSEK and PC IOL for corneal services, selective laser trabeculoplasty for glaucoma, implantable contact lens, Zeiss YAG II plus laser and LASIK for cataract service, minimal invasive strabismuss surgery for squint, and pre-filled syringes of Avastin for diabetic retinopathy. Aravind’s morbidity rates are benchmarked against and consistently exceed those of the Royal College of Ophthalmologists in the UK. Aravind Hospitals are now going in for NABH Accreditation.

Conclusion

Thus, by embracing best practices and business principles in lean management, rationalising manpower utilisation, adopting innovation, factory-like system efficiency and process optimisation, the scale of Ford Motors, the efficiency of McDonald and Toyota; professional excellence, Sri Aurobindo’s compassion, congruence of vision and values, committed leadership of Dr Venkataswamy and the current management, Aravind has woven a great success story that is truly Indian as well as worth emulating and replicating in any setting.

The author is a Hospital Administrator and NABH empanelled assessor based in Chandigarh.