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The Arvind Eye Hospital, Madurai, India

WORLD WIDE
(1992)
The blindness Problem
Projected- 30 Million
7%
7%

20%

Africa
Latin
america

Asia
others

67%

Developing Countries

Developed country

Macular Degeneration

Cataract (75%)

Diabetic Retinopathy
Glaucoma

The Arvind Eye Hospital, Madurai, India

Global View (WHO)

WHO estimates by 2020 the number


would increase by 75 million globally

40%
60%

Catarct
Focal
diseases

Reference- Low vision assessment -By Jane McNaughton, Jane


McNaughton (MCOptom.)

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

Ophthalmol
ogist

8000 performing 1.2 million Cataract


Operations/year

Eye Hospital 42,200


Medical R
and
Infrastructu
District
re
Hospitals

Two-third skewed to the Urban areas


Government Initiatives
where less than one third of the nations
population lived
425 offering free eye care and cataract
Surgery

Revenue
Allocated

Rs. 60 Million ($2milliion) for blindness


prevention

Challenges

1. Proper Infrastructure
2. State of Art Equipment
3. Training Personnel

The Arvind Eye Hospital, Madurai, India


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

The Arvind Eye Hospital, Madurai, India


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
DEVELOPING NATIONS
to earn money
Lack of business planning skill to raise money

The Arvind Eye Hospital, Madurai, India


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

Dr. Vs Approach and Level 5


leadership concept

Reference: 2005 Joe Tidd, John Bessant, Keith Pavitt


www.wileyeurope.com/college/tidd

The Arvind Eye Hospital, Madurai, India

Three Key Elements that defines


the Arvind Business Model
Reference: Treating Cataract In India
(Case Study)

The Arvind Eye Hospital, Madurai, India

Cost
Recovery
Model

The
Best
Three
Bottom
Arvind
Hedge
Cost
Horizon
Eye
of Provider
Pyramid
Hog
Hospital
Strategy
concept
Strategy
concept
Model
Concept
Revolves around the Following co

Level 5
Leadership
Concept

Conceptual Foundation

The Arvind Eye Hospital, Madurai, India


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

Level 5 Leadership Concept

Finally desired or Expected results are achieved

197
6

20 Bed Eye Hospital


Goal- Providing Quality
eye care at reasonable
cost

1981 Main Hospital


250 Beds

197
7

30 Bed Annex
Goal- To accommodate
patients after surgery

Specialty Clinics
Cornea Glaucoma
Squint Corrections
Diabetic Retinopathy
Pediatric Ophthalmology

197
8

The Arvind Eye Hospital, Madurai, India

70 Bed Free Hospital


Goal- Providing poor
with free eye care

Standardizing and
Engineering The Cataract
Surgery

80,000 sq. feet space


4 Major O.T.

Features
State of Art Equipment

Journey from 1976-1981

Strategic
Initiatives

The Arvind Eye Hospital, Madurai, India


and
s
e
lleng
a
h
C
es
issu
HORIZON
2
HORIZON
1
Medium
Jump
Short

Jump

Initiatives

Initiatives
(Fortify and
Extend
Current
business)

(Leveragin
g
existing
TIME
Resources)

HORIZON
3
Long
Jump
Initiatives

(Sow the
seeds for
Growth
and
Businesse
s for the
Future)

Reference: Crafting & Executing Strategy: Arthur

Three Strategy
Horizons
Concept

The Arvind Eye Hospital, Madurai, India


HORIZON
1

Objective:

Fortifying and extending the


Short companys
Jump
objective
Initiative

Building up of 350 bed free


1984
Hospital
36,000 sq. feet space
2 major OT and Minor theatre for
Septic care
Medical Personnel from main
Hospital

ASSEMBLY LINE PROCESS


Strategy
Eye
Hospital,
Since
1976

Building of Hospitals in
Tirunellvelli (1985) , Theni (1988)
Three Strategy Horizons
and other places of Tamil Nadu

The Arvind Eye Hospital, Madurai, India

From
McDonald's
.................T
o..Mc.
Surgery

"A blind person is a mouth with no hands,


is an Indian saying that Dr. V liked to quote.

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

The Arvind Eye Hospital, Madurai, India


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

WHY Mc. Donalds CONCEPT WAS SO


FASCINATING ?

The Arvind Eye Hospital, Madurai, India


The Morning is usually heavy an people are divided into two
groups for evaluation

Senior Medical
officer
Final Examination

Ophthalmic
Assistants

Eye Doctor

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

Assembly Line Model: The Main Hospital and The


Free Hospital

The Arvind Eye Hospital, Madurai, India


Final Examination
(Patients Could be Sub Divided
as)

Patients for
Cataract
Surgery

Patients for
Corrective
Actions are
suggested
Optometry
Room for
measurement
and
prescription
of Glasses

Patients
referred to
specialty
Clinics

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
Assembly Line Model:
The Main
Hospital and The
operation

The Arvind Eye Hospital, Madurai, India


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 setup, 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.

Cost Recovery is possible in Cataract


Surgery

The Arvind Eye Hospital, Madurai, India

Principles of Cost Recover

The Arvind Eye Hospital, Madurai, India

Source: Data supplied by Aravind Eye Care

The Arvind Eye Hospital, Madurai, India


AEH
draws its
patients
to eye
camps
through
organized
local
Business
units

Organizati
ons bear
the
publicity
costs and
other
costs
incurred

Organizati
ons also
pay for
expenses
related to
transporta
tion and
meals

AEH gets
supplies
of IOL
lenses
and other
products
at a
substanti
al
discount.

Several facilitating factors


helped AEH make its
business model sustainable

Factors assisting Arvind Eye Hospital- Eye cam


Model
Reference: Bottom of Pyramid by, C.K.

The Arvind Eye Hospital, Madurai, India


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

Paying 35%

Free Camp 47%

Subsidized 18%

Financial Viability

The Arvind Eye Hospital, Madurai, India


CHALLENGES AND ISSUES CONCERNED
The outpatient facilities at the free hospital were not well
organized
There was a temporary shelter at the free hospitals
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


FREE HOSPITAL and EYE CAMPS : MADURA
Organizing of Logistics
Requirement of consistent set of procedures and common
set of Principles

The Arvind Eye Hospital, Madurai, India


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
INITIATIVES FREE HOSPITAL and EYE CAMPS :
satisfaction within them as far as the services were
MADURAI

The Arvind Eye Hospital, Madurai, India


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.

INITIATIVES FREE HOSPITAL and EYE CAMPS :


MADURAI

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
Three Strategy Horizons
free and 799 paying beds

The Arvind Eye Hospital, Madurai, India

Major
Footsteps

SEVA
CIDA
Sight Savers

20 Bed to 600 Bed Hospital What served


as the Major footsteps?

The Arvind Eye Hospital, Madurai, India


Word of Mouth
Communication

Past Experience

GA
P

SERVIC
E
QUALIT
Y
MODEL

GA
P

GA
P

Personal Needs

GA
External
P Communication

The Arvind Eye Hospital, Madurai, India


ASSOCIATING DR. VENKATASWAMY CONSIDERATIONS
TO SERVICE QUALITY MODEL
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

The Arvind Eye Hospital, Madurai, India

The Arvind Eye Hospital, Madurai, India


OTHER CHALLENGES OR ISSUES CONCERNED
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)

FREE HOSPITAL : THULASI and TIRUNELVE

The Arvind Eye Hospital, Madurai, India


Reasons and Proposed Action: (Dr. Vs 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
Diabetic Retinopathy Management Project (2000)
Community eye health education through various
Community Based Rehabilitation Project (1996)
programmes:
Eye Screening of School Children
Use of IT Kiosks for Tele advice

The Arvind Eye Hospital, Madurai, India

Market Target

Overall Low
cost

Broad
differentiation

Best- Cost Provider


Strategy

Focused
Low cost

Focused
Differentiation

Lower Cost
Differentiation
Reference: Crafting & Executing Strategy:
Arthur
Provider
Strategy

Cost

The Arvind Eye Hospital, Madurai, India


Reliability:
At the hospital the staff must inform patients when and
where services will
be runlike 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 questionsbecause it instills assurance within the
patients that
this hospital is good and our investment is worthwhile.

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.

The Arvind Eye Hospital, Madurai, India


HORIZON 3

Objective:

Long Jump

Initiatives to sow the seed for Growth in


Businesses of
the future
Balancing the Portfolio

Initiatives

Establishing Lions Arvind Institute of


Technology

Arvind Medical Research Foundation


Eye Bank- Rotatory Arvind International
Eye Bank

Three Strategy Horizons

The Arvind Eye Hospital, Madurai, India


OVERVIEW
(LAICO) initiated a capacity building process with other eye
hospitals elsewhere based on Aravinds experience in
providing eye care service in partnership with the network of
eye care NGOs working in India and abroad.

3 Major activities in Capacity Building Process


Need assessment Visit
Vision Building
Follow up

The Arvind Eye Hospital, Madurai, India

THE GRAND
PORTFOLIO
ARVIND EYE
CARE

The Arvind Eye Hospital, Madurai, India


Location of Participating
Hospitals
Other Countries:
Banglade sh
Bulgaria
Cam bodia
Egypt
Indone s ia
Ke nya

Lions - 87
Sight Savers
CBM
WHO, Orbis,
Seva, others
Total:

Malaw i
Ne pal
Zam bia
Zim babw e
Guatem ala
El Salvador

- 39
- 20
- 15
161

Tanzania

A R A V I N D

E Y E

C A R E

S Y S T E M

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
Reference: Aravind Eye Care System: Giving Them The Most