Group Members: Ashok -14 Om Parkash -29 Manoj -22 Achal - 02 Sunny –54 Gaurav - 18.

Group Members:Ashok -14

Om Parkash -29Manoj -22

Achal - 02Sunny –54

Gaurav - 18

1991, there were around 20 million blind eyes in INDIA with 2 million added every year.

Main Cause of blindness: Cataract (~75% cases) Average per capita income: Rs 6800 with over

70% below Rs 2500 425 districts hospital : around 1 for every 2

million people. Surgeries

◦ 30% by Govt. Dept. ◦ 40% by private sector fully paid◦ 30% by volunteer groups and NGO’s

The Blindness Problem

Indian Name – Motiabind 2 Techniques used: ICCE & ECCE ICCE: Most widely used, use simple

instrument, take less then 20 minutes. Has longer recover period (3-5weeks), patient has to wear aphakic spectacles

ECCE: around 30 minutes, plastic intraocular lens required, no need of corrective spectacles, better then ICCE. Costs twice as much as ICCE

Cataract

Goal : Quality eye care at reasonable cost Founder: Dr. Venkataswamy born in 1918 in

small village near Madurai. Bachelor’s degree in medicine in 1944. Deeply influenced by Mahatma Gandhi Suffered from severe Rheumatoid Arthritis

for many years. After retirement he founded Aravind Eye

Hospital.

Aravind Eye Hospital

1976: 20 bed hospital opened. Performing all types of eye surgery

1981: 250 bed Main hospital, with specialty clinics

1984: 350 bed free hospital was opened, staffed by doctors and nurses from main hospital

1988 : Hospitals in Madurai(600 beds), Tirunelveli(400 beds) and Theni(100-beds)

1990: Opens Free hospital for walk in patients.

1992: 3.65 million patients screened and 335,000 cataract operations performed successfully.

History

Tamil Nadu

Pondicherry (2003) Coimbatore (1997)

Theni (1984)

Madurai (1978)Tirunelveli (1988)

Aravind Eye Hospitals (4000 Beds)

Amethi (UP) - 2005

Kolkatta (WB) - 2001

• First three surgeons were Dr Venkatswamy, Dr G Natchair(sister), Dr P Nampermualswany(Dr .Nam)(brother-in-law)

• In 1977, Heads of all clinics except one were family members of Dr V

•Was subsequently joined by other family members who helped in construction, financial management, hospital administration etc

•All senior staff member were highly qualified, experienced and were encouraged to participate in training and research

•Family members were committed and dedicated Aravind eye hospitals mission of providing eye care to the masses

•In 1992, total staff of 240 people including 30 doctors,120 nurses, 60 administrative and 30 housekeeping workers

•Employee were conditioned to work hard and put in 60 hour week to serve all patients

Principles:◦ Market driving

(reaching the unreached)

◦ Removing barriers◦ Community

participation Impact:

◦ Creating access◦ Growing the market

Financial Discipline Willingness to Learn & Change Attitude for perfection Passion to eliminate needless

blindness

Paying Free Total

Out Patient visits

1,321,317

(55%)

1,074,783

(45%)

2,396,100

Surgery 122,900 (43%)

162,845

(57%)

285,745

Cataract Surgery: 70% is free

6000 Outpatients in hospitals 4-5 outreach screening eye camps

◦ Examining 1500 people

◦ Transporting 300 patients to the hospital for surgery

850 – 1000 surgeries Classes for 100 Residents/Fellows & 300

technicians and administratorsMaking Aravind the largest provider of

eye care services and trainer of ophthalmic personnel in the

world

ProductivityProductivity

Practices Clinical Protocols Standardization of procedures Usage & Balancing of Resources Surgical Techniques & Technology Quality & reliability of resources Medical records Staff Training & Discipline

0 500 1000 1500 2000 2500

Bar 1

Bar 2

Less energy required for doctor

Greater safety Ease of use

Early adoption of relevant technologies

Skills & Perspectives upgraded through international visits and exchanges

QualityQuality

Exchange of Residents with the leading US institutions

Continuous improvements based on patient & employee feedback

Using emerging technologies to reduce the response time to patient complaints

Quality Assurance process

Gathering evidence Regular review &

follow-up on decisions Use of Wi-Fi PDA’s by Housekeeping

staff

17

Yearly/Monthly Planning Planning for the next day –scheduling

patient, staff & equipment Planning for supplies & spares Ensuring that resources match expected

workload◦Expected Patient load◦Weekly report◦Monthly report

Consulting fee◦ Poor Patients : Rs. 0 (free)◦ Paying patient : Rs. 50 / US $ 1(valid

for 3 months) Cataract Surgery with IOL (70% of all

surgeries)◦ Poor patients : Rs. 0 (- Rs.250)◦ Subsidized rate : Rs. 750 (15$)◦ Regular rate : Rs. 3,500 – 6,000◦ Phaco Surgery : Rs. 6,500 – 12,000

Affordable fees - Aimed at Middle Income group

53%22%

25%

Covering the entire spectrum

Covering the entire spectrum

Trust – Focus on good care regardless of

paying capacity

Transparency in billing

70% of the paying patient know the

services through word of mouth

Comprehensive speciality eye Care

Pricing for paying services Market prices are driven by their costs – a

reflection of low utilization (inefficiency) – and that helps too

Aravind charges are at least 25% to 30% less than the market charges

Exported to 120 countries

Impact: Price of IOL came down from $ 80 to $ 4 making cataract surgery affordable

• ISO 9001/CE Mark/US FDA approval

• 7% of global market share in IOL

• 5 million people see the world through Aurolab implants

• Patents

Mission & Objectives Produce quality products Provide at affordable cost Support avoidable

blindness effort Self sustain and grow

Turning apparent disadvantages into

realized opportunities

•In eighties all surgical consumables were imported & expensive

•Aurolab was started in 1992 to produce intraocular lenses (IOLs)

Backward Integration

Aim had been to provide quality health care to the masses Funds for main hospital used for construction and equipment for Free hospital 90% of annual budget was self generated, other 10% came from sources

around the world Surplus was reinvested in modernizing and updating equipment and facilities Main hospital provided three different classes of rooms, mostly performed

ECCE surgery and had dedicated specialty clinics. Almost all patients paid for service

Free hospital was run on no frill method. Rooms were shared by many people and beds were 6`x3` coir mats. Most surgeries were ICCE

Process of service delivery at both hospitals was almost identical Same Staff was shared by both hospitals on a rotational basis to provide same

quality in both hospitals Dr V aimed to shift completely to ECCE and decided on vertical integration to

reduce costs of IOLs Auro Labs was setup in 1991 to produce IOLs, long term aim was to reduce

cost of manufacturing to Rs 100 per lens

Aim was to attract patients in rural areas to get regular eye check ups

Promoted by local sponsors( business enterprises, social service organizations)

Sponsors brought in funds, advertised through newspapers, marketplaces, information pamphlets one to three weeks in advance

Sponsors paid for publicity, transportation and food for selected patients ( ~ Rs 200 per patient)

Aravind provided medical expertise and bore cost of surgery and medicines

For increasing patient willingness for surgery, patients were provided food, transportation and moved in groups to provide a safer environment

Follow-up for patients was done by Aravind three months after surgery

Special 10 member team for camp organization

Each member was assigned a district Member toured extensively, but met once a

week to discuss plans with Dr V Members worked with sponsors and helped

in organizing camps, logistics and guided new sponsors

Smoothening Demand – Flow of patients was much higher on certain week days and unusually low on other

Keeping employee motivated to work extra hours on relatively lesser salaries. Can Aravind afford to loose talented employees to private sector or will training initiatives, research opportunities and satisfaction of serving humanity provide sufficient reason for people to stay ?

Achieving financial self-sufficiency in all centers. Can the model be sustainable in smaller cities or should operations be centralized ?

Switching completely to latest technology (ECCE). How can cost be reduced for ECCE ?

Attracting more patients from rural area to eye camps Spreading the model world-wide. What could be the best

method, Franchising Vs Expansion ?