Arvindeyehospital

Aravind Eye Care System
Management Concepts in Eye care

Dr.R.D.Ravindran M.D., Joint Director Aravind Eye Care System, Madurai, India
A WHO Collaborating Centre for the Prevention of Blindness
Named after Sri Aurobindo Ghosh, his teachings form the basis for Aravinds work
The problemMagnitude of Blindness
Worldwide 4.5 Crore people are blind 1.2 Crore are in India 300,000 of them are children India has more blind people than any other country
Most of it is unnecessary
Simple Cataract Surgery Refraction & a pair of spectacles
Will restore vision to 75 Lakhs
Will restore vision to 24 Lakhs
India: Population 110 Crores
1.2 Crore are blind & 20 Crore need eye care
Glasses or otherwise
Genesis
In a developing country with
competing demands on limited

resources, government alone cannot
meet health needs of all the poor.
Dr. G. Venkataswamy
In 1976 Dr.V, feeling the urgent need, started an eye clinic with 11 beds, to create an alternate, sustainable eye care system to supplement the governments efforts
developed skills to perform 100 surgeries per day
Dr.Venkatasamys Vision
To eliminate needless blindness by providing appropriate, compassionate and high quality eye care to all
Genesis
Began here- as an 11 bedded clinic in 1976
Small team with a big mission

Money
His Guiding Philosophy

Spirituality allows the divine force to work through each of us for a greater good - Sri Aurobindo
Aravind Eye Hospitals (4000 Beds)

Amethi (UP) - 2005
Kolkatta (WB) - 2001
Pondicherry (2003)
Coimbatore (1997)
Tamil Nadu Theni (1984)
Tirunelveli (1988)
Madurai (1978)
Managed Hospitals-Today 4 in Northern Part of India
Priyamvada Birla Aravind Eye Hospital - Kolkata, West Bengal
Indira Gandhi Eye Hospital & Research Centre - Amethi,U.P
Sudharshan Nethralaya Amreli, Gujarat
Indira Gandhi Eye Hospital & Research Centre Lucknow,U.P

12
Hospital Based Facilities
13
Core Principles in delivering health care

S y S T E M S
Reaching the People
Efficient Service
S y S T E M S & P R O C E S S
&
P R O C E S S
PATIENT CENTRED CARE
Giving Value
Financial Sustainability
14
Demand Generation
Principles:
Market driving (reaching the unreached) Removing barriers Community participation Creating access Growing the market
Impact:

Outreach for Speciality Services
Outreach in 2008
No.of Screening Camps 1,442
Patients examined
Surgeries
412,683
98,326
Utilization Study at AECS
Only 7% of people with eye problems in village accessed care from eye camps
20
Innovation exploring newer approaches to deepen the reach into the market
Vision Centre
(Primary Eye Care) Covers a population of 50,000 Staffed by Ophthalmic technicians Active case finding at community level Linked to Base Hospital
Low Cost Wi-Fi 802.11b Connectivity (open spectrum)
Unidirectional antenna Line of Sight 4 MBPS Up to 75 KM
Collaboration with Univ. of Berkeley (PhD students) 23
Primary Eye Care IT Enabled Centers 30 in Tamilnadu

Wireless connectivity @ 4mbps Consultation with Ophthalmologist at Aravind Eye Hospital
Examination by Vision Centre Technician
Marratech Software for tele-conferencing collaboration
Each patient examined at the Vision Centre is discussed with the A WHO Collaborating Centre for the Prevention of Blindness Ophthalmologist through videoconferencing
Impact
Dramatic Reductions in cost Access to good eye care Increased coverage Scalability: Currently 12 will become 26 by year end Replicated in
Baramati, Maharashtra (Intel) Tripura (Govt. of Tripura & India) will be scaling it up to 60 locations
Aravind - Operational Model

Reaching the People
Efficient Service
Giving Value
26
Patient Statistics 2007 - 08

Paying Free Total
Out Patient visits Surgery
1,321,317 (55%) 122,900 (43%)
1,074,783 (45%) 162,845 (57%)
2,396,100
285,745
Cataract Surgery: 70% is free

27
Productivity
Volume Handled Per Day
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 administrators
Making Aravind the largest provider of eye care services and trainer of ophthalmic personnel in the world
28
Management Systems
29
Ensuring Efficiency & Quality

Practices
Clinical Protocols Standardization of procedures Usage & Balancing of Resources Surgical Techniques & Technology Quality & reliability of resources Medical records Staff Training & Discipline
30
31
Resource Balancing

Quantum & Quality of resources Balance between resources Appropriate use reduces cost
Maintaining the resource quality (skill) - at the required level

Eliminate non-productive activities & waiting time
Comparison of surgeon productivity

on ai la es nd sh ia
In d
Ba
ng la
In d
ia
ra vi n
de
Bar 1 Bar 2
Th
500
1000 1500 2000 2500
33
State-of-art technologies in surgery
Less energy required for doctor Greater safety Ease of use
Planning for Expected load & Monitoring
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

35

Reaching the People
Efficient Service
Giving Value
36
Covering the entire spectrum
Aravind Patient Fee Structure

: Rs. 0 (free) : Rs. 50 / US $ 1(valid for 3 months)
Consulting fee

Poor Patients Paying patient
Cataract Surgery with IOL (70% of all surgeries)
Poor patients
: Rs. 0 (- Rs.250)
: Rs. 750 (15$) : Rs. 3,500 6,000
53% Subsidized rate 22% Regular rate 25%
Phaco Surgery
: Rs. 6,500 12,000
Affordable fees - Aimed at Middle Income group

Financial Viability achieved through

- Trust - Attracts paying patients
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
Financial Viability achieved through

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

Reaching the People
Efficient Service
Giving Value
40
Quality
Quality always current
Early adoption of relevant technologies Skills & Perspectives upgraded through international visits and exchanges
Exchange of Residents with the leading US institutions Continuous improvements based on patient & employee feedback
Giving value
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 PDAs by Housekeeping staff
Teaching & Training

Technicians Ophthalmologists
Administrators
Affiliations: MCI, NBE, RCO-UK, JACHPO-USA, MGR Medical & MKU Universities
Backward Integration
Mission & Objectives
Produce quality products

Provide at affordable cost Support avoidable blindness effort Self sustain and grow
In eighties all surgical consumables were imported & expensive Aurolab was started in 1992 to produce intraocular lenses (IOLs)
Turning apparent disadvantages into realized opportunities

Intraocular Lens Division
Pharmaceutical Division
Suture Division
Blades Division
Instruments Division
Making Eye Care Affordable

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
Exported to 120 countries

46
Sharing makes you stronger

Lions Aravind Institute of community Ophthalmology
To contribute to the prevention and control of global blindness through Teaching, Training, Consultancy, Research, Publications & Advocacy
47
Aravind Medical Research Foundation
Microbiology
Community based
Clinical trials
Epidemiological surveys Genetics

48
New Research Facility

Inaugrated on 1st Oct 2008 by Past President APJ Abdul Kalam
49

Hospitals Training Aurolab
Eye Bank

LAICO
IT
Out Reach
Research
50
Commitment of leadership
Financial Discipline
Willingness to Learn & Change
Attitude for perfection

Passion to eliminate needless blindness
51
Recognitions

WHO Collaborating Center National Resources Center for the Govt of India for paramedical training
Resource & Training center for International Agency for Prevention of Blindness
Champalimaud Award, Portugal - 2007 Bill Gates Global Health Award - 2008
52
Where change touches many lives only superficially
Courtesy: Dr Allen Foster
Pursuing Our Mission Eliminating needless blindness
much has been done and much remains to be done . . .

Intelligence & Capabilities are not enough. There must be the joy of doing something beautiful.. Dr.V

Arvindeyehospital

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Aravind Eye Care System

Management Concepts in Eye care

The problemMagnitude of Blindness

Will restore vision to 75 Lakhs

Will restore vision to 24 Lakhs

India: Population 110 Crores

1.2 Crore are blind & 20 Crore need eye care

In a developing country with

competing demands on limited

meet health needs of all the poor.

A WHO Collaborating Centre for the Prevention of Blindness

developed skills to perform 100 surgeries per day

A WHO Collaborating Centre for the Prevention of Blindness

Began here- as an 11 bedded clinic in 1976

Small team with a big mission

His Guiding Philosophy

Aravind Eye Hospitals (4000 Beds)

Tamil Nadu Theni (1984)

A WHO Collaborating Centre for the Prevention of Blindness

Managed Hospitals-Today 4 in Northern Part of India

Priyamvada Birla Aravind Eye Hospital - Kolkata, West Bengal

Indira Gandhi Eye Hospital & Research Centre - Amethi,U.P

Sudharshan Nethralaya Amreli, Gujarat

Indira Gandhi Eye Hospital & Research Centre Lucknow,U.P

A WHO Collaborating Centre for the Prevention of Blindness

Hospital Based Facilities

A WHO Collaborating Centre for the Prevention of Blindness

Core Principles in delivering health care

Reaching the People

PATIENT CENTRED CARE

A WHO Collaborating Centre for the Prevention of Blindness

A WHO Collaborating Centre for the Prevention of Blindness

Outreach for Speciality Services

A WHO Collaborating Centre for the Prevention of Blindness

Outreach for Speciality Services

A WHO Collaborating Centre for the Prevention of Blindness

Outreach for Speciality Services

A WHO Collaborating Centre for the Prevention of Blindness

Utilization Study at AECS

A WHO Collaborating Centre for the Prevention of Blindness

A WHO Collaborating Centre for the Prevention of Blindness

Low Cost Wi-Fi 802.11b Connectivity (open spectrum)

Unidirectional antenna Line of Sight 4 MBPS Up to 75 KM

Collaboration with Univ. of Berkeley (PhD students) 23

A WHO Collaborating Centre for the Prevention of Blindness

Primary Eye Care IT Enabled Centers 30 in Tamilnadu

Examination by Vision Centre Technician

Marratech Software for tele-conferencing collaboration

Aravind - Operational Model

Reaching the People

PATIENT CENTRED CARE

A WHO Collaborating Centre for the Prevention of Blindness

Patient Statistics 2007 - 08

Out Patient visits Surgery

1,321,317 (55%) 122,900 (43%)

1,074,783 (45%) 162,845 (57%)

Cataract Surgery: 70% is free

Volume Handled Per Day

6000 Outpatients in hospitals

4-5 outreach screening eye camps

850 1000 surgeries

A WHO Collaborating Centre for the Prevention of Blindness

Ensuring Efficiency & Quality