Dr. V and McSurgery

Many of us in the northern part of the country may not have heard of “Dr. V” or the eye hospital he has built. Dr. Govindappa Venkataswamy or Dr. V as he was affectionately called brought about a revolution in eye care in the southern state of Tamil Nadu in India.

After his retirement as an eye surgeon in a government hospital, he started a small charitable hospital called the Aravind Eye Hospital in 1976 for cataract patients in Madurai with just 10 beds. Although the charitable nature of the hospital has been retained, the venture has earned enough in two decades to have started facilities in three locations with a total of more than 3000 beds where over 200,000 cataract operations are conducted each year. Aravind also boasts of a world class manufacturing unit for intraocular lenses. His achievements are spectacular enough for Harvard University to have done a case study on him for its graduate students.

Process has a major role in this amazing story. Dr. V revolutionized the delivery model for cataract operations in third world countries. Some facts and figures:

i) Aravind Eye Hospital has given sight back to more than 1.5 million people.ii) On an average a Doctor performs _about 20 – 25 operations everydayiii) The hospital has a gross margin (profit) of more than 40%.iv) A cataract surgery in the U.S. costs $1650. In Aravind it costs just $10.v) Aravind treats more than 60% 0f its patients free of cost and it still manages

to make profits.

Vision:

Dr. V saw the golden arch of McDonalds and thought “ If McDonalds can sell millions of burgers and cans of coke why can’t I sell millions of eye restoring operations?” He had the vision “to provide sight to as many people as possible and to mass market cataract surgery.”

Process and innovation:

According to the renowned management guru C.K. Prahlad, affordability is critical for both the business model and the underlying vision of service. The organization needs to be profitable for sustenance and growth. To keep the price low, Aravind resorted to innovation and processes. To lower cost, an organization has to play with volumes. Each doctor performs about 3600 surgeries in a year. Every step a patient takes is part of a very well researched and technology driven workflow. Each operation room contains 4 operation theatres manned by a two doctor team. The staff nurse takes over the pre-operation procedure and also prepares the patient for surgery. By the time the doctors are finished with the two patients in hand, on the adjacent beds lay two new patients ready with microscopes focused on their eyes. The first two patients are removed by a

nurse to post-op care ward and the cycle moves on. The doctors are expected to work without a break and only concentrate on their core job! The waiting time between patients is ZERO!! (Wish we were able to do this in our WBS!) Hence the eye operation cycle becomes a virtual assembly line where each member of the team knows exactly what they need to do. The operation room nurses, surgeons and anesthetists are constantly learning and using their reservoir of expertise to make appropriate adjustments to reflect the needs of the customers in a specific context. They improvise continuously like players in a jazz band.

Pricing and Training

Due to the mature and well running processes and innovations, effort and costs decrease. With innovations like use of bamboo sticks in stretchers instead of steel rods and alliances with financial institutions, Aravind subsidizes 70% of the patients and the remaining 30% pay market rates for its world class service quality and reputation. For the people who can not afford the cost the hospital provides free eye care and surgery. Aravind Eye Hospital markets itself by organizing free eye camps in rural areas to help treat people who are unable to afford a visit to the hospital. Training and skill building form an integral part of the model. The combination of specialization and volume makes the doctors and nurses experts in a relatively short span of time. To keep the costs low, the nurses and doctors are continuously trained so that they can specialize in their own field and in turn train the juniors.

Organizational values:

For running an organization as effectively as Aravind Eye Hospital, values and goals must be clear, motivating and easy to share. The overall culture is of service, humility, equality and kindness. All the doctors speak softly to patients. If a doctor behaves in an unacceptable manner, he is in for trouble. Mutual respect is a core value. All the employees at Aravind have the same purpose engrained in them - to provide for all people - rich and poor with world class quality and care.Due to the alignment in goals, teams of people organize themselves to work together without the need for expensive supervision.

Aravind Eye hospital is now more than a mere eye care centre. It also manufactures lenses, organizes medical training, runs an eye bank and a post graduate institute. Innovations have been put in place and the cost of a lens manufactured here is less than 1/8th of the international prices.

There is a lesson for all of us in the life and vision of Dr.V who invented “McSurgery”

Born to a rural family, he suffered from severe sporiatic arthritis which left his hand deformed and to think that this was the man responsible for saving 2.4 million eyes many of which were operated by Dr.V himself. The world lost this great visionary on 7 th July 2006. Interested people may learn more about Aravind Eye Hospital at http://www.aravind.org/