sm2ppt- Team 8.pptx

8/14/2019 sm2ppt- Team 8.pptx

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Aravind Eye Care Hospital is an ophthalmological hospitalwith several locations in India.

Currently at locations

Madurai, Pondicherry, Coimbatore, Theni, Tirunelveli,Kolkata & Amethi

Founded by Dr G. Venkataswamy in 1976 at Madurai

Awards (in 2008 -2009)

Bill and Melinda Gates Award for Global Health

Acknowledged by Clinton Global Initiative in Sep 2008

Recognized by C.K.Prahalad in his book The fortune atthe bottom of pyramid


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Source http://www.aravind.org

Source http://www.aravind.org

Source http://www.softexpune.or

Aurolab - Madurai

AEH- Madurai


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Mission

Elimination of needless blindness

By the end of 2009 AECS had set up 31 Vision Centres and 5Community Eye Clinics (Outreach Programme).

Aravind Managed Eye Care Services (AMECS)

Dr V had been succeeded by Dr P. Namperumalsamy (DrNam)in 2006

Its manufacturing arm Aurolab had moved to new facilityat Madurai.


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Established by Dr V as a 11 bed hospital at Madurai in 1976.

Dr V served Army Medical Corps from 1944 to 1948

Trained himself to do microsurgery and technique ofIntraocular Lens (IOL) insertion.

AECS Policy To serve paying as well as free patients.

Close control of costs, high productivity of doctors andachieving high volumes

AECS vital components - Values and spirituality Mr. R.D. Thulasiraj (Executive & IT Director at LAICO)

Our operational model is heavily dependent on work culturevalues.The systems are built in our basic values.


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Focused on cataract surgery.

Established 2 bed system of operation to increaseproductivity of doctors. Productivity rate of doctor 25 surgeries/day/doctor in contrast to

general avg of 5-6 surgeries/day/doctor. High quality surgical and medical equipments used.

Manufactured IOLs in house at Aurolab.

Cost of Imported IOL $80 andAurolabsIOL $5.

60% of surgeries were done free or almost free. AECS grew quickly

In 1997 - 1,23,095 Surgeries and 9,75,868 Outpatients per year In 2003 - 2,02,066 Surgeries and 14,50,000 Outpatients per year


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AECS created surplus income despite providing freetreatment.

In 2002-03 it had surplus of Rs 219 Mn out of total incomeof Rs 423 Mn

UNIT Free/SubsidizedBed

PayingBeds

Total OT/Tables

Madurai 900 325 1225 13/49Tirunelveli 482 158 640 5/16

Theni 123 40 163 2/8

Coimbatore 580 176 756 11/20

Pondicherr

y

600 136 736 8/21

Exhibit 1 : AECS , no of beds in differentHospitals

Source: Data supplied by AECS


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AESC did not consider the number of beds to be animportant parameter as most of the cataract patients weredischarged the same day.

Also, no. of mats had been converted to regular cots, andthe average stay of the patient had reduced.

Hence the no. of surgeries done was a more meaningfulindicator of its impact than the no. of beds


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YearPaying Free including camp Total

OP visits Surgery OP visits Surgery OP visits Surgery

2003 758,991 78,487 688,548 123,579 1,447,575 202,066

2004 870,171 85,745 765,860 141,690 1,636,031 227,435

2005 928,785 93,134 793,113 154,101 1.721,898 247,235

Jan 2006 till

March 20071,140,765 104,108 1,037,572 147,989 2,178,336 252,097

April 2007 to

March 20081,101,154 114,464 1,073,614 148,202 2,174,768 262,666

April 2008 to

March 20091,182,137 131,295 1,273,811 138,282 2,455,948 269,577

Source: Data su lied b Aravind e e care


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AECS conducted a number of outreach activities inaccordance with its mission.

EYE CAMPSwere the most important for they symbolizedthe organizations determination to reach out to the people in

the villages.COMPREHENSIVE EYE CAMPSwas the most importanttype of eye camp, where, complete examination of eye wasdone, spectacles were prescribed and delivered on the spot in

about 70% of the cases


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Year No. of campsorganized

Patients seen Surgeries of camp patients

2003 1158 388,594 81,357

2004 1271 433,502 95,249

2005 1335 437,224 98,3262006 1442 412,683 92,3462007 1448 377,377 87,667

2008 1302 320,563 69,5802009 1319 314,780 71,869

Source: Data supplied by Aravind Eye CareS stem


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AECS also organized diabetic retinopathy (DR) camps,refractive error camps, eye screening camps for schoolchildren, pediatric camps, and mobile van DR screeningcamps.

AECS had also setup its training institute, Aravind Post-Graduate Institute of Ophthalmology (APGIM) whichoffered PG program, fellowship program for superspecialization and Ophthalmic Assistants training.

Its manufacturing arm, Aurolab, produced IOLs andmedical consumables for eye care, like sutures andmedications at low cost.


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AECS achieved economies of scale by providing medicalconsumables to other hospitals and ophthalmologistsoutside AECS since its inception.

This was also in consonance with its mission of elimination

of needless blindness. This helped many hospitals not only in India but also

abroad to conduct surgeries at a much lower cost.

Some of the pioneering products from Aurolabs are:

Auroflex-EV, negative aspheric IOLs for better contrast andvisibility in low light conditions, green laser photocoagulators etc.


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AECS training arm, LionsAravind Institute of CommunityOphthalmology (LAICO) offered training programs tooutside hospitals to improve their practices.

LAICO provided programs both in techniques of surgery

and in management of doctors, hospital managers andparamedics.

LAICO provides training programs both at its facilities atMadhurai, at customer sites and also in a number of foreigncountries.

It also undertook consultancy for improving theperformance of hospitals, with need assessment, visionbuilding workshops, follow-up visits and monitoring.


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Cataract accounted for 62.6% of blindness.

Increased awareness resulted in early surgeries.

Cataract Surgery Rate(CSR)

India : 5000 Tamil Nadu : 9000

Bihar : 600

Increase in % of Intraocular Lens(IOL)


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High degree of operational efficiency enabled AECS to provide freesurgeries to as much as 60% of its patients.

source : Aarvind Eye Care System(2009),activity report,2008-2009

Category of surgery # Surgeries Percentage

Cataract 204,672 66.23

Laser Procedures 57,958 18.76

Retina & Vitreous surgery 8,393 2.72Trab & combined procedures 7,099 2.30

Lacrimal surgeries 5,218 1.69

Other orbit & Oculoplastysurgeries

6,336 2.05

Ocular injuries 1,164 0.38

Pterygium 3,565 1.15

LASIK refractive surgery 3,459 1.12

Other surgeries 9,458 0.55

Total surgeries 309,015 100


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General improvement in the living conditions.

Expectation of patients going up.

Multiple insurance schemes Private

State sponsored


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Diabetic Retinotherapy (DR) that included controlof diabetes,refraction correction and prevention andtreatment of glaucoma.

Unlike cataract,DR was preventable Focus on prevention and early attention then cure,

effective screening for diabetes and monitoring ofthe patients.

Glaucoma if left untreated also lead to blindness.

Refraction correction too had become an importantarea of concern.


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Doctors salaries were becoming highly competitive .

They were looking for opportunities to establish therename and in particular, looking for opportunities to doresearch , publish papers , to take part in conferenceand network among peers .

These would increase doctors competences and alsothe hospitals visibility .


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New hospitals with better looking building and betterroom and food facilities were coming up.

New hospital enticed the doctors with better pay butnone of them offered comparative scope forprofessional advancement.

Most of the doctors in these private chains were ex-AECS personnel.


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Out of 45 million blind population in the world , 7 millionwere in india .

12 million bilaterally blind persons in india with VA lessthan 6/60

11,000 eye surgeons

1 for about 100,000 people

50% qualified eye surgeons are non operating surgeons

Many of the operating surgeons could not perform IOLsurgeries .

These factor impacted the overall effectiveness of anti-cataract campaign


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Govt Of Indias vision 2020 envisaged Increase of CSR to 5,000 by 2010, 5,500 by 2015 and

6,000 by 2020

Increase in IOL surgeries to 100 2010

Paediatric blindness was also an area to be addressed .About 0.8 per 1000 children were estimated to haveserious vision problem .


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Four types of eye camps:

1. Traditional comprehensive eye camps

2. Diabetic retinopathy(DR) screening camps

(Mobile van screening camps)

3. Refraction Camps

4. School Eye Screening Camps

Camps provided a benefit of increased reach and number of

patients attended

Still only 85 of the people requiring screens were being screened


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School camps- 210,139 students (base) & 67,237 students (VCs)

Mobile screening vans.

Paediatric screening camps

Refraction camps

6. Arvind Managed Eye Care Services(AMECS)

Trained Doctors in other hospitals to improve their efficiency AECS neither provided any facilities nor made any investment

Selected personnel were sent to supervise the activities

5 yr agreement.


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Private rooms- new block @ AEH, Madurai

Floor mats for free patients AECS Centre for Patient Empowerment intended to improve

eye care awareness in patients and the community

8. Emphasis On Research Focus on research on- DR, transplantation of cells etc. Means of providing development opportunities to doctors-

optional 1 day/week off- international conferences etc.- aretention strategy.

Research- a source of funds: about Rs 15million (2008-09). Brand new research facility -in 2008- Dr.G. Venkataswamy Eye

Research Institute, Rs 290 mn. 25 research scholars in 2009.


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Year No. of Publications

2004 46

2005 49

2006 70

2007 65

2008 73

Total 303

Source: Data as supplied by AECS


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2004 4

2005 2

2006 8

2007 8

2008 12

Total 34

Source: Data as supplied by AECS


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Ouremphasis is to be at par with the best eye hospitals in the world

without diluting our vision....We see our activities in four broad areas-

paediatric eye care, cataract, retinopathy, glaucoma, and refraction

- Dr. Nam

They have plenty resources and therefore various options are

available.

We are a highly mission driven set of people. Resources are not the

only consideration in deciding the direction of growth

- Dr. Kim


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There were a number of directions that AECS could take; the real

problem was one of prioritization. The various directions ,as

suggested by the key personnel at Aravind eye care, are as follows:

a) According to Dr. Nam:

Diabetes is a challenge. To reach 46 million diabetics in India , innovative

methods are needed. E.g. Paramedic

Cataract prevention, refraction correction, glaucoma, etc. Will become

important.

Thus, Dr. Nam said, Weneed to move in multiple directions.


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b) According to Mr. Thulasiraj:

We have a tremendous opportunity in the treatment of refractive errors.Wecan set up a network of Refraction Centers.

He also saw big opportunity in training. He saw opportunities in LAICO.

There will also be a Projects Division to manage research projects.

c) According to Dr. Aravind:

Resources are not a problem. The challenge today is our aspiration, not ourresources. How do we retain the same hunger and the same passion?

Dr. Thulasiraj also shared similar concern- We have to address mindset issues.We are diffident about moving out of our comfort zone.


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There were different views on whether and how to grow beyond Tamil

Nadu. They are as follows:

1. Concerns about culture:

a) Dr. Nam felt that expansion to other Indian states is an issue. He said

Culture is an important issue for us. Speaking about his concerns, he

further said Westill have our doubts on the feasibility of transmission of

values like compassionate care

b) Dr. Kim and Mr. Thulasiraj shared similar concern about culture

transferability. Dr. Kim said Business models should not obscure our

hospitalsgrowth model..


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2. AECS executives saw opportunities to expand globally in certain

activities

a) According to Dr. Nam: DR (Diabetes Retinopathy) can be studied

adopting a global approach.

b) Dr. Kim We are moving into research , especially in specialities.

We have to give new services that are currently not available but

necessary for eye care to stay ahead of competition .

c) Mr. Thulasiraj said We have a global opportunity. There are 135

countries in the world with a population of less than 20 million each.

Wecan thus give our knowledge and offer our services in many of

these countries.


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A major challenge was to develop a large cadre of doctors,

nurses and paramedics, especially because they had to beimbibed with the right values. The various challenges are:

1. Training:

a) Dr. Nam said We need to train more ophthalmologistsin DR surgical procedures. Knowledge management isimportant. We are doing this through our Virtual

Academy.

b) Dr. Kim said that MLOP (Middle Level OphthalmicPersonnel) training is becoming an important activity.


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2. Developing next generation:

Dr. Aravind said, theolder generation is now in thesixties. And except for a few, the younger generationis in forties. There could be a situation when theyounger generation would have to take overresponsibilities before they are fully ready.

AECS is preparing itself for the same. For example,LAICO is developing a cadre of managers for AECS.


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It is important to use the right metrics when we are trying to measure the

success of any venture. In this case AECS changed their metric from no. ofbeds to no. of surgeries.

Having a long term mission and making sure all the activities are directedtowards the fulfillment of those missions are important if an organizationwants to succeed in the long run.

It is necessary to have standardized processes as it helps in increasing theefficiency as well as helps in reducing the overall operating cost.

For any organization to sustain its necessary to have a foresight, also theyshould be able to sense the future roadblocks to success and thereforeshould try to minimize future risks by undertaking preemptive actions.


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Standardization of processes is essential as it results in operational efficiency and lowoperational costs.

More awareness needs to be created among people about eye care since few people knowabout it.

More focus is now given to Lasik and other eye surgeries.

Research is extremely essential for development of robust technology and practices inmedical sector.

The firms need to be ready to overcome constraints like geography to tap opportunities.

Learning can be used as a very effective retention tool.

One should always look forward to give back to society with whatever is in onesreach.


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sm2ppt- Team 8.pptx

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