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Established in 1976 with the mission to eliminating needless blindness, Aravind is the largest and most productive eye care facility in the world. The brainchild of Dr. Venkataswamy, Aravind Eye Hospital provided free eye care and surgery to millions of needy patients apart from regular patients. Currently, there were 3 Aravind Eye Care hospitals across the state of Tamil Nadu – at Madurai, Tirunelveli and Theni. A new facility at Coimbatore was also under consideration. Since its inception, the Aravind group of hospitals had screened 3.65 million patients and performed some 335,000 cataract operations nearly 70% of which were done free of charge.
Aravind Eye Hospital adopted a unique model in order to try and achieve its vision of eradicating blindness in India.
Eye Care Delivery Model
The hospital ran 2 different kinds of hospitals – the main hospital and the free hospital.
The Main Hospital functioned like a regular ophthalmology hospital. All patients admitted here paid for the hospital’s services apart from a few complicated cases which were brought over from the Free Hospital for diagnosis and treatment. The hospital provided different kinds of rooms class A, B and C, each with somewhat different levels of privacy and facilities and consequently different price levels. Treatments performed in the main hospital varied from simple treatments to extremely complex surgeries like retina detachment repair. The cataract surgeries done at the main hospital were primarily the ECCE cataract surgeries that required an operating microscope and were also more expensive since it required an IOL lens.
The Free Hospital provided free eye treatment to the poorer section of the society free of charge. Patients brought in from eye camps were brought here for treatment. The patients in the Free Hospital were not provided a bed but were provided with choir mats and a small pillow. The hospital primarily provided ICCE type of cataract surgery with an ECCE recommended only when the ICCE could not be carried out due to medical reasons.
The eye camps were the most important means through which Aravind was able to reach the masses. These camps were conducted in rural and semi-urban areas with the help of the local community with either a local business enterprise or a social service organization taking the lead role in organizing the event. Public announcements, newspaper advertisements, and other material were distributed to publicize the camp and increase participation in and around the town in which the camp was being held 2-3 weeks in advance.
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Aravind’s key strength was its innovative operation procedure. They had created a process similar to that of an assembly line which helped them ensure that their turnaround time was very low. This ensured that the surgeons were able to carry about a significantly larger number of surgeries in a day than normal. In order to ensure that the surgeon’s time was not wasted batches of 20 patients each were prepared for surgery by the nurses in the hospital. Once this was done the patients were operated upon by skilled surgeons who after completing the surgery moved to the next operating table where there was a second support team waiting with the patient ready to be operated upon. This procedure resulted in a tremendous amount of efficiency with a team of 5 surgeons and 15 nurses in the Free Hospital being able to operate on about 150 cases in 5 hours.
Intraocular lenses which were an integral part of the ECCE surgery were imported from the United States. In order to bring down costs, Aravind set up an IOL plant, Aurolab which they hoped would help them achieve the goal of providing IOL surgeries to all its patients free of cost.
Weaknesses in the Delivery Model
Through eye camps and the free hospital, Aravind had been able to reach a majority of the population in Tamil Nadu. The number of beds had increased from 10 in 1976 to 1224 in 1992. However, though the company seems to be heading tirelessly towards its vision of eradicating blindness from India there are some issues that need to be looked into.
• Transportation: Even though the company has been able to reach a large market through eye camps, it still required the selected patients to come down to the hospital for surgery. This resulted in a drop in the number of patients accepting surgery since many had constraints which did not allow them to stay away from home for long periods.
• Irregular Patient Inflow: One of the biggest problems with Aravind’s eye care delivery model was that the inflow of patients was irregular being much larger immediately after an eye camp and being much lesser at other times. What this meant was that at some times the hospital was overcrowded while it others it operated much below is capacity. This can be observed from Exhibit 8 where we can see that the average occupancy was much below the capacity on most days even though the case clearly states that the hospital was often overcrowded.
• Scalability: The delivery model adopted by Aravind was not very scalable. This was because since the patients were required to come to the hospital for treatment the camp could not be conducted at a location which was very far from the hospitals that they had in 4 cities of Tamil Nadu.
Apart from this the organization was, almost entirely, family run. This meant that the organization could not grow rapidly since it was always constrained for good managers. Aravind Eye also had lower salaries as compared to the other private hospitals while it had longer and more strenuous working hours compared to the rest. This is a concern since they may not be able to retain the best talent with them. This also put a constraint on their medical staff which they may not be able to grow at a rapid pace for the want of motivated and dedicated people.
In order to solve the key issues that Aravind faces the following measures can be taken:
• Local Eye Care Centres: Aravind can start eye care centers where basic eye treatment and check-ups would be provided. The advantage of having these centers would be that it would distribute the workload which is currently concentrated at the 4 hospitals. A center would be located in each of the camp regions and would contain only the most basic equipment and an ophthalmologist. Since ICCE operations do not require much equipment these centers can be used to perform these operations. Follow-up tests could also be done through these centers thereby removing the need for patients to travel back to the main hospital again. The advantage of this scheme would be two fold. First, since many of the regular treatments would be taken from the hospitals’ plate the congestion in the hospitals as well as the workload on doctors would decrease. Apart from this, since the centers would be located closer to their homes travelling to and from the eye center would become more convenient which would increase the acceptance rate amongst patients.
• Franchising: In order to spread its reach Aravind can look to collaborate with other hospitals wherein some patients with simple requirements can be treated. This would again reduce the burden on the hospitals. The partner hospital would also benefit from this since Aravind’s doctors would provide training to the doctors of the other hospital.