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CASE STUDY

PRESENTATION:
ARAVIND EYE CARE

Introduction
Aravind Eye Hospital started with 11 beds in
1976 and now
they have transformed into Aravind eye care
system
Total 0f 3649 beds as of 2003 (2850 free, 799
paying)
5 AEHs (Madurai, Tirunelvelli,
Coimbatore, Theni and Poindecherry)
Surgery 123,095 in 1997 to 202,066 in
2003 to 269,577 in
2008
Cataract surgeries with IOL intra ocular
lenses

Divisions of the
Organisation
Eye
Care
faciliti
es
(AEHS)

Aurol
ab

Commu
nity
Out
reach
progra
m

Mission: To
eradicate
Needles
blindness by
providing
appropriate
compassionat
e and high
quality eye
care

Educati
on and
trainin
g

Lion
Aravind
Institute
of
communi
ty
ophthalm
olo gy

Resear
ch

Eye
bank

Work Flow: Out Patient


Dept.
Registration begins at 7AM and takes
about 1 min
Case counter: Computerized case sheet, 3
computers for new case 1 for old. 3 Computers
handles 200 cases (approx)
Trained Paramedical staff for preliminary
check up, conducts
basic refraction test

4-5 examination stations, Resident doctors


record diagnosis and recommendations

Permanent Doctor checks diagnosis and

Work Flow: Surgical ward

Doctors are ready by 7AM, nurses reports


by 6:30AM
2 patients in two adjacent operating tables
Operating theatre: 4 operating table, 2
doctors
Tim taken in one surgery is around 12 mins
25 surgeries per doctor per day (industry
average 5-6
surgeries per doctor per day)
Surgeries only in morning (7AM to 1PM)

Facilities for Patients

Patients needing surgeries are given


option between immediate surgery and
Scheduling a later date.

Flexibility to patients: (Patient can choose


mode of surgery, type of lens, type of room
and even the doctor)

AEHs provided a set of trained counsellors to


help patients .
Doctors only focused on medical advising

Eye Camps Outreach


program

Readily available glasses


(Common powers)
Surgeries in main hospital
Camps were sponsored locally
Other Community outreach
programmes:

Diabetic Retinopathy Management


Projects

Community Based Rehabilitation


Project
Eye Screening of School Children
IT kiosks

Other Units

Aurolab: Manufacture low cost lenses (brought


down cos from
$80 to $5), Eye drops and in-house spectacles ,
backward
integration.
LIACO: Managerial as well as Technician Training
Aravind Medical Research Foundation: Clinical
studies and
population studies
Eye Bank
Centre for women and children
Post graduation institute of opthalomology

Recruitment and Training

Standardized training practices and procedures


Doctor to nurse ratio 1:6
Highly trained nurses in order to complement
doctors
Hired from rural background and paid attention
to values and attitude
Offshore Training , 1 to 1 training, apprenticeship
Training in cooking, housekeeping and tailoring
(for marriage)
Fellowship and MS programs for doctors
Academic Exchange programs
Career development opportunities through

Financials

Self Sustaining model


Negligible amount of
donations
Profit Making
No-External financing
Appropriate pricing and
transparency

2003 Decision Dilemmas

Retention of employees
Expansion without compromising
culture
Promoting effective decentralized
decision making
Dual speciality for doctors
Under-utilization of doctors in India
Low adoption of IOL surgeries in India

Value Chain

Inbound Logistics: Supported through Aurolab


Operations: Very high efficiency
Sales and Marketing: Word of Mouth
Services: AEHs, outreach programs, camps
Firm Infrastructure: state-of-art equipments and
facilities
HRM: World-class and Integrated training
program to imbibe
organizational values
Technological development: Highly
computerized Systems and
IT kiosks, web cam facilities for patients

Changes in Environment
after 2003

Notable increase in no. of cataract surgeries but


% of cataract
surgeries were coming down
No. f IOL surgeries increased from 65% to 98%
in India
Reduced Demand for Free services
Competition started increasing
Changes in demand and need for other types eye
care
diseases
Increased emphasis on diabetic retinopathy
Increased demand for LASIK surgeries

AECSs Response

Reduced % of cataract surgeries and


expansion into other
areas
Reduction in Eye camps
Increased focus on LASIK
surgeries Introduction of
AMECS
Establishment of
Community Eye Clinics
and vision centres
Up gradation of Facilities
Emphasis on Research
More community outreach

Issues in Future directions

Movement in Multiple directions


Increasing need of decentralized model which
posed control issues
Mindset issues which hinders fast expansion
Need of project division to manage research
projects
HR issues
Training of ophthalmologists in newer surgical
procedures
Transferring responsibilities to younger
generations
Geographical Expansion
Experiments through AMECS
Global Opportunities

Suggestions

Making LASIK surgery affordable and in high


volumes

More research on Diabetic retinopathy

Separate division for DR and LASIK

Global expansion through LAICO and Aurolab

Presently, CECs should be paid more focus instead of


VCs

Compensation of doctors should be increased

Gradual decentralization by promoting existing and


experienced doctors into leadership/mentoring
roles.

Expansion of Hospitals in South India as culture


difference is less