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A WHO Collaborating Centre for the Prevention of Blindness

Aravind Eye Care SystemManagement Concepts in Eye care

Dr.R.D.Ravindran M.D.,

Joint Director

Aravind Eye Care System,

Madurai, India


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Named after

Sr i Au robindo Ghosh,

h is teachings form the basis

for Aravinds work


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The problemMagnitude of Blindness

Worldwide 4.5 Crorepeople are blind

1.2 Crore are in India

300,000 of them arechildren

India has more blind

people than any other

country


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A WHO Collaborating Centre for the Prevention of Blindness 4

Most of it is unnecessary

Simple Cataract Surgery Refraction & a pair of spectacle

Will restore vision to 75 Lakhs Will restore vision to 24 Lakhs

India: Population 110 Crores

1.2 Crore are blind & 20 Crore need eyecareGlasses or otherwise


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In a developing country with

competing demands on limited

resources, government alone cannot

meet health needs of all the poor.

Genesis


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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


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developed skills to perform 100 surgeries per day


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Dr.Venkatasamys Vision

To eliminate needless blindnessby providing appropriate,

compassionate and high qualityeye care to all


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Genesis

Began here- as an 11

bedded clin ic in 1976

Small team with a big m ission

Mone


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His Guiding Philosophy

Spirituality allows the divineforce to work through each of

us for a greater good

- Sri Aurobindo


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TamilNadu

Pondicherry (2003) Coimbatore (1997)

Theni (1984)

Madurai (1978)Tirunelveli (1988)

Aravind Eye Hospitals (4000 Beds)

Amethi (UP) - 2005

Kolkatta (WB) - 2001


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Managed Hospitals-Today

4 in Northern Part of India

Priyamvada Birla Aravind EyeHospital - Kolkata, West

Bengal

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

Sudharshan Nethralaya -Amreli, Gujarat Indira Gandhi Eye Hospital &

Research CentreLucknow,U.P


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Hospital Based Facilities


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Core Principles in delivering health care

Giving ValueFinancial

Sustainability

Efficient

Service

Reaching the

People

S

y

S

T

E

M

S

&

P

R

O

C

E

S

S

PATIENT

CENTRED CARE

S

y

S

T

E

M

S

&

P

R

O

C

E

S

S


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Demand Generation

Principles: Market driving

(reaching theunreached)

Removing barriers

Communityparticipation

Impact: Creating access

Growing the market


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Outreach for Speciality Services


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Outreach in 2008

No.of ScreeningCamps

1,442

Patients examined 412,683

Surgeries 98,326


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Only 7% of people with eye problems invillage accessed care from eye camps

UtilizationStudy at AECS


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Innovationexploring newerapproaches to deepen the reach into

the market


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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


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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)


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Wireless connectivity@ 4mbps

Marratech Software for

tele-conferencing

collaboration

Examination by Vision

Centre Technician

Each patient examined at the Vision Centre is discussed with the

Ophthalmologist through videoconferencing

Consultation with

Ophthalmologist at Aravin

Eye Hospital

Primary Eye Care IT Enabled Centers30

in Tamilnadu


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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 scalingit up to 60 locations

A i d O ti l M d l


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Aravind - Operational Model

Financial

SustainabilityGiving Value

Efficient

Service

Reaching the

People

S

y

S

T

E

M

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&

P

R

O

C

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S

S

PATIENT

CENTRED CARE

S

y

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Patient Statistics 2007 - 08

Paying Free Total

Out Patient

visits

1,321,317

(55%)

1,074,783

(45%)

2,396,100

Surgery 122,900 (43%) 162,845

(57%)

285,745

Cataract Surgery: 70% is free


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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 servicesand trainer of ophthalmic personnel in the world

Productivity

M m t S t m


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Management Systems

i ffi i Q li


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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


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R B l i


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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

C i f d ti it


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Comparison of surgeon productivity

0 500 1000 1500 2000 2500

India

AravindB

anglad

eshT

haila

ndInd

onesia

Bar 1

Bar 2

S f h l i i


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State-of-art technologies in surgery

Less energy required fordoctor

Greater safety

Ease of use

Pl nning for E pe ted lo d & Monitoring


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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

http://localhost/var/www/apps/conversion/tmp/scratch_8/Exp%20Week%20Pt%20Load%20-%2025%20Jun%2007.xlshttp://localhost/var/www/apps/conversion/tmp/scratch_8/V%20%20June%2003.XLShttp://localhost/var/www/apps/conversion/tmp/scratch_8/U%20May%2027.XLShttp://localhost/var/www/apps/conversion/tmp/scratch_8/May(PIC).ppthttp://localhost/var/www/apps/conversion/tmp/scratch_8/May(PIC).ppthttp://localhost/var/www/apps/conversion/tmp/scratch_8/U%20May%2027.XLShttp://localhost/var/www/apps/conversion/tmp/scratch_8/V%20%20June%2003.XLShttp://localhost/var/www/apps/conversion/tmp/scratch_8/Exp%20Week%20Pt%20Load%20-%2025%20Jun%2007.xls


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Financial


Efficient

Service

Reaching the

People

S

y

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&

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PATIENT

CENTRED CARE

S

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C i th


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Aravind Patient Fee Structure

Consulting fee Poor Patients : Rs. 0 (free)

Paying patient : Rs. 50 / US $ 1(valid for 3 months)

Cataract Surgery with IOL (70% of all surgeries)

Poor patients : Rs. 0 (- Rs.250) Subsidized rate : Rs. 750 (15$)

Regular rate : Rs. 3,500 6,000

Phaco Surgery : Rs. 6,500 12,000

Affordable fees - Aimed at Middle Income group

53%

22%

25%

Covering the

entire spectrum

Financial Viability achieved through


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- Trust - Attracts paying patients

Trust Focus on good care regardless of payingcapacity

Transparency in billing

70% of the paying patient know the services throughword of mouth

Comprehensive speciality eye Care



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Pricing for paying services

Market prices are driven by their costs areflection of low utilization (inefficiency) andthat helps too

Aravind charges are at least 25% to 30% less thanthe market charges



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Aravind Operational Model

Financial


Efficient

Service

Reaching the

People

S

y

S

T

E

M

S

&

P

R

O

C

E

S

S

PATIENT

CENTRED CARE

S

y

S

T

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&

P

R

O

C

E

S

S

Q li l


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Qualityalways current

Early adoption of relevanttechnologies

Skills & Perspectives upgradedthrough international visits andexchanges

Quality

Exchange of Residentswith the leading USinstitutions

Continuousimprovements based

on patient & employeefeedback

Giving value


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g

Using emergingtechnologies to

reduce the responsetime to patientcomplaints

Quality Assuranceprocess

Gathering evidence

Regular review &follow-up on

decisions

Use of Wi-Fi PDAs by Housekeeping staff

Teaching & Training


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Teaching & Training

OphthalmologistsTechnicians Administrators

Affiliations: MCI, NBE, RCO-UK, JACHPO-USA,MGR Medical & MKU Universities

Backward Integration


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Turning apparent disadvantages into

realized opportunities

Mission & Objectives Produce quality products

Provide at affordable cost

Support avoidable blindness effort

Self sustain and grow

In eighties all surgicaconsumables were

imported & expensive

Aurolab was started

1992 to produceintraocular lenses (IOL

Backward Integration


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Intraocular LensDivision

PharmaceuticalDivision

Suture Division Blades Division

InstrumentsDivision

Making Eye Care Affordable


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Making Eye Care Affordable

Exported to 120 countrie

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

Sharing makes you stronger


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Lions Aravind Institute of community Ophthalmology

To contribute to the prevention and control of global blindness throughTeaching, Training, Consultancy, Research, Publications & Advocacy

Aravind Medical Research Foundation


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d d d

Community based

Genetics

Microbiology

Epidemiologicalsurveys

Clinical trials

New Research Facility


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New esea ch Fac ty

Inaugrated on 1st

Oct 2008 byPast President APJ Abdul Kalam

Aravind Eye Care System


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Eye Bank

Hospitals

Aurolab

Out Reach

Research

Aravind Eye CareSystem

LAICO

IT

Training

Commitment of leadership


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p

Financial Discipline

Willingness to Learn & Change

Attitude for perfection

Passion to eliminate needless blindness

Recognitions


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Recognitions

WHO Collaborating Center National Resources Center for the Govt of India for

paramedical training

Resource & Training center for InternationalAgency for Prevention of Blindness

Champalimaud Award, Portugal - 2007

Bill Gates

Global Health Award - 2008


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Where change touches many lives only


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superficially

Courtesy:DrAllenFoster


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Pursuing Our MissionEliminating needless blindness

much has been done and

much remains to be done . . .

Intelligence & Capabilities are not


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enough. There must be the joy ofdoing something beautiful..

Dr.V

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