1. Scaling up Quality (our Perspectives & Lessons)
Thulasiraj Ravilla
LAICO - Aravind Eye Care System

2. Quality is critical To scale up eye care services
In scaled up eye care services - to sustain it

3. Our Quality Paradigm Everyone in need gets care
Gets appropriate care without gender, social, economic or location bias
Timely care – reaching the patient before it is too late
Appropriate clinical protocol
Clinical outcomes
Eliminating complications
Enhancing Compliance
Eliminating waste
Standardization
Value for money
Enhancing utilization
Minimizing delays
Patient at the centre of service design & care giving process
Patient friendly systems & facility
Maintaining Patient Dignity
Do no harm
Right Patient, right site & right treatment
Safe facility
Communication

4. Scaling up Quality
DNA
Design
QA Process
M & E
Tech-nology

5. Designing for Quality
Understanding the “non-customer” and designing the eye care services
Outreach with transportation
Vision Centers
Pricing & Free care: freedom to choose
Closing the service loop
Patient as a partner in the care process
Empowerment & counseling
Stretching the institutional boundary – to ensure ultimate impact, the Quality of Life

6. Service Design: Customer in Focus & End to end solutions
Creating
Awareness
Knowledge about
the condition
e. g: Spectacles
Diagnostic
Services
Addressing
Access Issues
Prescription
for Glasses
Counselling
Empowering
the customer
Benefits,
Cost, etc
Treatment
Services
Addressing Access &
Affordability Issues
On the spot
dispensing
Follow-up
Services
Outcome Assessment,
QA, Product Design
In schools &
Industries

7. Quality Assurance Process
Building the “quality culture”
Focus on process & not person
Willingness to flag/record errors
Systems to ensure quality (Safety & Effectiveness)
Review, root cause analysis & solutions
Follow-through on actions
Benchmarking – internal & external
Continuous Improvement

8. Standardization Clinical protocols & Process
Clarity in role
Decision making easier
Easy to train staff
Better use of equipment
Quality improvements
Start with common activities
Cataract surgery
Refraction Services

9. Refraction Protocol – 13 steps
Check preliminary vision PG power and vision with PG
Patients complaints & vision needs
Use torch light for finding eye condition
Do pin hole test, Duochrome test, cross cylinder
If difference is 0.25 not to prescribe
Check diplopia, prescribe glass for BSV
Ask the patient profession
Advise at 33 cms for reading books
Confirm the patients age, working distance for NV add
Compare present testing power& patients PG power
Always do not over correct
Satisfy your patient, by asking questions and counseling
Check the final prescription
Bottom Line
Right Process, Performed well
Results in
Good Quality & Outcomes

10. Monitoring – process & outcomes
Probably the most critical aspect in quality assurance
What do we monitor: inputs, process, output & outcomes
How do we monitor: timeliness, accuracy, completeness
Monitoring to be integral to workflow
Use of IT to make the process painless

13. What we look for in Technology / Techniques
Will it minimize complications
Will it Improve visual outcomes
Will it enhance productivity
Will it minimize follow up
Will it reduce cost
Will it improve comfort & satisfaction

14. Using cutting edge technology
Increased
productivity
Less stress
Doctors
Competitive
Advantage
Reduced
complications
enhanced
margin
of safety
Use only reliable, thoroughly tested technology that serves your people and process - Toyota 14 14 14

15. Aravind’s complications are less than half of those in UK
Surgical Quality2
Adverse Events During Surgery
Aravind, Coimbatore
N=22,912
UK National Survey
N=18,472
Capsule rupture & vitreous loss
2.0%
4.4%
Incomplete cortical clean up
0.75%
1.00%
Iris Trauma
0.3%
0.7%
Persistent Iris Prolapse
0.01%
0.07%
Anterior Chamber Collapse
0.5%
Loss of nuclear fragment into vit.
0.2%
Choroidal Haemorrhage
------
Loss of IOLinto vitreous
0.16%
Aravind’s complications are less than half of those in UK
2 “Fortune at the Bottom of the Pyramid” by C. K. Prahalad

16. Surgical & Laser Procedures 4.3 Million as of March 2012

17. Work Culture & Discipline
Commitment of leadership
Attitude for perfection
Passion to eliminate needless blindness
Systems, Processes & Technology are critical to quality but they will fail in the absence of right “Work Culture & Discipline”

18. Thank You

19. Technology