1. Group Members: Ashok -14 Om Parkash -29 Manoj -22 Achal - 02 Sunny –54 Gaurav - 18

2.  1991, there were around 20 million blind eyes in INDIA with 2 million added every year.  Main Cause of blindness: Cataract (~75% cases)  Average per capita income: Rs 6800 with over 70% below Rs 2500  425 districts hospital : around 1 for every 2 million people.  Surgeries ◦ 30% by Govt. Dept. ◦ 40% by private sector fully paid ◦ 30% by volunteer groups and NGO’s The Blindness Problem

3.  Indian Name – Motiabind  2 Techniques used: ICCE & ECCE  ICCE: Most widely used, use simple instrument, take less then 20 minutes. Has longer recover period (3-5weeks), patient has to wear aphakic spectacles  ECCE: around 30 minutes, plastic intraocular lens required, no need of corrective spectacles, better then ICCE. Costs twice as much as ICCE Cataract

4.  Goal : Quality eye care at reasonable cost  Founder: Dr. Venkataswamy born in 1918 in small village near Madurai.  Bachelor’s degree in medicine in 1944.  Deeply influenced by Mahatma Gandhi  Suffered from severe Rheumatoid Arthritis for many years.  After retirement he founded Aravind Eye Hospital. Aravind Eye Hospital

5.  1976: 20 bed hospital opened. Performing all types of eye surgery  1981: 250 bed Main hospital, with specialty clinics  1984: 350 bed free hospital was opened, staffed by doctors and nurses from main hospital  1988 : Hospitals in Madurai(600 beds), Tirunelveli(400 beds) and Theni(100-beds)  1990: Opens Free hospital for walk in patients.  1992: 3.65 million patients screened and 335,000 cataract operations performed successfully. History

6. Tamil Nadu Pondicherry (2003) Coimbatore (1997) Theni (1984) Madurai (1978) Tirunelveli (1988) Aravind Eye Hospitals (4000 Beds)  Amethi (UP) - 2005  Kolkatta (WB) - 2001

7. First three surgeons were Dr Venkatswamy, Dr G Natchair(sister), Dr P Nampermualswany(Dr.Nam)(brother-in-law) In 1977, Heads of all clinics except one were family members of Dr V Was subsequently joined by other family members who helped in construction, financial management, hospital administration etc All senior staff member were highly qualified, experienced and were encouraged to participate in training and research Family members were committed and dedicated Aravind eye hospitals mission of providing eye care to the masses In 1992, total staff of 240 people including 30 doctors,120 nurses, 60 administrative and 30 housekeeping workers Employee were conditioned to work hard and put in 60 hour week to serve all patients

8. Demand Generation  Principles: ◦ Market driving (reaching the unreached) ◦ Removing barriers ◦ Community participation  Impact: ◦ Creating access ◦ Growing the market

9. Commitment of leadership  Financial Discipline  Willingness to Learn & Change  Attitude for perfection  Passion to eliminate needless blindness

10. PayingFreeTotal Out Patient visits 1,321,317 (55%) 1,074,783 (45%) 2,396,100 Surgery122,900 (43%) 162,845 (57%) 285,745 Cataract Surgery: 70% is free

11. 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 services and trainer of ophthalmic personnel in the world Productivity

12. Practices  Clinical Protocols  Standardization of procedures  Usage & Balancing of Resources  Surgical Techniques & Technology  Quality & reliability of resources  Medical records  Staff Training & Discipline

13. Comparison of surgeon productivity

14. State-of-art technologies in surgery  Less energy required for doctor  Greater safety  Ease of use

15. Quality – always current  Early adoption of relevant technologies  Skills & Perspectives upgraded through international visits and exchanges Quality  Exchange of Residents with the leading US institutions  Continuous improvements based on patient & employee feedback

16. Giving value  Using emerging technologies to reduce the response time to patient complaints  Quality Assurance process  Gathering evidence  Regular review & follow-up on decisions Use of Wi-Fi PDA’s by Housekeeping staff

17. 17 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 Expected Patient load ◦ Weekly report Weekly report ◦ Monthly report Monthly report

18. 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 Covering the entire spectrum

19. Financial Viability achieved through - Trust - Attracts paying patients  Trust – Focus on good care regardless of paying capacity  Transparency in billing  70% of the paying patient know the services through word of mouth  Comprehensive speciality eye Care

20. Financial Viability achieved through Pricing for paying services  Market prices are driven by their costs – a reflection of low utilization (inefficiency) – and that helps too  Aravind charges are at least 25% to 30% less than the market charges

21. Making Eye Care Affordable Exported to 120 countries 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

22. Mission & Objectives  Produce quality products  Provide at affordable cost  Support avoidable blindness effort  Self sustain and grow Turning apparent disadvantages into realized opportunities In eighties all surgical consumables were imported & expensive Aurolab was started in 1992 to produce intraocular lenses ( IOLs ) Backward Integration

23.  Aim had been to provide quality health care to the masses  Funds for main hospital used for construction and equipment for Free hospital  90% of annual budget was self generated, other 10% came from sources around the world  Surplus was reinvested in modernizing and updating equipment and facilities  Main hospital provided three different classes of rooms, mostly performed ECCE surgery and had dedicated specialty clinics. Almost all patients paid for service  Free hospital was run on no frill method. Rooms were shared by many people and beds were 6`x3` coir mats. Most surgeries were ICCE  Process of service delivery at both hospitals was almost identical  Same Staff was shared by both hospitals on a rotational basis to provide same quality in both hospitals  Dr V aimed to shift completely to ECCE and decided on vertical integration to reduce costs of IOLs  Auro Labs was setup in 1991 to produce IOLs, long term aim was to reduce cost of manufacturing to Rs 100 per lens

24.  Aim was to attract patients in rural areas to get regular eye check ups  Promoted by local sponsors( business enterprises, social service organizations)  Sponsors brought in funds, advertised through newspapers, marketplaces, information pamphlets one to three weeks in advance  Sponsors paid for publicity, transportation and food for selected patients ( ~ Rs 200 per patient)  Aravind provided medical expertise and bore cost of surgery and medicines  For increasing patient willingness for surgery, patients were provided food, transportation and moved in groups to provide a safer environment  Follow-up for patients was done by Aravind three months after surgery

25.  Special 10 member team for camp organization  Each member was assigned a district  Member toured extensively, but met once a week to discuss plans with Dr V  Members worked with sponsors and helped in organizing camps, logistics and guided new sponsors

26.  Smoothening Demand – Flow of patients was much higher on certain week days and unusually low on other  Keeping employee motivated to work extra hours on relatively lesser salaries. Can Aravind afford to loose talented employees to private sector or will training initiatives, research opportunities and satisfaction of serving humanity provide sufficient reason for people to stay ?  Achieving financial self-sufficiency in all centers. Can the model be sustainable in smaller cities or should operations be centralized ?  Switching completely to latest technology (ECCE). How can cost be reduced for ECCE ?  Attracting more patients from rural area to eye camps  Spreading the model world-wide. What could be the best method, Franchising Vs Expansion ?