“Intelligence and capability are not enough. There must also be the joy of doing something beautiful. Being of service to God and humanity means going well beyond the sophistication of the best technology, to the humble demonstration of courtesy and compassion to each patient.”
Dr G. Venkataswamy
What do people do when they retire? Start growing vegetables? Take up golf? Join a painting class? For many people, retirement is the time to relax, take up new hobbies and spend quality time with family and friends. Not so, however, for Dr. G. Venkataswamy, who, by the age of 58, had worked for many years as the head of the Department of Ophthalmology at the Government Medical College in Madurai. For him, retirement signalled the beginning of a new challenge: how to treat the millions of people in India who suffered from cataracts, and – with an average income of $2 a day – could not afford the relatively straightforward surgery that would spare them from blindness (in the US, the average cataract operation costs $2500 - $3000).
McEye-care: How McDonalds inspired the world’s largest provider of cataract operations
That was back in 1976, and the Aravind eye clinics which Venkatskaswany (affectionately known as ‘Mr V’ amongst his colleagues) founded have since become the most efficient and productive eye care facilities in the world. Interestingly, Mr V drew his inspiration from two seemingly contradictory sources: on the one hand, he based the name ‘Aravind’ on Sri Aurobindo, a spiritual leader whose teachings endorse transcendence into a heightened state of consciousness so that people can serve as better instruments for the divine force to work through. On the other hand, the business model for Aravind was inspired by that used by McDonalds (which itself came from the design principles of Henry Ford, which can be traced right back to Adam Smith’s 18th century observations on pin-making and the division of labour), whose highly successful formula was founded on the concept of standardisation and reproducibility – training staff in core skills and using the same set of systems and techniques to ensure that the model could be applied in different locations, at a high volume of production and at low cost.
The first Aravind eye clinic, which opened in 1977 in Madurai, contained 30 beds for fee-paying patients. This generated a surplus that enabled the funding of a further 70 beds, catering exclusively to the poor and offering operations free of charge. By 2000, there were around 1500 beds in Madurai. The model then spread out to other locations across Tamil Nadu so that by 2003 there were five Aravind hospitals with a total of 3659 beds, of which 2850 were free.
The Aravind system is extremely efficient, with cataract operations taking 10 minutes compared with an average of 30 minutes in the Western world. This is achieved through relying on a team of trained nurses and paramedics to carry out lower-skilled tasks such as washing the eye, thereby allowing surgeons to operate on two patients alternately within the same operating theatre. Most doctors at Aravind therefore carry out an average of 2600 operations per year, compared with around 400 operations in other Indian hospitals. This means that Aravind currently conducts around 200000 eye operations every year, making it the largest provider of cataract operations in the world.
Aravind eyecare is an ever-expanding enterprise that is no longer limited to clinics: it also consists of a dedicated factory for producing lenses, a training centre to provide key skills, specialist ophthalmic research centres, and an international eye bank. Its manufacturing division – Aurolab – enables Aravind to produce such materials as ‘IOLs’ (intra-ocular lenses) for a fraction of the import price, thus making further cost savings. Aurolab is now one of the largest global producers of IOLs, exporting them to 120 countries and boasting a 7.8% share of the global market. By building up and drawing on a strong base of resources and expertise, Aravind has also become a world-class system of healthcare which is able to report lower infection rates than most Western hospitals (in 2004 it reported 4 per 10000 cases, compared with 6 per 100000 cases in the UK). The system is subject to continual feedback and improvement, relying on close monitoring and evaluation to optimise levels of quality and efficiency.
Social welfare: Inspiring staff to work for less
Like Narayana Hrudalaya, a hospital in India specialising in cardiac procedures which similarly relies on economies of scale to deliver a large volume of high quality, low cost operations, preventative interventions are a key feature of Aravind’s healthcare model. Aravind Eye Camps are set up in isolated rural communities to offer people advice and diagnosis, screening people for eye problems that can be treated through relatively low-cost measures if caught early enough (through, for example, the fitting of corrective glasses). These camps also channel patients to the core hospitals in cases where treatment and surgery are necessary. Education is also an aspect of their work: they run numerous outreach programs which teach people about how to care for their eyes. In the year ending March 2010, 2,148 camps were conducted, through which a staggering half a million patients were screened, and 76,081 patients underwent surgery.
Because of Aravind’s strong social mission, it inspires and draws on the support of a dedicated team of staff who are happy to work for less than they might be paid in other hospitals in the pursuit of a society in which high-quality healthcare is accessible to the most deprived and vulnerable. Mr V. believed that people must, first and foremost, be able to share in what he called ‘the joy of doing something beautiful’, and built a highly successful healthcare model around the core values of care, compassion and commitment.
To find out more, visit the Aravind website or read this case study.
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