arvind eye hospital
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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
A WHO Collaborating Centre for the Prevention of Blindness
Named after Sri Aurobindo Ghosh, his teachings form the basis for Aravind’s work
A WHO Collaborating Centre for the Prevention of Blindness
The problem……Magnitude of Blindness
Worldwide 4.5 Crore people are blind
1.2 Crore are in India
300,000 of them are children
India has more blind people than any other country
A WHO Collaborating Centre for the Prevention of Blindness 4
Most of it is unnecessary …
Simple Cataract Surgery
Refraction & a pair of spectacles
Will restore vision to 75 Lakhs Will restore vision to 24 Lakhs
India: Population 110 Crores
1.2 Crore are blind & 20 Crore need eye care
– Glasses or otherwise –
India: Population 110 Crores
1.2 Crore are blind & 20 Crore need eye care
– Glasses or otherwise –
A WHO Collaborating Centre for the Prevention of Blindness
In a developing country with
competing demands on limited
resources, government alone cannot
meet health needs of all the poor.
Genesis
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 government’s efforts
…developed skills to perform 100 surgeries per day
A WHO Collaborating Centre for the Prevention of Blindness
Dr.Venkatasamy’s Vision
“To eliminate needless blindness by providing
appropriate, compassionate and high quality eye care to
all”
A WHO Collaborating Centre for the Prevention of Blindness
Genesis
Began here- as an 11 bedded clinic in 1976
Small team with a big mission
Money
His Guiding Philosophy
‘Spirituality allows the divine force to work through each of us for a greater good’ - Sri Aurobindo
A WHO Collaborating Centre for the Prevention of Blindness
Tamil Nadu
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 Eye Hospital - Kolkata, West
Bengal
Indira Gandhi Eye Hospital & Research Centre - Amethi,U.P
Sudharshan Nethralaya - Amreli, Gujarat Indira Gandhi Eye Hospital &
Research Centre – Lucknow,U.P
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Hospital Based Facilities
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Core Principles in delivering health care
Giving ValueGiving ValueFinancial
Sustainability
Financial
Sustainability
Efficient Service
Efficient Service
Reaching the People
Reaching the People
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PATIENTCENTRED CARE
PATIENTCENTRED CARE
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A WHO Collaborating Centre for the Prevention of Blindness
Demand Generation Principles:
Market driving (reaching the unreached)
Removing barriers Community
participation Impact:
Creating access Growing the
market
A WHO Collaborating Centre for the Prevention of Blindness
Outreach for Speciality Services
A WHO Collaborating Centre for the Prevention of Blindness
Outreach for Speciality Services
A WHO Collaborating Centre for the Prevention of Blindness
Outreach for Speciality Services
A WHO Collaborating Centre for the Prevention of Blindness
Outreach in 2008
No.of Screening Camps
1,442
Patients examined 412,683
Surgeries 98,326
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Only 7% of people with eye problems in village accessed care from eye camps
Utilization – Study at AECS
A WHO Collaborating Centre for the Prevention of Blindness
Innovation – exploring newer approaches to deepen the reach into the market
A WHO Collaborating Centre for the Prevention of Blindness
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)
A WHO Collaborating Centre for the Prevention of Blindness
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 Aravind
Eye Hospital
Primary Eye Care IT Enabled Centers – 30 in Tamilnadu
A WHO Collaborating Centre for the Prevention of Blindness
Impact Dramatic Reductions in cost Access to good eye care Increased coverageScalability: Currently 12 – will become 26 by year
end Replicated in
Baramati, Maharashtra (Intel) Tripura (Govt. of Tripura & India) – will be
scaling it up to 60 locations
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Aravind - Operational Model
Financial Sustainability
Financial Sustainability Giving ValueGiving Value
Efficient Service
Efficient Service
Reaching the People
Reaching the People
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PATIENTCENTRED CARE
PATIENTCENTRED CARE
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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 services
and trainer of ophthalmic personnel in the world
ProductivityProductivity
A WHO Collaborating Centre for the Prevention of Blindness 29
Management Systems
A WHO Collaborating Centre for the Prevention of Blindness 30
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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A WHO Collaborating Centre for the Prevention of Blindness
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
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Comparison of surgeon productivity
0 500 1000 1500 2000 2500
Bar 1
Bar 2
A WHO Collaborating Centre for the Prevention of Blindness
State-of-art technologies in surgery
Less energy required for doctor
Greater safety Ease of use
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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
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Aravind - Operational Model
Financial Sustainability
Financial Sustainability Giving ValueGiving Value
Efficient Service
Efficient Service
Reaching the People
Reaching the People
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PATIENTCENTRED CARE
PATIENTCENTRED CARE
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A WHO Collaborating Centre for the Prevention of Blindness
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
A WHO Collaborating Centre for the Prevention of Blindness
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
A WHO Collaborating Centre for the Prevention of Blindness
Financial Viability achieved throughPricing 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
A WHO Collaborating Centre for the Prevention of Blindness 40
Aravind - Operational Model
Financial Sustainability
Financial Sustainability Giving ValueGiving Value
Efficient Service
Efficient Service
Reaching the People
Reaching the People
S
y
S
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M
S
&
P
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PATIENTCENTRED CARE
PATIENTCENTRED CARE
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A WHO Collaborating Centre for the Prevention of Blindness
Quality – always current
Early adoption of relevant technologies
Skills & Perspectives upgraded through international visits and exchanges
QualityQuality
Exchange of Residents with the leading US institutions
Continuous improvements based on patient & employee feedback
A WHO Collaborating Centre for the Prevention of Blindness
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
A WHO Collaborating Centre for the Prevention of Blindness
Teaching & TrainingOphthalmologistsTechnicians Administrators
Affiliations: MCI, NBE, RCO-UK, JACHPO-USA,
MGR Medical & MKU Universities
A WHO Collaborating Centre for the Prevention of Blindness
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 surgical consumables were imported & expensive
•Aurolab was started in 1992 to produce intraocular lenses (IOLs)
Backward Integration
A WHO Collaborating Centre for the Prevention of Blindness
Intraocular Lens Division
Pharmaceutical Division
Suture Division Blades Division
InstrumentsDivision
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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
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Sharing makes you strongerLions Aravind Institute of community
Ophthalmology
To contribute to the prevention and control of global blindness through Teaching, Training, Consultancy, Research,
Publications & Advocacy
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Aravind Medical Research Foundation
Community based
Genetics
Microbiology
Epidemiological surveys
Clinical trials
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New Research Facility
•Inaugrated on 1st Oct 2008 by Past President APJ Abdul Kalam
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Aravind Eye Care System
Eye Bank
Hospitals
Aurolab
Out Reach
Research
“Aravind Eye Care System”
LAICO
IT
Training
A WHO Collaborating Centre for the Prevention of Blindness 51
Commitment of leadership
Financial Discipline
Willingness to Learn & Change
Attitude for perfection
Passion to eliminate needless
blindness
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Recognitions WHO Collaborating Center
National Resources Center for the Govt of India for
paramedical training
Resource & Training center for International Agency
for Prevention of Blindness
Champalimaud Award, Portugal - 2007
Bill Gates – Global Health Award - 2008
A WHO Collaborating Centre for the Prevention of Blindness
Where change touches many lives … only superficially
Cou
rtes
y: D
r A
llen
Fos
ter
A WHO Collaborating Centre for the Prevention of Blindness
Pursuing Our MissionEliminating needless blindness
much has been done and much remains to be done . . .
A WHO Collaborating Centre for the Prevention of Blindness
“Intelligence & Capabilities are not enough. There must be the joy of doing something beautiful..”
Dr.V
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