ordinary people delivering extraordinary results

8/6/2019 Ordinary People Delivering Extraordinary Results

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CASE STUDY: Ordinary people delivering extraordinary results!

Aravind Eye Hospital (AEH) is a three decade old eye care institution situated in a tiny place---known as

Madurai in Tamil Nadu, India. There are over 25 million blind in the world. Nearly one third of these are

unnecessarily blind, implying blindness which could be cured through medical intervention. AEHs

missionright from inception-- is very clear: put an end to this kind of unnecessary blindness caused by

factors which are within the control of medical professionals.

It tried to achieve this with a single minded focus on improving the productivity levels of its own

employees---the doctors and nurses. To this end, it had to come out with what is known as an assembly

line technique of surgery that increases this productivity by a factor of ten. Most operations at AEH---

over 70 per cent are carried out without charging anything from the patientthese are carried out for a

pittance. The revenues, therefore, are miniscule ---especially from the patients paying a fee (only 30 per

cent) for the services availed. Working in such an environment AEH is able to generate profits in excess

of 35 per cent, treating nearly 2.5 million patients till date! It does nearly 3 lakh cataract surgeries every

year, making it by far the largest ophthalmological institution in the world. The business model is

somewhat unique. It takes the cues from STD booth owners and Xerox machine operators. It makes

money by generating enormous volumesor simply carry out more operations per day and plough back

profits to generate more numbers.

The Impossible Dream!

At the age of 56, Dr. Govindappa Venkataswamy (or simply Dr.V) gave shape to his dream of endingcataract induced blindness in Indiawith help from his sister and brother in law, both from Harvard---by

setting up a thirty bed hospital in Madurai. The journey in the beginning was quite tough and

challengingin the form of chronic shortage of funds, lack of trained hands, absence of latest medical

equipment, lenses, instruments etc. Dr. V pushed himself to the extreme and made others also run that

extra mile while trying to covert the dream into a concrete reality. In order to make things happen, he

had to break the cake of custom, overturn established practices and rewrite the rule book. Common

men had to do uncommon things in order to put AEH on the road to success. Some of the initiatives

undertaken by AEH are well documented in the annals of corporate history.

The Aravind Way of Life

At Aravind, every one seems to carry out assigned tasks with utmost care, love, passion and

commitment. Nurses (mostly fresh from school with 10th

standard qualification) report for work on time.

There is no supervision. There is no one to let any one know what to do, when to do, how to do and

where to report and how long to stay. Everything proceeds with clockwork precision in a silent,

mechanical and almost boring manner---most activities done in the same way, repeatedly. Doctors also

seem to work putting their heart and soul into every operation---with absolutely no failures occurring at



any stage. Quality of service at dirt cheap rates characterizes Aravinds operations at every stage.

Certain things that present a mirror image of the Aravind way of life definitely merit our attention at

this stage:

Get the right people: To ensure quality patient care at affordable prices, AEH had to hire the

right talent. To this end, every attempt is made to get young girls from nearby villages.Intensive training helps these girls to understand the importance of patient care, apart from

learning the basics of patient care. The top management would usually spend hours trying to

observe and understand the new hires closely. They generally pick up people with common

sense rather than intelligence. Factors such as having a right mental attitude and willingness to

learn and work with passion and dedication are also looked at closely.

Teach the culture: Fit with AEHs culture and ability to get along with people and serve the

patients with warmth and friendliness are being stressed at all times. The nurses and doctors

must understand the culture of AEH and work to preserve the prevailing value system rather

than using the position as a spring board to jump out at the first available opportunity. In a

twelve hour routine---7am to 7pmthere will not be anything coming from top management in

the form of instructions and dictation. They have to carry out everything with clock work

precision and certainty. There is no room for supervision eithersince AEH aims to save everyrupee thats contributed by patients.

Do it silently: Three thousand people carry out operations on three hundred almost on a daily

basis with frustrating regularity--without any noise anywhere. All operations are being carried

out silently, smoothly and in quick succession. In an atmosphere of all pervasive calmness (no

rush, no chaos, no yelling, and no last minute hurdles) everything proceeds in a mechanical and

systematic manner.

McDonaldization of Procedures: Standardisation of systems, procedures, methods and practices

would separate the AEH model from other eye hospitals in the world ---like what you find in a

typical McDonalds restaurant turning out thousands of burgers per day in exactly the same

manner. The doctors are also pushed to the limits. They need to work full time and private

practice is disallowed. They are also trained to understand the philosophy, culture and valuesystem of AEH for fairly longer periods before being asked to take up the job. Trained

ophthalmologists perform over 2000 operations per year (as against an average of 250 to 400

performed by a trained ophthalmologist in other hospitals), report for work by 7 am and follow

a back breaking routine upto 1 pm daily; and spend rest of the time on outpatients or research.

Two patients are placed in the operation theatre on adjacent tables (against the traditional

practice of only one at a time, assisted by one nurse---due to the fear of infection) assisted by

two nursesone helping the doctor and the other bringing surgical instruments. The nurses put

everything in place, keep the microscope focused on the eye in each case and help the doctor

run through the operation quickly. The patient on the adjacent table is waiting to be operated

uponfollowing an identical process and after the operation; the third one waiting in the queue

on the adjoining table with the microscope focused on the eye is being pushed forward. In

about 6 hours, doctors perform over 30 operations without designated breaks of any kind!

Little wonder, students from Harvard, John Hopkins, Yale et all consider an internship at AEH as

one of the best opportunities in their lifetime to enhance their skills and competencies in the

field. Currently Aravind is doing nearly 3 lakh operations per year and the hospital talks about

one million operations by 2015 and then stretch the number to a billion!

Cost cutting to bare bone levels: The Intraocular Lens (IOL) used by patients used to cost nearly

$100 each when AEH began its journey. For Dr.V importing these and making them available to

patients at affordable prices presented the biggest challenge. Without any further thought, one

ordinary people delivering extraordinary results

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