Case : Aravind Eye Care System (AECS)

By: Shubha Brota Raha

AECS - Case Facts

Aravind Eye Care Systems (AECS) recognized as worlds most productive eye hospital, was founded in Madurai, by Dr. Govindappa Venkatawamy (Dr. V) in 1976 with the initial goal of providing quality eye care at reasonable cost.

India has more than 20million blind people and 75% blindness is caused due to cataract. Thus Dr. V coined the idea of mass marketing cataract surgeries, something like what Mc Donalds or Pizza Hut does.

This vision led to Aravind accounting for 5% of total ophthalmic surgeries in India with less than 1% of Indias ophthalmic manpower. The new mission statement was to eradicate needless blindness by providing appropriate, compassionate and quality eye care for all. Aravind started providing services to rich and poor alike.

AECS - Case Facts

There are 2 types of surgeries 1. ICCE Glasses are provided after removal and natural lens and 2. ECCE Intraocular lenses are inserted after removal of natural lenses. ECCE is better but intraocular lens needed to be imported and thus used to cost Rs. 800.

Aravind started manufacturing intraocular lenses and with 50% defect rate its cost worked out to be Rs. 200. With constant reduction in defect rate the cost is also going down.

Optimum use of its surgeons time, efficient surgeons, effective recruitment and training techniques for its nurses, maintaining of high quality standards, organizing rural camps to attract volumes of patients and in-house manufacturing of intraocular lenses have made quality care and productivity at affordable prices, the hall mark of AECS.

Q.1. What is the vision of AECS? What is the role of operations in meeting it?
Vision of AECS: Eradicate needless blindness by providing appropriate, compassionate and quality eye care for all Role of Operations:
Effective system to save time of its surgeons Leads to increased efficiency and productivity (10min per surgery while industry standard is 30min) to ensure service to maximum patients (word all in the vision). Low infection rates Leads to quality eye care service Division of labor and surgical process standardization (registration, preliminary inspection, final inspection and surgery) Leads to increased efficiency and provides maximum patients (all), quality eye care service

Manufacturing of intraocular lenses and other surgical items Reduced cost, increased affordability thus ensuring appropriate eye care service for all.
Designing effective recruitment and training process for nurses Ensures compassionate and quality eye care for patients.

Q.2 Can this system be replicated to other aspects of health care? What will be the problems and advantages?
Replication: AECS model can be replicated to all those aspects of healthcare where customization required is minimum and standardization of processes is possible and also the volume of operations is high e.g. child vaccinations, Caesarean births, etc. Advantage: The key advantage will be similar to AECS wherein economies of scale would not only make medical access to poor people more affordable but also make the healthcare organization profitable through adoption of Standard Operating Processes and through division of labour. Problems: 1. In case of most other aspects of healthcare, patients are treated on case to case basis and hence so much standardization, as in case of cataract surgeries, is not possible 2. Wherever else standardization is possible, volume of operation is not very high 3. Willingness of doctors to work so many hours at lesser compensation packages is another concern 4. Non-availability of low cost medical equipments/medicines/etc

Q.3. How do different elements at AECS work together to deliver the vision of Dr V?
Operations
Doctors perform surgeries at a very high efficiency rate and work for more hours than industry avg. While a surgeon is working on one table, the surgical team keeps the other table ready Low infection rates ensured by medical team Medical teams follow standards operating procedures

HR
Training rural girls without much educational background to become efficient nurses Training of doctors Recruit employees who have motivation towards social service

Marketing
Organizing camps to attract more and more patients to ensure high volume of operations

R&D
Constantly working to produce equipments in the AECS factory to bring cost further down.

Q.4. Problems at AECS? Are they inherent or can be rectified?

Availability and retention of skilled manpower AECS model requires highly trained and efficient doctors and nurses who are willing to work for more hrs. than industrial avg. at low compensation packages. Even the doctors who joins under these constraints due to some need, leave after sometime commanding higher compensation. Cost of maintaining volumes AECS model can succeed only when there is volume in operations. To fetch volumes, they not only organize camps in rural areas on a regular basis but also bear some amount of cost required to transport patient to nearest Aravind. All these activities have costs attached to them and AECS doesnt have very high revenues to meet these costs constantly. Operations related problems Constantly maintaining high quality service along with high efficiency and productivity is solely dependent on human skill at AECS. So there is a lot of scope in terms of automation and operations refinement.