Offer quality eye care at reasonable cost. Provide services to rich and poor alike. Financially self supporting. Eradication of eye diseases.

2. The Arvind Eye Hospital, Madurai, India
The blindness Problem
6%
WORLD WIDE (1992)
7%
Projected- 30 Million
20%
Africa
Asia
Latin america
67%
others
Developing Countries
Developed country
Macular Degeneration
Cataract (75%)
Diabetic Retinopathy
Glaucoma

3. The Arvind Eye Hospital, Madurai, India
• 180 million people suffer from blindness world wide
• 50 million people in the world are bilaterally blind
• 90% of the world blind live in Developing Countries
• 60% of which reside in Sub Saharan Africa, India and
China
• In Africa one in every 100 people are Blind
• In European nations it is 0.33% per 1000
Global View (WHO)
Catarct
40%
WHO estimates by 2020 the number would increase
by 75 million globally
60%
Focal
diseases
Reference- “Low vision assessment” -By Jane McNaughton, Jane McNaughton (MCOptom.)

4. The Arvind Eye Hospital, Madurai, India
Scenario of Blindness in India (1991)
Population
850 Million
Blindness
20 million blind eyes (2 million being added annually)
Main Cause
Cataract (75-80%) uniformly distributed
Ophthalmologist
8000 performing 1.2 million Cataract Operations/year
Eye Hospital
42,200
Medical R and
Infrastructure
Two-third skewed to the Urban areas where less than
one third of the nation’s population lived
Government Initiatives
District Hospitals
425 offering free eye care and cataract Surgery
Revenue Allocated
Rs. 60 Million ($2milliion) for blindness prevention
Challenges
1. Proper Infrastructure
2. State of Art Equipment
3. Training Personnel

5. The Arvind Eye Hospital, Madurai, India
VISION :
To Mass Market Cataract Surgery on a Global
perspective
Offer quality eye care at reasonable cost
Provide services to rich and poor alike
Dr. G. Venkataswamy
DREAM- “Eradication of Needless Blindness”
by creating a private, non profit eye
hospital that would provide quality eye care

6. The Arvind Eye Hospital, Madurai, India
CHALLENGES AND ISSUES
• Large % of people are poor and people do not have health Insurance
•
Government Infrastructure poor to provide adequate health Services
• Lack of Incentives to promote excellence and concern for the poor
• International and local non governmental organization depend on
donations for Operating Cost they find it difficult to finance and expand
services
• When the organization is tied into the charitable mentality for their fund
raising appeals, they often lack the skill and attitude to earn money
• Lack of business planning skill to raise money
DEVELOPING NATIONS

7. The Arvind Eye Hospital, Madurai, India
APPROACH
•Carry out a high quality process at low cost
•Followed the idea of reproducibility
•Achieving High productivity by a significant process innovation driven
by close analysis of value adding time
• Economically self sustaining Model- By generating enough Revenue
from the paying Patients to recover the cost of providing eye care free
of cost services to the Majority
Dr. V’s Approach and ‘Level 5 leadership’ concept
Reference: ©2005 Joe Tidd, John Bessant, Keith Pavitt
www.wileyeurope.com/college/tidd

8. The Arvind Eye Hospital, Madurai, India
Economies
of scale
Vertical
integration
Reference: Treating Cataract In India
(Case Study)
Crosssubsidies
Three Key Elements that defines the Arvind
Business Model

9. Cost Recovery
Model
The Arvind Eye Hospital, Madurai, India
Level 5 Leadership
Concept
Conceptual Foundation

10. The Arvind Eye Hospital, Madurai, India
Level 5 Leaders lead with Disciplined People, Discipline Thought and
Disciplined Action
•Identify Discipline people, but do no manage them because they do not
need to.
• Through these Discipline People or right people they manage the Whole
System
• These disciplined People bring in the necessary discipline for Executing
Organization strategy
• Finally desired or Expected results are achieved
Level 5 Leadership Concept

11. 1981 Main Hospital
• 250 Beds
1977
30 Bed Annex
Goal- To accommodate
patients after surgery
Specialty Clinics
• Cornea Glaucoma
• Squint Corrections
• Diabetic Retinopathy
• Pediatric Ophthalmology
70 Bed Free Hospital
Goal- Providing poor with
free eye care
1976
20 Bed Eye Hospital
Goal- Providing Quality eye
care at reasonable cost
1978
The Arvind Eye Hospital, Madurai, India
Standardizing and Engineering The
Cataract Surgery
• 80,000 sq. feet space
• 4 Major O.T.
Features
• State of Art Equipment
Journey from 1976-1981

12. The Arvind Eye Hospital, Madurai, India
HORIZON 3
Strategic Initiatives
HORIZON 2
HORIZON 1
“Short Jump
Initiatives”
(Fortify and
Extend Current
business)
“Medium Jump
Initiatives”
(Leveraging
existing
Resources)
“Long Jump
Initiatives”
(Sow the
seeds for
Growth and
Businesses for
the Future)
TIME
Reference: Crafting & Executing Strategy: Arthur A. Thompson
Three Strategy
Horizons Concept

13. The Arvind Eye Hospital, Madurai, India
HORIZON 1
Objective:
“Short Jump • Fortifying and extending the company’s
Initiative” objective
1984
Building up of 350 bed free Hospital
• 36,000 sq. feet space
• 2 major OT and Minor theatre for Septic care
• Medical Personnel from main Hospital
Strategy ASSEMBLY LINE PROCESS
Eye
Hospital,
Since 1976
Building of Hospitals in Tirunellvelli (1985) ,
Theni (1988) and other places of Tamil Nadu
Three Strategy Horizons

14. The Arvind Eye Hospital, Madurai, India
From……………………
…McDonald's…………
….................To………
…………..Mc. Surgery
"A blind person is a mouth with no hands,“
is an Indian saying that Dr. V liked to quote.

15. The Arvind Eye Hospital, Madurai, India
McDonalds, has managed to spread its golden-arched empire across
the planet based on
•Systematic
•high volume production of a range of meals offered at low cost
•Idea of reproducibility
•All McDonalds outlets operate on the same model
•Staff are trained in a core set of skills which are common to all its operations
Reference: ©2005 Joe Tidd, John Bessant, Keith Pavitt
www.wileyeurope.com/college/tidd

16. The Arvind Eye Hospital, Madurai, India
McDonald's success can be attributed to the following:
• Defining the basic premise of the service they offer
• Breaking up the labor into constituent parts, and then continually
reassemble and fine tune the many steps
• System works without a hitch, to the degree that such operations maintain
quality control, and cherish customer satisfaction, profits flow
“WHY Mc. Donald’s CONCEPT WAS SO FASCINATING ?”

17. The Arvind Eye Hospital, Madurai, India
The Morning is usually heavy an people are divided into two groups for evaluation
Senior Medical officer
Final Examination
Ophthalmic Assistants
Records Persons Vision
Eye Doctor
Preliminary Eye Examination
Records Preliminary
Diagnosis of the patients
Medical Record
Testing the patient for
Ocular Tension, Tear Duct
Function and Refraction Test
PHASE 1
Assembly Line Model: The Main Hospital and The Free Hospital

18. The Arvind Eye Hospital, Madurai, India
Final Examination
(Patients Could be Sub Divided as)
Patients for Cataract
Surgery
Patients referred to
specialty Clinics
Patients for
Corrective Actions
are suggested
Optometry Room
for measurement
and prescription of
Glasses
• 20 patients seated in the halfway
were prepared by the Medical Staff
• In the O.T. there were 2 active
operating table
• 3 rd Bed for preparing Patient
• Cataract Surgery took 15mins.
• The moment first operation
completes the Next starts
Assembly Line Model: The Main Hospital and The Free Hospital

19. The Arvind Eye Hospital, Madurai, India
Carrying Out high Quality Process at Low cost
Cataract unlike most surgical procedures is the same procedure performed
repetitively with Little Variation
Per unit surgery cost vary very little, allowing for very accurate cost projection
Same procedure performed repetitively hence facility set-up, Training
procedures can be standardized
Cataract is procedure oriented and curative. People are generally willing to pay
for cure but unlikely to pay for preventive services
Because of large number of people requiring Cataract surgery in Developing
Countries, it is one of the few health care procedures that has the potential to
pay for itself through user fees.
Cost Recovery is possible in Cataract Surgery

20. The Arvind Eye Hospital, Madurai, India
High Quality. +
Large Volume =
Low Cost
Programme
planning for
standardized
approach
Compassiona
te Capitalism
People
Capacity to Pay
Cost
Recovery
Principles
Accountability
Multi-Tiered
Pricing
Changing the
Mindset and
Practices of
Surgeons
Principles of Cost Recovery

21. The Arvind Eye Hospital, Madurai, India
Source: Data supplied by Aravind Eye Care System.

22. The Arvind Eye Hospital, Madurai, India
AEH draws its
patients to
eye camps
through
organized
local Business
units
Organizations
bear the
publicity
costs and
other costs
incurred
Organizations
also pay for
expenses
related to
transportation
and meals
AEH gets
supplies of
IOL lenses
and other
products at a
substantial
discount.
Several facilitating factors helped AEH
make its business model sustainable
Factors assisting Arvind Eye Hospital- Eye camp Model
Reference: Bottom of Pyramid by, C.K. Prahlad

23. The Arvind Eye Hospital, Madurai, India
10
Through a unique fee system & effective management, Aravind
provides free eye care to 2/3 of its patients.
9
For each $1 spent, $1.60 is earned
8
Million $
7
6
5
Free Camp 47%
Paying 35%
4
3
Subsidized 18%
2
1
0
79-80
81-82
83-84
85-86
87-88
89-90
91-92
93-94
95-96
97-98
99-00
01-02
Year
Revenue
Expense
Financial Viability

24. The Arvind Eye Hospital, Madurai, India
CHALLENGES AND ISSUES CONCERNED
• The outpatient facilities at the free hospital were not well organized
• There was a temporary shelter at the free hospital’s entrance
• Those who came for a return Visit were directed to different lines
• Less administrative assistants helping patients and guiding them sequential flow
• Operating theatre appeared to be more crowded and cramped
• Only 1 or the other operating tables was equipped with an operating Microscope
• Free hospital did not have “beds” in which to recuperate and recover
• Need of Organized Camp, Need to Create Propaganda, and Organizing of Logistics
• Requirement of consistent set of procedures and common set of Principles
FREE HOSPITAL and EYE CAMPS : MADURAI

25. The Arvind Eye Hospital, Madurai, India
INITIATIVES
The Government of India launched a cataract blindness control programme
with World Bank funding and offered a subsidy for the camp patients. In stages,
the number of beds increased to the present 1468 beds (1200 free and 268
paying) in the hospital at Madurai.
Multiple "camps" were conducted every week, to propagate more and more
about the services. Skilled and technically qualified personnel were brought in
solve out these issues.
The use of mats enabled better utilization of floor space —about 30 patients
could be accommodated in one room.
Establishment of complete Arvind Eye care system, helped in Eliminating the
Major Issues Concerned, to provide quality eye care, Keeping in view the
requirements of every patient, so as to instill a satisfaction within them as far
as the services were concerned.
INITIATIVES FREE HOSPITAL and EYE CAMPS : MADURAI

26. The Arvind Eye Hospital, Madurai, India
INITIATIVES
The Arvind Eye Hospital, had build up an excellent IT system that kept track of
all the patients. The system generated daily schedules taking into account the
load on that day, patients’ preferences for doctors, and the pending work. This
enabled the hospital administration to keep track of the workload in different
units.
The Aravind management kept a very close track of the intra-operative as well
as post-operative complication rates. The major complications were very much
under control and were considered highly satisfactory, according to the doctors
at Aravind.
INITIATIVES FREE HOSPITAL and EYE CAMPS : MADURAI

27. The Arvind Eye Hospital, Madurai, India
HORIZON 2:
“Medium
Jump”
• Leveraging existing resource and capabilities
by entering into new areas with promising
growth potential
Arvind Eye Hospitals gradually shifted to
become the Arvind Eye Care System.
Community Outreach Programs (1500/year)
Making Technology Affordable (AUROLAB)
A 874 bed hospital (1997) was opened at
Coimbatore & 750 bed hospital (2003) at
Pondicherry
Total of 3649 beds, consisting of 2850
free and 799 paying beds
Three Strategy Horizons

28. The Arvind Eye Hospital, Madurai, India
Brother Shri
G
.Shrinivasan
• Constructing all 5
Hospitals
• Serving as
Hospitals Finance
Manager
Nephew
R.D.
Thulasiraj
• Gave up the
management job
• Joined as Hospital
administrator
Major Footsteps
organized
local
Business
units
Family
Members
• SEVA
• CIDA
• Sight Savers
• Sister and Brother
in law gave up
there Govt. jobs to
fulfill Dr. V dreams
20 Bed to 600 Bed Hospital – What served as the Major
footsteps?

29. The Arvind Eye Hospital, Madurai, India
Word of Mouth
Communication
Past Experience
Personal Needs
GAP
Expected Service
Perceived Service
Translation of Perception
GAP
SERVICE
QUALITY
MODEL
GAP
Service Delivery
Management Perception of Consumer Expectation
GAP
External
Communication

30. The Arvind Eye Hospital, Madurai, India
ASSOCIATING DR. VENKATASWAMY CONSIDERATIONS TO SERVICE QUALITY
MODEL
Expected Service
• Doctors requirement for Long Hours of
concentrated Work
• Dedication and Devotion to the Practice
GAP
•Most believe they need work only for a few Hours and
that too two days a weak
•Requirement of well trained people not fulfilled
Perceived Service
Lot of chaos in free hospitals
Service Delivery
Operating theatre appeared to be more crowded and
Cramped
GAP
Less administrative assistants helping patients and
guiding them sequential flow
Translation of
Perception
Operating efficiently a good number of Patients

31. The Arvind Eye Hospital, Madurai, India

32. The Arvind Eye Hospital, Madurai, India
OTHER CHALLENGES OR ISSUES CONCERNED
• Less occupancy rate in the free hospital (7), (9)
• On Monday, Tuesday and Wednesday – Patients are Overflowing (2), (1)
• Repayment of Cost of Capital (7)
• Not Financially self Sufficient (6), (7), (8)
• Meeting up the salary scale as compared to Private Hospital (3),(6),(7)
• Getting people who are motivated towards the working philosophy of Arvind eye
Centers (10)
FREE HOSPITAL : THULASI and TIRUNELVELI

33. The Arvind Eye Hospital, Madurai, India
Reasons and Proposed Action: (Dr. V’s Insight)
“Despite all our efforts, so many people with problems with their vision have
still no access to hospitals. Much of the blindness can be corrected through
surgery. But they are afraid of operations. So we have to increase the
awareness of the causes of blindness and the need for early treatment. Even
in villages where we conduct eye camps, only seven percent of people having
eye problems turn up. We have to do more to create demand.”
Other Initiatives
•Increasing community involvement
•Community eye health education through various programmes:
Diabetic Retinopathy Management Project (2000)
Community Based Rehabilitation Project (1996)
Eye Screening of School Children
Use of IT Kiosks for Tele advice

34. The Arvind Eye Hospital, Madurai, India
Broad
differentiation
Market Target
Overall Low cost
Best- Cost Provider Strategy
Focused Low cost
Lower Cost
Reference: Crafting & Executing Strategy: Arthur A. Thompson
Focused
Differentiation
Differentiation
Cost Provider Strategy

35. The Arvind Eye Hospital, Madurai, India
Reliability:
• At the hospital the staff must inform patients when and where services will
be run…like eye camps
• At the hospital the staff should be more prompt in providing services
Safety:
• behavior of the staff should be such to reassure the patients
• At the hospital the team should have adequate knowledge to answer
patients questions…because it instills assurance within the patients that
…this hospital is good and our investment is worthwhile.

36. The Arvind Eye Hospital, Madurai, India
Reliability:
• The hospital must operate during the times when maximum percentage of
patients availability suits there time and the rest part should be shown to
other activities.

37. The Arvind Eye Hospital, Madurai, India
HORIZON 3
“Long Jump
Initiatives”
Objective:
• Initiatives to sow the seed for Growth in Businesses of
the future
• Balancing the Portfolio
• Establishing Lions Arvind Institute of Technology
• Arvind Medical Research Foundation
• Eye Bank- Rotatory Arvind International Eye Bank
Three Strategy Horizons

38. The Arvind Eye Hospital, Madurai, India
OVERVIEW
(LAICO) initiated a capacity building process with other eye hospitals elsewhere
based on Aravind’s experience in providing eye care service in partnership with the
network of eye care NGO’s working in India and abroad.
3 Major activities in Capacity Building Process
• Need assessment Visit
• Vision Building
• Follow up

39. The Arvind Eye Hospital, Madurai, India
THE GRAND
PORTFOLIO
“ARVIND EYE CARE”

40. The Arvind Eye Hospital, Madurai, India

41. The Arvind Eye Hospital, Madurai, India
Eye to Future : (As per Dr. Venkataswamy)
One of our key strategic future steps is to develop dual specialties among our
doctors. We would like to retain and get the best out of our doctors. One way
may be to provide more meaning to their work. We are trying to help
doctors to develop at least one other specialty. We can then also involve
them in the running of the Aravind Eye Care System. We also need to find
resources to fund our research projects. We need to build more linkages
with other eye care institutions all over the world.
Reference: Aravind Eye Care System: Giving Them The Most Precious Gift (R1)