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Aravind eye care system in 2009 team 1


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Aravind eye care system in 2009 team 1

  1. 1. Presented By:Team 1
  2. 2. Source AEH- Madurai Source
  3. 3.  Aravind Eye Care Hospital is an ophthalmological hospital with several locations in India.  Currently located at  Madurai, Pondicherry, Coimbatore, Theni, Tirunelveli, Kolkata & Amethi  Founded by Dr G. Venkataswamy in 1976 at Madurai  Awards (in 2008 -2009)  Bill and Melinda Gates Award for Global Health  Acknowledged by Clinton Global Initiative in Sep 2008  Recognized by C.K.Prahalad in his book „The fortune at the bottom of pyramid‟
  4. 4. Source
  5. 5.  Mission “Elimination of needless blindness”  By the end of 2009 AECS had set up 31 Vision Centres and 5 Community Eye Clinics (Outreach Programme).  Aravind Managed Eye Care Services (AMECS)  Dr V had been succeeded by Dr P. Namperumalsamy (Dr Nam)in 2006  Its manufacturing arm Aurolab had moved to new facility at Madurai.
  6. 6.  Established by Dr V as a 11 bed hospital at Madurai in 1976.  Dr V served Army Medical Corps from 1944 to 1948  Trained himself to do microsurgery and technique of Intraocular Lens (IOL) insertion.  AECS Policy  To serve paying as well as free patients.  Close control of costs, high productivity of doctors and achieving high volumes  AECS vital components - Values and spirituality  Mr. R.D. Thulasiraj (Executive & IT Director at LAICO) “Our operational model is heavily dependent on work culture values.The systems are built in our basic values”.
  7. 7.  Focused on cataract surgery.  Established 2 bed system of operation to increase productivity of doctors.  Productivity rate of doctor 25 surgeries/day/doctor in contrast to general avg of 5-6 surgeries/day/doctor.  High quality surgical and medical equipments used.  Manufactured IOLs in house at Aurolab.  Cost of Imported IOL $80 and Aurolab‟s IOL $5.  60% of surgeries were done free or almost free.  AECS grew quickly –  In 1997 - 1,23,095 Surgeries and 9,75,868 Outpatients per year  In 2003 - 2,02,066 Surgeries and 14,50,000 Outpatients per year
  8. 8.  AECS created surplus income despite providing free treatment.  In 2002-03 it had surplus of Rs 219 Mn out of total income of Rs 423 Mn Exhibit 1 : AECS , no of beds in different Hospitals UNIT Free/Subsidiz ed Bed Paying Beds Total OT/Tables Madurai 900 325 1225 13/49 Tirunelveli 482 158 640 5/16 Theni 123 40 163 2/8 Coimbatore 580 176 756 11/20 Pondicherry 600 136 736 8/21 Total 2685 835 3500 39/114 Source: Data supplied by
  9. 9.  AESC did not consider the number of beds to be an important parameter as most of the cataract patients were discharged the same day.  Also, no. of mats had been converted to regular cost, and the average stay of the patient had reduced.  Hence the no. of surgeries done was a more meaningful indicator of its impact than the no. of beds
  10. 10. Paying 2003 758,991 Free including camp Surgery OP visits Surgery 78,487 688,548 123,579 2004 870,171 85,745 765,860 141,690 1,636,031 227,435 2005 928,785 93,134 793,113 154,101 1.721,898 247,235 Jan 2006 till 1,140,765 March 2007 104,108 1,037,57 2 147,989 2,178,336 252,097 April 2007 to March 2008 1,101,154 114,464 1,073,61 4 148,202 2,174,768 262,666 April 2008 to March 2009 1,182,137 131,295 1,273,81 1 138,282 2,455,948 269,577 Year OP visits Total OP visits 1,447,575 Surgery 202,066 Source: Data supplied by Aravind eye care system
  11. 11.  AECS conducted a number of outreach activities in accordance with its mission.  EYE CAMPS were the most important for they symbolized the organization‟s determination to reach out to the people in the villages.  COMPREHENSIVE EYE CAMPS was the most important type of eye camp, where, complete examination of eye was done, spectacles were prescribed and delivered on the spot in about 70% of the cases
  12. 12. Year Patients seen Surgeries of “camp” patients 2003 No. of camps organized 1158 388,594 81,357 2004 1271 433,502 95,249 2005 2006 2007 1335 1442 1448 437,224 412,683 377,377 98,326 92,346 87,667 2008 1302 320,563 69,580 2009 1319 314,780 71,869 Source: Data supplied by Aravind Eye Care System
  13. 13.  AECS also organized diabetic retinopathy (DR) camps, refractive error camps, eye screening camps for school children, pediatric camps, and mobile van DR screening camps.  AECS had also setup its training institute, Arvind Post-Graduate Institute of Ophthalmology (APGIM) which offered PG program, fellowship program for super specialization and Ophthalmic Assistant‟s training.  Its manufacturing arm, Aurolab, produced IOLs and medical consumables for eye care, like sutures and medications at low cost.
  14. 14.  AECS achieved economies of scale by providing medical consumables to other hospitals and ophthalmologists outside AECS since its inception.  This was also in consonance with its mission of elimination of needless blindness.  This helped many hospitals not only in India but also abroad to conduct surgeries at a much lower cost.  Some of the pioneering products from Aurolabs are: Auroflex-EV, negative aspheric IOLs for better contrast and visibility in low light conditions, green laser photo coagulators etc.
  15. 15.  Aravind Medical Research Foundation expanded its research activities dramatically with the commissioning of Dr. G. Venkataswamy Research Institute on 1st October, 2008.  It was engaged in cutting edge research in all the areas connected to eye diseases.  Some researches going here are: 1. Vision Rehabilitation 2. Glucoma Studies 3. Retina Services and Drug Trials 4. Orbit and Oculoplasty 5. Cornea Clinic
  16. 16.  AECS „ training arm, Lions Aravind Institute of Community Ophthalmology (LAICO) offered training programs to outside hospitals to improve their practices.  LAICO provided programs both in techniques of surgery and in management of doctors, hospital managers and paramedics.  LAICO provides training programs both at its facilities at Madhurai, at customer sites and also in a number of foreign countries.  It also undertook consultancy for improving the performance of hospitals, with need assessment, vision building workshops, follow-up visits and monitoring.
  17. 17.  Cataract accounted for 62.6% of blindness.  Increased awareness resulted in early surgeries.  Cataract Surgery Rate(CSR) ( average per million of population)  India : 5000  Tamil Nadu : 9000  Bihar : 600  Increase in % of Intraocular Lens(IOL)
  18. 18.  High degree of operational efficiency enabled AECS to provide free surgeries to as much as 60% of its patients. Source : Aarvind Eye Care System(2009),activity report,2008-2009 Category of surgery # Surgeries Percentage Cataract 204,672 66.23 Laser Procedures 57,958 18.76 Retina & Vitreous surgery 8,393 2.72 Trab & combined procedures 7,099 2.30 Lacrimal surgeries 5,218 1.69 Other orbit & Oculoplasty surgeries 6,336 2.05 Ocular injuries 1,164 0.38 Pterygium 3,565 1.15 LASIK refractive surgery 3,459 1.12 Other surgeries 9,458 0.55 Total surgeries 309,015 100
  19. 19.  General improvement in the living conditions.  Expectation of patients going up.  Multiple insurance schemes  Private  State sponsored
  20. 20.  Diabetic Retinotherapy (DR) – that included control of diabetes,refraction correction and prevention and treatment of glaucoma.  Unlike cataract,DR was preventable  Focus on prevention and early attention then cure, effective screening for diabetes and monitoring of the patients.  Glaucoma if left untreated also lead to blindness.  Refraction correction too had become an important area of concern.
  21. 21. Cataract Refractive errors Corneal blindness Glaucoma others Source : vision 2020 document Percentage 62.6 19.7 0.9 5.8 11.0
  22. 22.  Doctor‟s salaries were becoming highly competitive .  They were looking for opportunities to establish there name and in particular, looking for opportunities to do research , publish papers , to take part in conference and network among peers .  These would increase doctors competences and also the hospital‟s visibility .
  23. 23.  New hospitals with better looking building and better room and food facilities were coming up.  New hospital enticed the doctor‟s with better pay but none of them offered comparative scope for professional advancement.  Most of the doctor‟s in these private chains were ex-AECS personnel.
  24. 24.  Out of 45 million blind population in the world , 7 million were in india .  12 million bilaterally blind persons in india with VA less than 6/60  11,000 eye surgeons in India  1 for about 100,000 people  50% qualified eye surgeons are “non operating “ surgeons  Many of the operating surgeons could not perform IOL surgeries .  These factor impacted the overall effectiveness of anti-cataract campaign
  25. 25.  Paediatric blindness was also an area to be addressed . About 0.8 per 1000 children were estimated to have serious vision problem .
  26. 26.  Absolute number still increased but as a percentage it reduced.  Laser surgeries = 20% of AESCS‟s surgeries  Performed in smaller units too- like in Theni & Tirunelveli.  Other areas gained importance
  27. 27. Four types of eye camps: 1. Traditional comprehensive eye camps 2. Diabetic retinopathy(DR) screening camps (Mobile van screening camps) 3. Refraction Camps 4. School Eye Screening Camps Camps provided a benefit of increased reach and number of patients attended Still only 8% of the people requiring screens were being screened
  28. 28. 3. ESTABLISHMENT OF A NETWORK OF VISION CENTRES (VC) AND COMMUNITY EYE CLINICS(CEC)  VC: small unit staffed with an opthalmic technician and had telemedicine support from the base hospital and an admin support person with doctor available on video.  31 VCs (plan to increase to about 50) with each serving a population of about 50,000 operating from rented buildings. Patients were charged Rs.20  CECs: larger than VCs but smaller than hospitals with 1doctor visit per day and one of each- optician, field organizer, optical shop person, nurse. Had diagnostics facility, prescribe and delivery spectacles. 5 CECs with around 60-70 patients/day & served a population of about 3,00,000
  29. 29. 5. OTHER OUTREACH ACTIVITIES • School camps- 210,139 students (base) & 67,237 students (VCs) • Mobile screening vans. • Paediatric screening camps • Refraction camps 6. Arvind Managed Eye Care Services (AMECS) • Trained Doctors in other hospitals to improve their efficiency • AECS neither provided any facilities nor made any investment • Selected personnel were sent to supervise the activities • 5 yr agreement.
  30. 30. 7. UPGRADING OF FACILITIES • • • Private rooms- new block @ AEH, Madurai Floor mats for free patients AECS‟ Centre for Patient Empowerment intended to improve eye care awareness in patients and the community 8. Emphasis On Research • Focus on research on- DR, transplantation of cells etc. • Means of providing development opportunities to doctorsoptional 1 day/week off- international conferences etc.- a “retention” strategy. • Research- a source of funds: about Rs 15million (2008-09). • Brand new research facility -in 2008- Dr.G. Venkataswamy Eye Research Institute, Rs 290 mn. • 25 research scholars in 2009.
  31. 31. Year No. of Publications 2004 46 2005 49 2006 70 2007 65 2008 73 Total 303 Source: Data as supplied by AECS
  32. 32. 2004 4 2005 2 2006 8 2007 8 2008 12 Total 34 Source: Data as supplied by AECS
  33. 33.  “Our emphasis is to be at par with the best eye hospitals in the world without diluting our vision....We see our activities in four broad areaspaediatric eye care, cataract, retinopathy, glaucoma, and refraction” - Dr. Nam  They have plenty resources and therefore various options are available.  “We are a highly mission driven set of people. Resources are not the only consideration in deciding the direction of growth” - Dr. Kim
  34. 34. • There were a number of directions that AECS could take; the real problem was one of prioritization. The various directions ,as suggested by the key personnel at Aravind eye care, are as follows: a) According to Dr. Nam:  Diabetes is a challenge. To reach 46 million diabetics in India , innovative methods are needed. E.g. Paramedic  Cataract prevention, refraction correction, glaucoma, etc. Will become important.  Thus, Dr. Nam said, “We need to move in multiple directions.”
  35. 35. b) According to Mr. Thulasiraj:  “ We have a tremendous opportunity in the treatment of refractive errors.” “We can set up a network of Refraction Centers.”  He also saw big opportunity in training. He saw opportunities in LAICO.  There will also be a Projects Division to manage research projects. c) According to Dr. Aravind:  “Resources are not a problem. The challenge today is our aspiration, not our resources. How do we retain the same hunger and the same passion?”  Dr. Thulasiraj also shared similar concern- “ We have to address mindset issues. We are diffident about moving out of our comfort zone.”
  36. 36.  There were different views on whether and how to grow beyond Tamil Nadu. They are as follows: 1. Concerns about culture: a) Dr. Nam felt that expansion to other Indian states is an issue. He said “ Culture is an important issue for us.” Speaking about his concerns, he further said “We still have our doubts on the feasibility of transmission of values like compassionate care” b) Dr. Kim and Mr. Thulasiraj shared similar concern about culture transferability. Dr. Kim said “Business models should not obscure our hospital‟s growth model.”.
  37. 37. 2. AECS executives saw opportunities to expand globally in certain activities a) According to Dr. Nam: “DR (Diabetes Retinopathy) can be studied adopting a global approach.” b) Dr. Kim – “ We are moving into research , especially in specialities. We have to give new services that are currently not available but necessary for eye care to stay ahead of competition .” c) Mr. Thulasiraj said “ We have a global opportunity. There are 135 countries in the world with a population of less than 20 million each.” “We can thus give our knowledge and offer our services in many of these countries.”
  38. 38.  A major challenge was to develop a large cadre of doctors, nurses and paramedics, especially because they had to be imbibed with the right values. The various challenges are: 1. Training: a) Dr. Nam said “We need to train more ophthalmologists in DR surgical procedures. Knowledge management is important. We are doing this through our Virtual Academy.” b) Dr. Kim said that MLOP (Middle Level Ophthalmic Personnel) training is becoming an important activity.
  39. 39. 2. Developing next generation:  Dr. Aravind said, “the older generation is now in the sixties. And except for a few, the younger generation is in forties. There could be a situation when the younger generation would have to take over responsibilities before they are fully ready.”  AECS is preparing itself for the same. For example, LAICO is developing a cadre of managers for AECS.
  40. 40. • Change of metrics from no. of beds to no. of surgeries. • Standardization is helpful in achieving efficiency. • Prepared for problems and Ready for the risk management. • For the long run, the organization have to take necessary steps to succeed.