ARvind Eye Hospital


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  • ARvind Eye Hospital

    1. 1. Aravind Eye Care System Management Concepts in Eye care Dr.R.D.Ravindran M.D., Joint Director Aravind Eye Care System, Madurai, India
    2. 2. Named after Sri Aurobindo Ghosh, his teachings form the basis for Aravind’s work
    3. 3. The problem……Magnitude of Blindness <ul><li>Worldwide 4.5 Crore people are blind </li></ul><ul><li>1.2 Crore are in India </li></ul><ul><li>300,000 of them are children </li></ul><ul><li>India has more blind people than any other country </li></ul>
    4. 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 –
    5. 5. <ul><li>In a developing country with competing demands on limited resources, government alone cannot meet health needs of all the poor. </li></ul>Genesis
    6. 6. Dr. G. Venkataswamy <ul><li>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 </li></ul>
    7. 7. … developed skills to perform 100 surgeries per day
    8. 8. Dr.Venkatasamy’s Vision “ To eliminate needless blindness by providing appropriate, compassionate and high quality eye care to all”
    9. 9. Genesis Began here- as an 11 bedded clinic in 1976 Small team with a big mission Money
    10. 10. His Guiding Philosophy <ul><li>‘ Spirituality allows the divine force to work through each of us for a greater good ’ - Sri Aurobindo </li></ul>
    11. 11. Pondicherry (2003) Tirunelveli (1988) Aravind Eye Hospitals (4000 Beds) <ul><li>Amethi (UP) - 2005 </li></ul><ul><li>Kolkatta (WB) - 2001 </li></ul>Tamil Nadu Coimbatore (1997) Theni (1984) Madurai (1978)
    12. 12. Managed Hospitals-Today – 4 in Northern Part of India <ul><li>Priyamvada Birla Aravind Eye Hospital - Kolkata, West Bengal </li></ul>Indira Gandhi Eye Hospital & Research Centre - Amethi,U.P Sudharshan Nethralaya - Amreli, Gujarat Indira Gandhi Eye Hospital & Research Centre – Lucknow,U.P
    13. 13. Hospital Based Facilities
    14. 14. Core Principles in delivering health care Giving Value Financial Sustainability Efficient Service Reaching the People S y S T E M S & P R O C E S S PATIENT CENTRED CARE S y S T E M S & P R O C E S S
    15. 15. Demand Generation <ul><li>Principles: </li></ul><ul><ul><li>Market driving (reaching the unreached) </li></ul></ul><ul><ul><li>Removing barriers </li></ul></ul><ul><ul><li>Community participation </li></ul></ul><ul><li>Impact: </li></ul><ul><ul><li>Creating access </li></ul></ul><ul><ul><li>Growing the market </li></ul></ul>
    16. 16. Outreach for Speciality Services
    17. 17. Outreach for Speciality Services
    18. 18. Outreach for Speciality Services
    19. 19. Outreach in 2008 No.of Screening Camps 1,442 Patients examined 412,683 Surgeries 98,326
    20. 20. Utilization – Study at AECS Only 7% of people with eye problems in village accessed care from eye camps
    21. 21. Innovation – exploring newer approaches to deepen the reach into the market
    22. 22. Vision Centre (Primary Eye Care) <ul><li>Covers a population of 50,000 </li></ul><ul><li>Staffed by Ophthalmic technicians </li></ul><ul><li>Active case finding at community level </li></ul><ul><li>Linked to Base Hospital </li></ul>
    23. 23. Low Cost Wi-Fi 802.11b Connectivity (open spectrum) <ul><li>Unidirectional antenna </li></ul><ul><li>Line of Sight </li></ul><ul><li>4 MBPS Up to 75 KM </li></ul>Collaboration with Univ. of Berkeley ( PhD students)
    24. 24. Primary Eye Care IT Enabled Centers – 30 in Tamilnadu 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
    25. 25. Impact <ul><li>Dramatic Reductions in cost </li></ul><ul><li>Access to good eye care </li></ul><ul><li>Increased coverage </li></ul><ul><li>Scalability: </li></ul><ul><li>Currently 12 – will become 26 by year end </li></ul><ul><li>Replicated in </li></ul><ul><ul><li>Baramati, Maharashtra (Intel) </li></ul></ul><ul><ul><li>Tripura (Govt. of Tripura & India) – will be scaling it up to 60 locations </li></ul></ul>
    26. 26. Aravind - Operational Model Financial Sustainability Giving Value Efficient Service Reaching the People S y S T E M S & P R O C E S S PATIENT CENTRED CARE S y S T E M S & P R O C E S S
    27. 27. Patient Statistics 2007 - 08 Cataract Surgery: 70% is free 285,745 162,845 (57%) 122,900 (43%) Surgery 2,396,100 1,074,783 (45%) 1,321,317 (55%) Out Patient visits Total Free Paying
    28. 28. Volume Handled Per Day <ul><li>6000 Outpatients in hospitals </li></ul><ul><li>4-5 outreach screening eye camps </li></ul><ul><ul><li>Examining 1500 people </li></ul></ul><ul><ul><li>Transporting 300 patients to the hospital for surgery </li></ul></ul><ul><li>850 – 1000 surgeries </li></ul><ul><li>Classes for 100 Residents/Fellows & 300 technicians and administrators </li></ul>Making Aravind the largest provider of eye care services and trainer of ophthalmic personnel in the world Productivity
    29. 29. Management Systems
    30. 30. Ensuring Efficiency & Quality <ul><li>Practices </li></ul><ul><li>Clinical Protocols </li></ul><ul><li>Standardization of procedures </li></ul><ul><li>Usage & Balancing of Resources </li></ul><ul><li>Surgical Techniques & Technology </li></ul><ul><li>Quality & reliability of resources </li></ul><ul><li>Medical records </li></ul><ul><li>Staff Training & Discipline </li></ul>
    31. 32. Resource Balancing <ul><li>Quantum & Quality of resources </li></ul><ul><li>Balance between resources </li></ul><ul><li>Appropriate use reduces cost </li></ul><ul><li>Maintaining the resource quality (skill) - at the required level </li></ul><ul><li>Eliminate non-productive activities & waiting time </li></ul>
    32. 33. Comparison of surgeon productivity
    33. 34. State-of-art technologies in surgery <ul><li>Less energy required for doctor </li></ul><ul><li>Greater safety </li></ul><ul><li>Ease of use </li></ul>
    34. 35. Planning for Expected load & Monitoring <ul><li>Yearly/Monthly Planning </li></ul><ul><li>Planning for the next day –scheduling patient, staff & equipment </li></ul><ul><li>Planning for supplies & spares </li></ul><ul><li>Ensuring that resources match expected workload </li></ul><ul><ul><li>Expected Patient load </li></ul></ul><ul><ul><li>Weekly report </li></ul></ul><ul><ul><li>Monthly report </li></ul></ul>
    35. 36. Aravind - Operational Model Financial Sustainability Giving Value Efficient Service Reaching the People S y S T E M S & P R O C E S S PATIENT CENTRED CARE S y S T E M S & P R O C E S S
    36. 37. Aravind Patient Fee Structure <ul><li>Consulting fee </li></ul><ul><ul><li>Poor Patients : Rs. 0 (free) </li></ul></ul><ul><ul><li>Paying patient : Rs. 50 / US $ 1(valid for 3 months) </li></ul></ul><ul><li>Cataract Surgery with IOL (70% of all surgeries) </li></ul><ul><ul><li>Poor patients : Rs. 0 (- Rs.250) </li></ul></ul><ul><ul><li>Subsidized rate : Rs. 750 (15$) </li></ul></ul><ul><ul><li>Regular rate : Rs. 3,500 – 6,000 </li></ul></ul><ul><ul><li>Phaco Surgery : Rs. 6,500 – 12,000 </li></ul></ul><ul><ul><li>Affordable fees - Aimed at Middle Income group </li></ul></ul>Covering the entire spectrum 53% 22% 25%
    37. 38. Financial Viability achieved through - Trust - Attracts paying patients <ul><li>Trust – Focus on good care regardless of paying capacity </li></ul><ul><li>Transparency in billing </li></ul><ul><li>70% of the paying patient know the services through word of mouth </li></ul><ul><li>Comprehensive speciality eye Care </li></ul>
    38. 39. Financial Viability achieved through <ul><li>Pricing for paying services </li></ul><ul><li>Market prices are driven by their costs – a reflection of low utilization (inefficiency) – and that helps too </li></ul><ul><li>Aravind charges are at least 25% to 30% less than the market charges </li></ul>
    39. 40. Aravind - Operational Model Financial Sustainability Giving Value Efficient Service Reaching the People S y S T E M S & P R O C E S S PATIENT CENTRED CARE S y S T E M S & P R O C E S S
    40. 41. Quality – always current <ul><li>Early adoption of relevant technologies </li></ul><ul><li>Skills & Perspectives upgraded through international visits and exchanges </li></ul>Quality <ul><li>Exchange of Residents with the leading US institutions </li></ul><ul><li>Continuous improvements based on patient & employee feedback </li></ul>
    41. 42. Giving value <ul><li>Using emerging technologies to reduce the response time to patient complaints </li></ul><ul><li>Quality Assurance process </li></ul><ul><ul><ul><li>Gathering evidence </li></ul></ul></ul><ul><ul><ul><li>Regular review & follow-up on decisions </li></ul></ul></ul>Use of Wi-Fi PDA’s by Housekeeping staff
    42. 43. Teaching & Training Ophthalmologists Technicians Administrators Affiliations: MCI, NBE, RCO-UK, JACHPO-USA, MGR Medical & MKU Universities
    43. 44. <ul><li>Mission & Objectives </li></ul><ul><li>Produce quality products </li></ul><ul><li>Provide at affordable cost </li></ul><ul><li>Support avoidable blindness effort </li></ul><ul><li>Self sustain and grow </li></ul>Turning apparent disadvantages into realized opportunities <ul><li>In eighties all surgical consumables were imported & expensive </li></ul><ul><li>Aurolab was started in 1992 to produce intraocular lenses ( IOLs ) </li></ul>Backward Integration
    44. 45. Intraocular Lens Division Pharmaceutical Division Suture Division Blades Division Instruments Division
    45. 46. Making Eye Care Affordable Exported to 120 countries Impact: Price of IOL came down from $ 80 to $ 4 making cataract surgery affordable <ul><li>ISO 9001/CE Mark/US FDA approval </li></ul><ul><li>7% of global market share in IOL </li></ul><ul><li>5 million people see the world through Aurolab implants </li></ul><ul><li>Patents </li></ul>
    46. 47. Sharing makes you stronger Lions Aravind Institute of community Ophthalmology To contribute to the prevention and control of global blindness through Teaching, Training, Consultancy, Research, Publications & Advocacy
    47. 48. Aravind Medical Research Foundation Community based Genetics Microbiology Epidemiological surveys Clinical trials
    48. 49. New Research Facility <ul><li>Inaugrated on 1 st Oct 2008 by Past President APJ Abdul Kalam </li></ul>
    49. 50. Aravind Eye Care System Eye Bank Hospitals Aurolab Out Reach Research “ Aravind Eye Care System” LAICO IT Training
    50. 51. Commitment of leadership <ul><li>Financial Discipline </li></ul><ul><li>Willingness to Learn & Change </li></ul><ul><li>Attitude for perfection </li></ul><ul><li>Passion to eliminate needless blindness </li></ul>
    51. 52. Recognitions <ul><li>WHO Collaborating Center </li></ul><ul><li>National Resources Center for the Govt of India for paramedical training </li></ul><ul><li>Resource & Training center for International Agency for Prevention of Blindness </li></ul><ul><li>Champalimaud Award, Portugal - 2007 </li></ul><ul><li>Bill Gates – Global Health Award - 2008 </li></ul>
    52. 54. Where change touches many lives … only superficially Courtesy: Dr Allen Foster
    53. 55. Pursuing Our Mission Eliminating needless blindness much has been done and much remains to be done . . .
    54. 56. “ Intelligence & Capabilities are not enough. There must be the joy of doing something beautiful..” Dr.V Thank You