How it led to productivity improvement
Aravind Eye Care System operates as a network of eye care facilities where doctors are encouraged to spend approximately 60 percent of their time on clinical work, 20 percent on teaching and 20 percent on research. The system is focused on enabling doctors to be as productive as possible by limiting their responsibilities to initial diagnoses, verifying routine test results and performing surgeries using an ‘assembly-line’ approach, thereby ensuring that the most expert and expensive professionals are used to their maximum capacity. To manage the variety of other responsibilities such as administrative work, diagnostics, nursing and assisting, young women (aged 17 to 19 years), are recruited from local villages by word of mouth and trained extensively in a variety of skills.
AECS has also focused on optimizing the flow of patients throughout the clinic which has resulted in faster throughput times and a decreased number of patient visits. Notably, the clinic largely operates on a walk-in system which means that demand for care tends to fluctuate from day to day and hour to hour. To manage these demand peaks, the clinics constantly project expected patient numbers and adjust manpower accordingly. For example, the clinics maintain a real-time dashboard that shows how many patients in each clinic have exceeded the standard throughput time and extra staff are then transferred to that location from nearby clinics.
While the AECS focuses on ‘assembly line’ models, the quality of care is of the upmost concern and is monitored extensively and reported transparently. The clinics follow a ‘no secrets’ rule where complication rates are presented on a monthly basis by clinic as well as by individual surgeon allowing leadership to actively strive to improve the complication rates at every level. In addition, ophthalmologists are rotated between free and paying hospitals in order to ensure an equal level of quality between the different patient categories.
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Starting from just eleven beds, the clinic now treats more than 2.6 million outpatients and performs more than 300,000 ophthalmic high-volume surgeries per year. Not only is Aravind Eye Care System the largest provider of eye care services in the world, it has also achieved the highest national productivity rate while delivering world-class outcomes. Indeed, Aravind doctors perform on average 2,000 surgeries per doctor each year, versus an average annual rate of 400 surgeries by other Indian doctors.
AECS also rivals leading providers in the developed world. When compared to the UK, for example, Aravind Eye Care handles slightly less than two thirds of the volume of the NHS at just one percent of the cost, with complication rates of half of the British standards.
And while Aravind treats most of its patients for free or at a deeply subsidized rate, the organization is not only fully self-sustainable, but is also one of the few not-for-profit organizations that achieve a financial surplus through revenues alone (only six percent of its operating budget comes from grants).
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