Aravind Eye Hospital, Madurai
Friday, September 14, 2007
Spearheading the revolution of providing quality healthcare to the needy, Aravind Eye Hospital (AEH), Madurai, has won as many accolades from management gurus for its effective business model, as from its millions of patients. And why not? From a 11-bed Hospital in Madurai to the largest provider of eye care services in the world, Aravind has come a long way indeed.
Working with the mission of ’Eliminating Needless Blindness’, the main hospital (paying section) has eight speciality clinics, seven operating theatres (OTs) and 268 patient beds. Every day, an average of 100 surgeries are performed and 1,200 outpatients are treated. While the free hospital, situated adjacent to the main hospital, has four OTs with a capacity for 320 inpatients. Every day, on an average, it handles about 800 outpatients and 200 surgeries are performed. The camp Hospital, situated close to the main Hospital, with two OTs with a capacity for 600 inpatients handles an average, handles about 100 camp surgeries.
It has full-fledged super-speciality clinics including retina and vitreous, cornea, glaucoma, IOL, paediatric ophthalmology, neuro-ophthalmology, uvea and orbit and oculoplasty, manned by highly-qualified specialists. The Hospital is the headquarter for the Madurai Eye Bank Association, which receives corneas from various institutions in India and the US.
“The Hospital was self-supporting for all the recurring expenditures from the beginning, and after five years it had accumulated surplus for its own development and the establishment of the new hospitals at Theni, Tirunelveli, Coimbatore, and Pondicherry,” beams Dr Aravind Srinivasan, Administrator, Aravind Eye Care System. Around 70 per cent of its patients are provided free treatment.
The model of healthcare used at AEH is not only innovative, but absolutely the most effective model of healthcare. It operates under the notion of compassionate capitalism. With good management and a highly efficient fee system, the non-profit hospital is able to operate with a 40 per cent margin. This is despite the fact that 7 out of 10 patients pay nothing, or close to nothing, and the Hospital does not depend on donations. This economically self-sustaining model is based on generating enough revenue from 30 per cent of the patients to cover the costs of the providing free or low-cost eye care to the majority. Instead of relying on donations and funding, AEH developed the ability to manufacture all the materials it needed.
The Hospital reduces costs by using ophthalmic paramedical staff to do all the preparatory and post-operative work on each patient, allowing ophthalmologists to perform an increased number of surgeries. Each ophthalmic surgeon has two tables, which allows a surgeon to perform one 10 to 20 minute operation, and then swivel around to do the next. Post-op patients are wheeled out and new patients wheeled in. With its efficient strategies, AEH is known to reach the bottom of the pyramid.
The Hospital was also one of the early starters to integrate ICT in its healthcare services as early as in 1983. “Using Wi-fi, we created ’vision-centres’ to generate awareness about eye camps, and VSAT-mobile vans to go into the interiors of the villages about 8-10 times a month,” informs RD Thulasiraj, Director IT and Systems, AEH.
Its self-sustaining model is being copied in at least 30 countries around the world. “The staff is almost 10 times as efficient as the national average. And the engine of growth is not a hard-headed businessman, but a 86-year-old philanthropist called Dr Govindappa Venkataswamy,” beams Dr Srinivasan.
Not a Smooth Ride
One of the main hurdles was getting patients to the hospital. The often elderly patients required escorts, or could not afford transportation and the rural-urban divide was more evident than ever. AEH started an outreach programme using community organisations to identify and assist potential patients with the help of tele-opthalomology. Today, the patient acceptance rate is between 95 to 98 per cent.
Another realisation was that the Hospital alone could not do it and that it would have to facilitate training for other surgeons and other staff members, such as nurses, technicians, administrators, and managers. “So we started the training programmes. The direct impact was huge, and the indirect impact is compounding,” informs Dr Srinivasan.
AEH has indeed spread its wings faster and higher. In addition to hospitals, it has an ocular products manufacturing facility?Aurolab. Its tele-ophthalmology network has become a global online resource for AEH and for the entire field of ophthalmology. AEH partners with over a thousand community organisations and international NGOs such as the Lions Club International, Sight Savers International, Seva Foundation and Orbis International. The World Health Organisation has designated it as a ’Collaborating Centre for Prevention of Blindness’. “Our focus now is to expand throughout developing countries. The long-term plan is to grow in capacity to reach out to a larger population in need through a network of 100 managed eye hospitals and attain the mission of Eliminating Needless Blindness,” visions Dr Srinivasan.
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