i've come here to share with you an experiment of how to get rid of one form of human suffering
and the irony is that they don't need to be a simple well proven surgery can restore sight to millions and something even simpler a pair of glasses can make millions more see
if we add to that the many of us here now who are more productive because they have a pair of glasses then almost
one in five indians will require eye care a staggering two hundred million people today we're reaching not even ten percent of them
started this with no money he had to mortgage all his life savings to make a bank loan
and over time we have grown into a network of five hospitals predominately in the state of tamil nadu and
and then we added several what we call vision centers as a hub and spoke model and then more recently we started managing hospitals in other parts of the country and also setting up hospitals in other parts of the world
the last three decades we have done about three and a half million surgeries a vast majority of them for the poor people now each year we perform about three hundred thousand surgeries
typical day at aravind we would do about a thousand surgeries maybe see about six thousand patients
do a lot of training both for doctors and technicians who will become the future staff of
and then doing this day in and day out and doing it well requires a lot of inspiration and a lot of hard work and i think this was possible thanks to the building blocks put in place by
doctor v a value system an efficientdelivery process and fostering the culture of innovation
a soul which has got all the simplicity of confidence doctor whatever you
an implicit faith in you and then you respond to it here is an old lady who has got so much faith in me i must do my best for
so
a very ethical and very highly patient centric organization and systems that support it but on a practical level you also have to deliver services efficiently
and
the inspiration came from
he kept talking about mcdonalds and hamburgers and
he wanted to create a franchise a mechanism of delivery of eye care
with the efficiency of mcdonald 's
and of course the challenge was that it's a huge problem we are talking of millions of people very little resource to deal with it and then
lots of logistics and affordability issues and then so one had to constantly innovate and one of the early innovations which still continues is to create ownership in the community to the problem
and then engage with them as a partner and here is one such event here a community camp just organized by the
and then you have doctors who you find out what the problem is and then determine what further testing should be done and then those tests are done by technicians who check for glasses
or
and if they need a pair of glasses they are available right there at the camp site usually under a tree but they get glasses
in the frames of their choice and that's very important because i think glasses in addition to helping people see is also a fashion statement and they're willing to pay for it
so they get it in about twenty minutes and those who require surgery are counseled and then there are buses waiting which will transport them to the base hospital and if it was not for this
kind of logistics and support many people like this would probably never get services and certainly not when they most need it they receive surgery the following day
and then they will stay for a day or two and then they are put back on the buses to be taken back to where they came from and where their families will be waiting to take them back home
did a study a scientifically designed process and then to our dismay we found this was only reaching seven percent of those in need
and we're not adequately addressing more bigger problems so we had to do something different so we set up what
primary eye care centers vision centers these are truly paperless offices with completely electronic medical records and so on
the effect of this has been that within the first year we really had a forty percent penetration in the market that it served which is over fifty thousand people
was how do you give high tech or more advancedtreatment and care we designed a van with
sends out images of patients to the base hospital where it is diagnosed and then as the patient is waiting the report goes back to the patient
it gets printed out the patient gets it and then gets a consultation about what they should be doing i mean go see a doctor or come back after six months and then this happens as a way of bridging the technology competence
so the impact of all this has been essentially one of growing the market because it focused on the non customer and then by reaching the unreached we're able to significantly grow the market
the other aspect is how do you deal with this efficiently when you have very few ophthalmologists so what is in this video
a surgeon operating and then you see on the other side another patient is getting ready so as they finish
they just swing the microscope over the tables are placed so that their distance is just right
and then we need to do this because by doing this kind of process we're able to more than quadruple the productivity of the surgeon
almost all of the skill based routine tasks they do one thing at a time they do it extremely well with the result we have very high productivity very high quality at very very low cost
so putting all this together what really happened was the productivity of our staff
was significantly higher than anyone
this is a very busy table but what this really is conveying is that when it comes to quality we have put in very good quality assurance systems
so the final part of the puzzle is how do you make all this work financially especially when the people can't pay for it so what we did was we gave away a lot of it for free
and then those who pay i mean they paid local market rates nothing more and often much less and we were helped by the market inefficiency i think that has been a big
savior even now and of course one needs the mindset to be wanting to give away what you have
been over the years the expenditure has increased with volumes the revenues increase at a higher level giving us a healthymargin while you're treating a large number of people for free
i think in absolute terms last year we earned about twenty odd million dollars spent about thirteen million with over a forty percent
this really requires going beyond what we do or what we have done if you really want to achieve solving this problem of blindness and what we did was a couple of very counter intuitive things
the impact of this has been that these hospitals in the second year after our consultation are double their output and then achievefinancialrecovery as
the
this increase in cost of technology there was a time when we failed to negotiate the prices to be at affordable levels so we set up a manufacturing unit
and then over time we were able to bring down the cost significantly to about two percent of what it used to be
what we do does it have a broader relevance or is it just india or developing countries so to address this we studied
what it shows is that we do roughly about sixty percent of the volume of what the uk does near a half million surgeries as a whole country and we do about three hundred thousand
and then we train about fifty ophthalmologists against the seventy trained by them comparable quality both in training and in patient care so we're really comparing apples to apples we looked at cost
the solution to the cost could be in productivity maybe in efficiency in the clinical process or in how much they pay for the lenses or consumables or regulations their defensive practice
so i think decoding this can probably bring answers to most developed countries including the u s and maybe obama 's ratings can go up again
i think the process i described you know productivity quality patient centered care can give an answer
now how do you make people own the problem want to do something about it there are a bit harder issues and i'm sure people in this crowd can probably find the solutions to these so i want to end my talk
all that is in the world so
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