When Dr. Govindappa Venkataswamy (Dr. V) retired from performing eye surgery at the Government Medical College in Madurai, India, he decided to devote his remaining years to eliminating needless blindness among India’s poor. In 1976, he started with an 11-bed hospital – six beds reserved for patients who could not pay, and five for those who could pay a modest rate. Today, the Aravind Eye Care System is a network of hospitals, clinics, community outreach efforts, factories, research and training institutes in south India that has treated more than 32 million patients and has performed 4 million surgeries. Dr. V’s system and success is surprisingly modeled after – McDonald’s.
Dr. V has an obsession with efficiency and brings it to everything he does, even attending the McDonald’s Hamburger University in Oak Brook, Ill., in order to observe their techniques. Aravind has since become not just a health success, but a financial success, and a model for compassionate capitalism. Many health nonprofits in developing countries rely on government help or donations, but Aravind’s core services are self-sustainable. Patient care and the construction of new hospitals are funded by fees from paying patients, even though at Aravind the majority of the patients pay only a symbolic amount, or nothing at all.
The hospital can only practice this compassion successfully because it is run like a McDonald’s, with assembly-line efficiency, strict quality norms, brand recognition, standardization, consistency, cost control and above all, volume. The efficiency and scale allows for paying patients to subsidize the free ones, while still paying far less than they would at other Indian hospitals. Doctors are expensive, so the surgical system is set up to get the most out of them. Patients are prepared before surgery and bandaged afterwards by Aravind trained nurses. The operating room has two tables. The doctor performs a surgery, perhaps five minutes, on Table 1, then sterilizes her hands again and turns to Table 2. Meanwhile, a new patient is prepped on Table 1. Aravind doctors do more than 2,000 surgeries a year; the average at other Indian hospitals is around 300. As for quality, Aravind’s rate of surgical complications is half that of eye hospitals in Britain. This volume is what’s key to the system’s success and sustainability.
The vast majority of people blind from cataracts in rural India have no idea why they are blind, nor that a surgery exists that can restore their sight in a few minutes. Blindness robs a poor person of his livelihood and often becomes a fatal disease. Aravind goes after these patients in two ways. First, it holds eye camps, or clinics – educating people about the problem & the treatment. Second, it has set up permanent “vision centers” in rural areas, offering eye exams, basic treatments, and fast, cheap glasses. Patients requiring surgery are invited with a family member to come to the nearest Aravind hospital, with all transport and lodging, and the surgery, offered for free.
– Mary Purcell