The Aravind Eye Care System


“Intelligence and capability are not enough. There must be the joy of doing something beautiful. Being of service means going beyond the sophistication of the best technology, to the humble demonstration of courtesy and compassion to each patient.” 1

– Padmashree Dr. Govindappa Venkataswamy

Background

Aravind Eye Care System (AECS) is a non-profit eye hospital chain in India. It was founded by PadmashreeDr. Govindappa Venkataswamy (fondly known as Dr. V) at Madurai, Tamil Naduin 1976, with the vision of eradicating needless blindness in India. 

Inspired by (and named after) the sage Sri Aurobindo, the mission of AECS is to provide compassionate and high-quality eye care that is universally affordable. Since its inception, AECS has treated over 40 million patients and performed more than 5 million eye surgeries and laser procedures.

About 40 million people across the world are blind. Nearly 80% of these cases are curable. Blindness afflicts around 1.5% of the population in the developing nations. Cataract is a major cause of this blindness. It accounts for about 75% of all cases in Asia. A cataract forms as the natural lens of the eye clouds over time, and has to be surgically replaced by an artificial one. 

Over the four decadesof its existence, AECS has created a major impact towards eradicating cataract-related blindness in India. Its network presently includes ten eyehospitals, a research institute, an intraocular lens factory, an eye bank, and a training institute .2AECS has also established an extensive outreach program, wherein doctors reach out to remote villages to conduct eye camps that are sponsored by various charitable institutions.

To progressively eradicate needless blindness in India, Dr. V studied the fast-food assembly line approach of McDonald’s and then intelligently adapted it to eye-care. This innovation allowed the institution to leverage the power of standardization, scale, product recognition, accessibility, and service efficiency.

The three pillars of the AECS businessmodelare:a) high volume, b) high quality and c) affordable cost. Its operationaland growthmodel has been widely applauded, and also studied in depth by numerous internationally reputed business schools. 3

The Institution

The Aravind Eye Care System (AECS) is a 4,000-bed hospital system that offers a comprehensive range of specialty eye care. Covering everything from cataract to corneal ulcers and eye cancer, AECS annually treats 3.5 million patients and performs over 400,000 surgical procedures. This makes it the world’s largest and most productive eye-care services group. 4

AECS doctors carry out nearly 2600 surgeries per surgeon per year, compared to an all-India average of about 400. The institution’s processes enable the surgeons to be at their productive best. A battalion of paramedical staff (young village women who are rigorously trained to carry out the routine tasks associated with eye surgery) at AECS allows the doctors to focus on the diagnosis and the surgical procedure itself. Extensive training and experience enable some of these surgical nurses to detect vision problems with their bare eyes, when a doctor may not spot these as quickly even through a microscope.

However, the uniqueness of the AECS model arises primarily from its deeply humane value system. If a person is blind, Aravind considers this to be a matter of its active concern – irrespective of the individual’s capacity to pay. As an institution, AECS thrives on generosity. In turn, it benefits from serving all those in need. 

The scale and productivity of AECS become even more remarkable on account of the fact that its services are ultra-subsidized (or even free) for the poor, without any compromise on the quality of treatment. AECS remains a self-financed institution that sustains itself by treating the well-off patients who are attracted by its reputation for excellence in eye care. 

At AECS, there are no eligibility criteria or “assessment of means” to decide if a patient should pay for the services. The choice of whether to pay lies exclusively with the person. A barefoot farmer may come in, and utilize paid services. On the other hand, Dr. APJ Abdul Kalam (before he became the President of India) received wonderful service when he once wandered into the free section of the hospital as he had forgotten to carry his money wallet. 5The AECS philosophy may best be described as, “Do the work well, and the money shall follow.”

AECS not only works towards the mechanical restoration of “sight”, but also seeks to actively affirm the dignity of its patients. The organization invests immense energy into bringing eye care within the reach of people who may otherwise be too poor to seek out its services. 

All the patients receive the same excellent surgical care, regardless of their ability to pay. The same doctors work across the free and paid service sections of the hospital. However, paying patients can choose private rooms, air-conditioning and other technology options, whereas non-paying patients recover in large dormitory-style wards. 6Patient outcomes hold their own in comparison with those of the best hospitals in the world. AECS never advertises. Instead, the institution relies upon its satisfied patients to carry the “Aravind” banner.

AECS integrates universal access to services with the notion of self-reliance.The institution synergizes between the quality, the cost and the demand for its services. It thus demonstrates that high-quality surgical outcomes may be fostered by high volume as well as affordability. AECS fuses innovation with empathy, business principles with active service, and outer transformation with inner change.

AECS is not just a financially sustainable organization, but a profitable one too. In a particularly good year, it made an operating surplus of US$ 13 million on revenues of US$ 27 million. Patient services, as well as institutional growth and expansion, are all covered by patient revenue.

Rather than build a fortress around the magic that it has developed, AECS amplifies its strength by sharing it with others. The institution gladly assists other hospitals around the world to enhance their productivity and efficiency by deploying its principles and practices. It has open-sourced its success for the benefit of all its stakeholders, and for humanity at large.

The Genesis of the Institution

Born in October 1918 as a farmer’s son in Vadamalapuram(a village eighty kilometers from Madurai), the Aravind Eye Care System’s founder Dr. Venkataswamy grew up walking barefoot to school. He tended the family buffalo, and wrote his lessons in the sand. The loss of a cousin sister due to childbirth complications seeded in the young boy the conviction of becoming a doctor, so as to prevent such untimely tragedies. 

After graduating with a B.A. in chemistry from Madurai’s American College, Dr. V received his medical degree from Stanley Medical College, Chennai in 1944. He joined the Indian Army Medical Corps thereafter. 7 Page 48-50

However, Dr. V had to retire from the armed forces in 1948 after developing chronic rheumatoid arthritis and psoriasis. This severely debilitating and painful disease persisted for a long time. He found it difficult to walk or even hold a pen in his badly crippled fingers. 

Dr. V never married either. This noble suffering perhaps prepared him for the visionary endeavour of eradicating curable blindness. 7 Page 61

Despite his condition, Dr. V earned a Diploma and a Master’s Degree in Ophthalmology. In 1956, he joined the faculty of the Madurai Medical College. Through painstaking determination and hard work, he taught himself how to cut and operate the eye with his twisted fingers. He learned how to hold a scalpel in his hand, and to perform cataract surgery. Eventually, he was able to carry out over a hundred eye surgeries within the space of a single day.

In the ensuing two decades, Dr. V introduced a number of innovative programs to deal with the problem of blindness in India. He developed the Outreach Eye Camp programs in 1960, and a Rehabilitation Centre for the blind in 1966. Dr. V was also instrumental in the creation of a training program for Ophthalmic Assistants in 1973. 

In his clinical work, Dr. V personally performed over 100,000 successful eye surgeries. In recognition of these achievements, the Government of India awarded him with the Padmashreein 1973. 7 Page 66

As a young man, Dr. V had become a disciple of the sage Sri Aurobindo. The latter’s teachings emphasized that human beings must transcend into a heightened state of consciousness, so as to become better instruments for the divine force to work through in life. 

Thus inspired, Dr. V audaciously ventured to create the Aravind Eye Hospital as a self-supporting, humanitarian institution. He was propelled less by a business strategy, and much more by an intense desire and an infinite vision to offer selfless service to those in need.

After retiring as the Head of the Department of Ophthalmology at Madurai’s Government Medical College, the 58-year-old Dr. V wished to continue his professional work of providing quality eye care on an even larger scale. He put his life savings on the line to establish the Govel Trust, under whose auspices a modest 11-bed eye clinic was founded in order to work towards the eradication of “needless” blindness in India. 7 Page 66

Dr. V recruited his extended family to join in this mission. His youngest sister Dr. G. Natchiar and her husband Dr. P Namperumalsamy were the first to come on board. Dr. Vijayalaksmi (the sister of Dr. Nam) and her husband Dr. M. Srinivasan soon followed. The team established three simple rules, which they seeded as the organization’s DNA from the outset: 7 Page 61

  • We shall not turn away any patient, irrespective of the person’s economic capacity. 
  • We shall never compromise upon quality.
  • We must remain financially self-reliant, so as to refrain from compromising our freedom. 

This meant that all of Aravind’s activities needed to embody compassion, excellence, and integrity. Indeed, Dr. V started the institution without raising any external funds or donations. Marketing was directed exclusively towards people who did not have the capacity to pay, and sixty percent of the services were to be given away for free. All the same, world-class quality was to be offered and maintained at all times. The organization that was founded on this seemingly absurd framework is paradoxically the world’s largest provider of eye care today.

Establishing the Enterprise

The initial source of funds for AECS was personal savings and the family silver. For instance, in order to build the first hospital, Dr. V mortgaged his house. His siblings pooled their life savings (Rs. 500 each), and even pawned their jewellery in order to pay for the construction.

Aravind was guided from the outset by the policy that the paying, as well as the free patients, would be treated side-by-side. The patients who could afford to pay were charged no more than the fees levied by the comparable hospitals in the city.

The enterprise began to generate a surplus from the very outset. The accrued funds facilitated the construction of a 30-bed hospital within one year. A 70-bed hospital meant exclusively for free patients was built in 1978. The existing paying hospital building at Madurai was opened in 1981, with 250 beds and 80,000 sq. ft. of space over five floors. 

In 1984, a new 350-bed hospital was opened in Madurai to cater exclusively to free patients. In stages, the number of beds increased to 1468 (1200 free and 268 paying) in the hospitals there. The equipment was always of the best quality, much of it being imported. However, the examination rooms, waiting halls, and other facilities were utilitarian.

In addition, a 100-bed hospital was set up at Theniin 1985. A hospital with 400 beds was opened at Tirunelveliin 1988. An 874-bed hospital was opened at Coimbatore in 1997. In 1998, the Rotary Aravind International Eye Bank was set up at Madurai. In 2003, a 750-bed hospital was started at Pondicherry – the home of the Aurobindo Ashram.

While AECS primarily targeted the lower and middle-class segments of society, it also provided treatment to the people from the upper class. The paying patients paid market prices, because Aravind was the quality leader in its field. The income so generated helped to subsidize the organization’s core mission.In fact, AECS positioned free service not as a charitable service but as one of the many options in a price menu that ranged from zero to market rates. 8

While Dr. V. was the chief architect and keeper of the AECS mission, each member of the core management team took on the primary responsibility for one aspect of organizational functioning. Dr. Natchiar oversaw the clinical and service side of operations, while Dr. Namperumalsamy guided the clinical specialties and advanced training for the doctors, along with research and innovation. 

Mr. G. Srinivasan looked after the maintenance and expansion of the physical plant. Dr. Vijayalakshmi and M. Srinivasan provided leadership with respect to cataract surgery and its advances. Mr. Thulasiraj led the outreach activities and also organized the training of other eye care providers who wished to learn from the experience of AECS.

As new hospitals were added, a second-generation leadership team from Madurai was transferred to the new location to facilitate their launch. Because of their significant experience with the operating procedures and principles at Madurai, the transition was relatively smooth.

While the initial focus of the Govel Trust was on building eye hospitals and reaching out to the poor, several supplementary activities were later added in order to accelerate the progress towards the eradication of needless blindness. For instance, Aurolab was established in 1992 for the production of intra-ocular lenses (IOLs). 9Further, Lions Aravind Institute for Community Ophthalmology (LAICO) was founded in 1996 in order to promote best practices, carry out structured training and research programs, and also conduct capacity building activities. 10 page 5

The establishment of these and other support organizations such as the Aravind Medical Research Foundation (AMRF) and the Dr. G Venkataswamy Eye Research Institute gradually helped Aravind Eye Hospital to evolve into the Aravind Eye Care System (AECS).

Scaling the Organization

AECS realized that the key requirement for rapidly scaling an organization is to standardize its key activities. The cataract surgery procedures, and even the screening activities at the eye camps, were all amenable to value-engineering techniques. The ancillary activities that supported the organization’s core operations also lent themselves well to standardization.

As a result, every activity at AECS was carefully designed and neatly orchestrated. Detailed procedures governed how an AECS eye camp was to be promoted, how patients were to be brought in, how its logistics were to be organized, how medical screening was to be done, and how patients were to be selected and prepared for the journey to the main hospital. The same applied to the surgical procedures as well as the preliminary and post-surgical processes.

In aspirit of learning-by-doing, AECSconstantly innovated its delivery model. For instance, when Dr. V’s applicationfor a bank loan to support free eye care for the poorwas rejected, he built the ground floor of his hospital as “fee-for-service”. However, the foundation of the building was laid deep enough for the vertical expansion of the facility with ease at a later date.

Similarly, less than one in five potential patients were found to actually avail of the “free surgery” offer during the initial eye camps. It was discovered that poor rural people faced many barriers in the making the choice to have a surgery. The institution then added services such as food, lodging, and transportation to address those constraints. As a result, the acceptance rates increased to around 90%. Through a similar process of trial and error, the yield at refractive camps (where eyeglasses are prescribed and fitted) surged from less than 10% in 2000 to over 80% in 2006.

Unsuccessful experiments were terminated after being given a fair chance. For instance, several surgical camps were initially conducted on-site in order to make it convenient for rural people to accept the surgery. However, the medical outcomes were found to be hard to manage because of the variable quality of the surgical environment. AECS abandoned the surgical camp model, and reverted to utilizing the camps only for the purpose of screening the patients.

In 2004, AECS began to establish permanent Vision Centers in villages in order to provide basic eye care services. Staffed by paramedical personnel and equipped with a high-speed communication link to the main hospital, the Vision Center conducts eye examinations and helps to identify refractive errors. If spectacles are needed, the prescription is sent to the base hospital for fulfillment. Complicated as well as surgery cases are referred to the main hospital. 7 Page 137

The Managed-Care Hospital Model

All the Aravind-owned hospitals are vertically integrated medical facilities. That is, AECS directly controls all of their operations – from the design of the hospital to its physical building, and from the training of the staff to the manufacturing of key supplies (intraocular lenses, sutures, blades, and instruments). All the Tamil Nadu hospitals continue to run on this model. 

In 2001, with a view to expand its reach, AECS began to experiment with an alternative business model in the form of “managed-care” hospitals. Three such medical facilities have been developed in other parts of India so far, in collaboration with different agencies.

The Indira Gandhi Eye Hospital and Research Center in Amethi, Uttar Pradesh was established by the Rajiv Gandhi Charitable Trust. The Priyamvada BirlaAravind Eye Hospital at Kolkata is funded and largely overseen by the MP Birla Group. Sudarshan Netralaya at Amreliin Gujarat was established in collaboration with the Nagardas Dhanji ShanghviTrust. 

These institutions are relatively independent of the main hospital system in Tamil Nadu. They are not led by an AECS-trained doctor, but are supported by a manager trained at LAICO. The staff members at these facilities also see themselves as separate from AECS. 

There is a significant difference in the degree of vertical integration between the core and the “managed-care” hospitals. AECS is involved in almost every operational aspect of the southern hospitals, while its scope of work at the managed-care hospitals is limited to surgery and overall management. It has little involvement in the building, financing or outreach activities. 

Cultural differences also come in the way of the AECS model being effectively transferred to the managed-care hospitals. For instance, the internally trained nurses perform a wide range of roles such as assisting in the operating theater, processing admissions, and maintaining the facilities. 

However, the efficiency and dedication of these “sisters” in the managed-care hospitals is not observed to match that at the core hospitals. A few of them were deputed from Madurai to develop the local nursing staff. However, such transfers have decreased over time. 11

The Work Flow

The hospital processes at AECS, across the paying as well as the free sections, are carefully designed and well established. They play a key role in enabling high operational efficiency. 10 Page 7-10

Patients start to gather at the entrance much earlier than the designated hour of opening. They enter the hospital through the designated Outpatient Department (OPD) entrance. Patients usually drop in without any prior appointment, and are often accompanied by one or two family members.

At 7 am sharp, the first patient is registered at the Reception Counter. She fills out the basic personal information in a card, and then waits in the queue in front of a Registration Counter. The computerized registration process takes about one minute per patient, and prints an OPD Patient Card as well as a tag that serves as the patient passport for subsequent visits. 

Patients then take their seat in the designated waiting area. Each unit has a nurse-in-charge responsible for managing the patient flow. After the preliminary checks carried out by the paramedical staff, the standard routine begins with the Refraction or the Vision Test. 

The patient then meets the Resident Doctor at the Examination Station, where the diagnosis and the recommendations are recorded. Special tests (dilation, A-test, blood tests) may be necessary for some patients, while additional procedures (blood pressure, ocular tension, urine sugar) are required for patients over 40 years of age. A senior Doctor examines the patient thereafter. 

Finally, the patient is counseled and discharged from the OPD – often for further consultation at one of the hospital’s Specialty Clinics. The entire process takes no more than two hours, depending upon the tests needed. At the end of the hospital visit, the diagnosis is entered into a computer system.

Spectacles are prescribed to many patients after the refraction tests. They might (but are not obliged to) go to one of the spectacle shops located in the hospital. These shops are run as separate profit centres. They sell spectacles at a price less than what they would cost in an external optical shop. The grinding and fitting of the glasses are also done in-house. The entire system is geared towards enabling patients to leave the hospital with the prescribed pair of glasses, within a span of four hours.

Patients requiring surgery are admitted immediately, subject to their readiness as well as the availability of rooms. The paying patients may choose specific doctors to carry out the surgery, as well as the type of surgery (e.g. phaco-surgery), the type of lenses (rigid or foldable etc.), and the type of rooms. Staff counselors assist the patients in making these choices. These requests and preferences are processed on the computer, and an admission or reservation slip is generated. 

The workflow in the surgical wards is equally smooth and efficient. The nursing staff comes in at 6.30 am. The names of patients to be operated on during the day in each theatre is put up by 6.45 am. The patients to be operated upon during the day are moved to a ward adjacent to the Operation Theatre (OT). After the local anesthesia injections, their eyes are washed and disinfected. By 7.15 am, two patients are lying on adjacent operating tables within the OT.

The OT has four operating tables that are laid out side-by-side. Two surgical teams, each consisting of one doctor and four nurses, operate simultaneously. Every team looks after two adjacent tables. Although operating theatres usually do not allow simultaneous operations to take place due to the risk of infection, no such difficulty has been reported at AECS.

The first patient is on table #1. He is ready for the operation, and the nurses are also fully prepared. The doctor commences the procedure, which takes up to 12 minutes to complete. When the first surgery is over, the doctor moves to table #2 where the second patient is ready. The microscope is already focused upon the eye to be operated upon. The instruments are ready too. 

Meanwhile, the first patient is bandaged by the nurses and moved out, and the third patient is moved in (on table # 1) and readied for the operation. As soon as the second patient’s surgery is completed, the doctor moves back to table # 1 to operate upon the third patient. The surgeon constantly shuffles between the two tables in this manner, with hardly any intervening break or loss of time.

AECS is very particular about the quality of the surgery. The management keeps a very close track of the intra-operative as well as postoperative complication rates. Each case of complication is traced to the operating team that performed the surgery, and the reasons are identified. Corrective action, including the training of whosoever was found deficient, is undertaken.

The Strategic Pillars

The extraordinary success of AECS lies in the innovative design and thoughtful integration of several elements that are woven tightly together into a virtuous cycle of synergistic performance. The development of the institution has been supported by five strategic choices:

a) Focus on cataract treatment, 

b) Hybrid business model, 

c) Operational efficiency, 

d) Vertical integration, and

e) Spirit of service. 

Some of these are based upon pure economic reasoning, while the others help to align the management processes with the core mission of the organization. However, each one of them is critical towards collective success. If even a single element of the strategy was to fail, the entire system may unravel. However, when all the elements click together symbiotically, the results are there for all to see, experience and emulate.

Focus on Cataract Treatment

Since its inception, the unstinting focus of the organization has been on the elimination of cataract blindness. In founding Aravind, Dr. V. could have gone in many directions. He chose cataract blindness. That rest of the AECS strategy was predicated upon this singular choice.

Even as AECS is a multi-faceted clinical and research institution with many ophthalmic specialties, it principally remains a large-scale cataract surgery “factory”. Since cataracts are the leading cause of blindness in India, about 65% of AECS surgeries are carried out for their removal. 

AECS conducts several studies every year that investigate the causes of blindness. These include nutrition, lifestyle, culture, and customs. However, these activities are not a significant part of its core programs. The institution remains focused upon the surgical treatment of cataract. 

Hybrid Business Model

The core mission of AECS is to address the eye care needs of the vast numbers of poor people who live mainly in the rural areas. To that end, the organization has improvised a “hybrid” model whereby paying and free patients are treated together. This has allowed AECS to reach a scale of operations that matched the enormous challenge of needless blindness in the country.

The development of a clientele of paying customers seeking specialized services was initially driven by the need to secure the necessary funds for the accomplishment of its core mission. However, it soon emerged that the pool of paying patients was a very important source of market feedback for the institution too. It helped AECS to maintain the discipline of performing at very high-quality standards, which had a positive rub-off on the treatment of poor patients.

To address the needs of this income-generating market segment, AECS began to offer a comprehensive variety of non-cataract specialty services such as retina, cornea, glaucoma, pediatric ophthalmology, neuro-ophthalmology, uvea, low vision, and orbit etc. As a result, the AECS doctors are challenged to master new skills for these specialist disciplines. Even though cataract provides doctors with the satisfaction of serving the poor and the needy, many surgeons may not consider it to be professionally challenging or adequately remunerative.

Eye Camps

Given India’s population demographics and disease incidence, AECS required a robust system to take care of the millions of rural poor who were cataract blind. During his days in government service, Dr. V had pioneered the large-scale use of eye screening camps to bring those selected for surgery into the base hospital. Accordingly, AECSadopted and refined the channel of “screening camps” as its preferred way of reaching out to the rural poor.

The institution conducts eye camps through mobile units that travel to rural locations 20 km to 200 km away from the main hospital. Medical teams work closely with community leaders and philanthropic groups much in advance, so as to set up these camps that screen hundreds of people in a single day. Local organizations help with the operational and the marketing activities related to the camp, while AECS provides the staff and the medical equipment.

Each eye camp team comprises of at least two doctors and seven paramedical staff. Eye exams are conducted, and spectacles, as well as medication, are provided on site too. Those selected for a surgical procedure are transported by bus to the base hospital, where the operation takes place on the next day. 

Operational Efficiency

Having put in place a strategy for gaining volume, the next challenge for AECS lay in building the capacity to address the massive volume of cataract surgery that was being targeted. The shortage of trained ophthalmologists in the country also was a limiting factor.

In order to sidestep these “production” bottlenecks,AECS designed an innovative low-cost but high-quality operating system for eye care. The institution also employed IT systems to monitor patient flow as well as the workload in the different units of the hospital. This ensured that no facility, staff or medical equipment was left idle. 

At AECS, the processes of preparing the patient for surgery, performing the surgery, and getting the patient through recovery are all configured on the lines of a modern and efficient “assembly” line. The factors underlying this level of efficiency are broadly as follows:

  • Steady flow of patients, which keeps the patient supply line busy;
  • Surgical flow, which ensures minimal waiting time between surgeries;
  • Well-trained surgical assistants and adequate staffing;
  • Detailed logistics planning that ensures zero downtime for want of supplies or equipment;
  • Micro-planning to match the surgical load to the staffing and supply requirements; and
  • The skill and stamina of the surgeons.

As a result, the cost of a cataract surgery at AECS is about $18 per person, inclusive of the intra-ocular lens. The cost of a comparable surgery in the United States is about $1,800. 

Over the years, AECS has continued to reinvest its operating surplus towards the acquisition of the latest technology and equipment – while innovating to keep costs down to the bare minimum.Studies of patient outcomes have shown that the quality of care at AECS is comparable to that at top hospitals across the world. 11 Page 23

Vertical Integration

A low-cost assembly line system can produce excellent output at an affordable cost, only if the incoming components are of high quality and low cost too. This logic has led AECS to the vertical integration of its key production inputs. The two important cost elements in eye care are: 11 Page 20-21

a) The wages of the trained medical personnel such as doctors and nurses, and 

b) The high technology components in the surgery that include the intra-ocular lens (IOL). 

Therefore, an essential facet of the AECS model is the optimal leverage of the surgeon’s time through the provision of highly trained ophthalmic nurses. Since a large pool of such talent was not readily available, Aravind chose to create its own supply. 

Every year, over a hundred girls are selected from the nearby villages to attend 2 years of rigourous training before their absorption into the system. These “sisters” form the backbone of clinical operations at AECS. Most of these young women have barely passed high school, and are unlikely to find any meaningful employment in their village. AECS steps in to hire them, and then provides for their training free of cost. During this period, the interns also receive free housing and a stipend.

During the structured training program, the emphasis is as much upon the development of skill in ophthalmic techniques as in learning to deliver care in a compassionate, patient-centric way. Combined with the supervised living accommodation at the nurses’ hostel, this is seen by many families as the ultimate mode of employment as well as income in a safe environment.

Most nurses serve at AECS for several years, during which time they develop valuable skills as well as self-confidence. This stint also provides them with an opportunity to earn some money for themselves, before they return to their families in order to get married and settle down.

During the eighties, the surgical technology had evolved considerably. However, AECS still lacked a viable source for the intra-ocular lenses (IOL) that are an essential component of cataract surgery. This led to a wide quality gap between the paying and the poor patients. The manufacturing of such lenses was considered extremely high-tech at that time. It required the latest in precision machining techniques and quality control. 

In the face of adversity, AECS once again chose to innovate boldly in order to fulfill its vision. In 1992, in the teeth of opposition from the developed world and against the advice of the World Health Organization (WHO), AECS acquired the IOL technology from the Western world with the help of supporters such as David Green of the SevaFoundation. 

This led to the establishment of Aurolab, a manufacturing facility that currently produces enough quality lenses to meet the internal needs. Aurolab presently manufactures 2 million lenses an year, within a highly affordable price range of $2 to $10. Italso exportsophthalmic supplies to 130 other countries.

Spirit of Service

The bedrock of the Aravind Eye Care System is the committed human engine that runs it. The institution’s doctors and support staff work together as a highly disciplined and inspired workforce. AECS currently has over 4,000 people engaged in its mission. This includes 35 of Dr. V’s family members. It is difficult to run such a huge system on the philosophy of its founder, especially when that calls for sharp attention to efficiency and dedication to service quality.

To address the challenge, AECS built institutional mechanisms to motivate its people. Its doctors are encouraged and supported in research activities that involve training in cutting-edge techniques. The nursing staff is also treated with care. Keen attention is paid to their development. Given its size and reputation, AECS attracts doctors from leading academic institutions around the world to visit and spend time in training its personnel. AECS is often the lead user for advanced technologies or treatments from leading equipment suppliers.

All of this supplements the satisfaction of providing people with the gift of being able to see again.

Concluding Reflections

AECS is a remarkable institution that holds valuable lessons for all kinds of individuals as well as organizations. Its primary innovation was the achievement of unprecedented efficiency through the application of assembly line techniques in healthcare. This helped in paring the operational costs down to the bare minimum. Its other key innovation was product differentiation. The institution never compromised upon its core service, even as it sought to create a superior service experience for the paying customers – much like the economy and business class services on an airplane.

Blindness has an external form, but also an internal one. The latter takes the form of anger, greed and jealousy. These handicaps clutter the vision and make it hard to decide the right way forward. 

Clarity in thought and action comes from the discipline of the mind and the heart. When human energy and attention is directed towards unconditional service, the boundaries of perception get shifted. Trust and goodwill are generated. The work is fired by a magnetic quality. The individual then becomes a more perfect instrument for delivering the highest that he or she is capable of.

When a person works at the boundaries of compassion with self-awareness, it helps one to tap into a higher wisdom that transforms the work. The AECS founder Dr. V demonstrated that when compassion is skillfully channelized, it yields scale, efficiency, productivity, transparency, equality, and inclusion.

Values are the unique strength of AECS, and perhaps the true reason for its efficiency. The institution needs to find ways of sustaining and strengthening its values and integrate the culture across all its units. Integrity is the hallmark of AECS and needs to be kept intact.

In a vast field of action that is characterized by unmet demand, there are no competitors but only co-passengers in the journey. AECS remains deeply committed to serving the largest number of free patients possible. The institution never restricts demand. Instead, it seeks to build up internal capacity to meet that demand. Community outreach demands a missionary spirit and leadership with empathy.

Even though he passed away on 7 July 2006, Dr. V continues to be the beacon of light at AECS. His vision and memory continue to inspire the next generation at the institution. Much more needs to be done in order to achieve his larger vision of eliminating needless blindness. 

To paraphrase Abraham Lincoln, an institution of the people, by the people and for the people shall never perish from this earth. The Aravind Eye Care System appears to be destined to serve humanity for all times to come, and set an example for others that is eminently worthy of emulation.

References

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