Aravind Eye Hospital treats two thirds of the volume of patients seen by the UK’s National Health … [+] Service (NHS), at one hundredth of cost. Photo: Arun Sankar.
AFP via Getty Images
By Kamalini Ramdas, Professor of Management Science and Operations and Deloitte Chair in Innovation and Entrepreneurship at London Business School
Southern India’s Aravind Eye Hospital in driven by a clear mission to ‘eliminate needless blindness’.
That clarity of purpose is laudable, but many organizations would baulk at the thought of articulating such an ambitious goal so publicly. After all, cataracts – a reversible condition that is the leading cause of blindness – is projected to afflict 39 Million individuals worldwide in 2030.
With statistics such as these, eliminating needless blindness would seem inconceivable to most.
And yet, despite the odds, Aravind Eye Hospital’s progress towards realizing its mission appears miraculous.
As the largest eye hospital in the world, it treats two thirds of the volume of patients seen by the UK’s National Health Service (NHS) at one hundredth of cost, while achieving outcomes comparable to those seen in some of the best hospitals globally. Approximately half of its patients are seen for free.
How has it realized such remarkable results and what lessons are there for business leaders hoping to achieve similar success in their own fields?
Do things differently
Taking a ‘business as usual’ approach rarely works when it comes to forging new ground. It stifles the ideation, relationship building and experimentation that allows organizations to innovate.
Aravind realized that to make significant progress towards eliminating needless blindness it would need to do things differently.
During cataract surgery, doctors only perform those tasks that require their level of experience and expertise. This means that, in a single operating theatre, just two doctors simultaneously treat multiple patients.
The idea that patients would undergo surgery together and share a physician would seem alien to many. But by taking an unconventional approach to tackling high patient demand, Aravind has been able to greatly increase the number of cataract surgeries it performs with no significant impact on health outcomes.
When the usual course of action isn’t producing the results you need, step back and do things differently. It is a simple sentiment, but one that often requires permission and buy in from stakeholders.
“You can always pay to hire a resume, but you can’t buy a relationship.” – Thulsiraj Ravilla, Director of Operations, Aravind Eye Care System.
Aravind is able to realize such large surgery volumes without compromising patient care in part because of the trust it cultivates – with both the communities it serves and those it employs.
The hospital relies heavily on a workforce of highly motivated, young women, largely recruited from remote villages, who live together in a “home away from home” hostel environment near the hospital. These women often come from conservative families that would not otherwise allow their daughters to live independently before marriage. By fostering a positive relationship with its young employees and their families, Aravind is able to tap into an invaluable talent pool that would ordinarily be unavailable. It also benefits from employee loyalty.
For some of these young women, that relationship endures even after their return to their home village. Aravind recruits the highest achieving employees to lead remote telehealth centres in rural areas. These women act as influencers in their own communities and, in turn, help to foster trust in both Aravind and telehealth treatment options.
As Aravind’s experience demonstrates, trust transforms transactions into relationships and breeds the conditions needed to allow organizations to “do things differently”. Successful experimentation requires organizations to get buy in from their stakeholders – both customers and employees. It is that permission to try new things and have the freedom to fail that allows better ways of working to emerge, but it is unlikely to be given without trust.
Learn from anywhere
There is no monopoly on good ideas. Leaders that leave ego at the door and open themselves to listening to, and taking ideas from, a wide range of sources will benefit from access to perspectives beyond their own siloed thinking.
This proved to be the case when Aravind agreed to trial a little known method for seeing patients known as “shared medical appointments”.
The approach had earlier been introduced by health systems in the US, including the Cleveland Clinic, Kaiser Permanente and the Cooper University Hospital in the deprived city of Camden, New Jersey. In shared appointments, patients receive one-to-one treatment from a clinician as part of a group of patients that share the same condition. This allows the doctor to save time and increase their productivity. Similarly, patients benefit from access to more information and the ability to learn from each other.
Despite the success of shared medical appointments at a few leading healthcare providers, efforts to get hospitals on three different continents to introduce scientific trials on it were unsuccessful.
Aravind Eye Hospital took a different approach. On hearing about the innovation, it decided to introduce a trial of shared medical appointments for glaucoma. Glaucoma is the second largest cause of blindness globally. Its progression can only be slowed through attendance at regular appointments, the use of eye drops and, on occasion, surgery.
A trial conducted at Aravind to test the effectiveness of shared medical appointments against traditional one-on-one appointments for regular glaucoma follow-up found that patients in the shared medical appointments asked more questions, showed more signs of engagement and were 40% less likely to not comply with taking their medication.
Similarly, Aravind shares its own ideas freely, understanding that who eliminates needless blindness is less important than actually realizing that mission. Now, the World Health Organization has taken note of Aravind’s experience in its role of informing the future healthcare.
Aravind’s story is remarkable, but it is not unique. Countless organizations have set out, and subsequently achieved, what was once thought to be inconceivable by drawing on those three key pillars: do things differently, build trust and source ideas from anywhere.
Stepping away from the “way things are done” always entails risk. Getting permission to take that chance relies on strong relationships, trust and humility to accept that the best ideas might come from the unlikeliest of places.
Professor Kamalini Ramdas is an expert in the innovation arena. Her current research examines new ways to create value through innovation, including: service innovation, operational innovation and business model innovation. She has also examined the amount of product variety and component-level variety that firms should offer, and how variety can be managed effectively through design. Professor Ramdas presented ‘Achieving the inconceivable’ at TEDxLondonBusinessSchool on 29 April 2022.