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Aravind Eye Care System: Facing The Future

Why is Aravind Eye Care System so special? Quite simply no other organisation on earth combines their clarity of purpose with world beating operational excellence, productivity and profitability to achieve social impact at staggering scale.

44 years ago the Aravind Eye Care System was established in Madurai to alleviate the suffering brought about by needless blindness and today is one of the finest examples of a purpose-led organisation that exists anywhere in the world.

This February we returned to India with 17 top social entrepreneurs, business leaders and change agents, eager to find out more about the organisation and how it is facing the future.

Aravind Eye Care System today

Since the organisation was founded by Govindappa Venkataswamy, an iconic figure in India who was known as Dr. V, Aravind Eye Care System has treated 62m patients and performed 7m eye surgeries. Its innovative cross subsidy business model means affluent patients pay full market rate, cross subsidising the provision of eye care to the rural poor, which is delivered either free of charge or at greatly subsidised rates.

“We were all gob-smacked by what was being achieved. Patients are diagnosed by video link in field hospitals local to them. It reduces the stress involved and begs the question why don’t we, in the UK, operate in this patient-first way? It’s effortless for people to get the treatment they need - transport is provided for them, they are fed and taken home afterwards,” commented Sir Tim Smit KBE, Executive Co-Chair Eden Project International and Executive Vice Chair & Co-Founder Eden Project.

Aravind surgeons are five times more productive than the industry norm which means that in just one day Aravind can perform 13,000 patient examinations and 1,500 eye surgeries. Aravind’s exemplary productivity means that truly astonishing margins are achieved of around 39% EBITDA. In 2017-18 they performed 60% of the volume of surgeries performed by the NHS, at one hundredth of the cost, with less than half the rate of complications.

As Faisel Rahman, Managing Director and Founder of Fair Finance observed: “By the end of the first day I realised why it was called Aravind Eye Care System. I knew quite a bit about its purpose and was already inspired by what they do. The revelatory thing for me was that the system was able to deliver scale. It took the kernel of what they did really well and then scaled it to make it most cost effective. It’s a story not of healthcare - although that is the outcome. It is one of audacious process management.”

Aravind operates at a level of productivity, quality and profitability that serves as a model for the rest of the world. Aravind Eye Care System was awarded the Gates Award for Global Health, the Conrad D. Hilton award for humanitarianism, and has been taught by Harvard since 1993 as an exemplary case study.

Looking to the future

In such a well-established and successfully operating organisation how do you keep innovating and moving forwards without jeopardising the traditional roots of the organisation or damaging the business as usual? It’s a tough challenge.

Wavelength’s founder and chief connector, Adrian Simpson, explains:

“We’ve visited Aravind on many occasions and we never fail to be impressed by the sheer scale of the organisation, by the efficiency, and running true to purpose. This year we got more of a sense of an organisation looking to the future and continuing to innovate to remain relevant.”

Google and AI - diversifying through new partnerships

One example of this is the partnership with Google in using AI and Big Data, to automate identification of diabetic retinopathy from eye exams. Diabetic retinopathy is a major cause of blindness if left untreated and which is characterised by destruction of the small capillaries in the retina. The challenge for India is that there are an estimated 74 million diabetics and not enough screening resources to go around. The hope is that by using AI to help automate the process, more people’s sight can be saved (usually by laser treatment). Even more exciting is the prospect of detecting other medical conditions from eye exams. Earlier this year Google debuted an algorithm that can identify a person’s sex and smoking status and predict the five-year risk of a heart attack, all on the basis of retinal imagery. It’s hoped that in time researchers can extend this to be the early-warning system for dementia, multiple sclerosis, Parkinson’s, Alzheimer’s, and even schizophrenia. (source: Wired Magazine, To an AI, Every Eye Tells a Story)

AI relies on a sufficiency of data to learn, so Aravind is using their own millions of eye exams plus those from other eye organisations. The IP is shared with competitors. Their view? ‘We cannot get there on our own.’ Sometimes fulfilling purpose transcends competition.

Facial reconstruction to overcome needless blindness

Another area that they are now working in is facial reconstruction, where the eye socket has been affected and sight is at risk. Obviously, this is not an area that can currently be performed at scale and with the levels of productivity and efficiency developed in their core business. But it is a subtle shift towards other related areas of medicine with the same purpose as their own.

The stark reality in the past was that Aravind had to turn away people who had been involved in traffic accidents, whose sight had been impaired through trauma and that they could not treat. Aravind is now exploring these new partnerships so they can do the ‘business as usual’ and the ‘business as unusual.’

Leadership challenges

With any multi-generational, family owned and run company there will inevitably be challenges and tensions, especially around the way the company grows, innovates and diversifies.

For Aravind Eye Care System leadership team there is a strong sense of wanting to preserve the legacy of Dr V and the core business model, not to dilute it. The business model and purpose that serves a segment of the Indian population so well could, in theory, be expanded to benefit a far larger number of people in other regions. And now with the government providing insurance for the poorest citizens of India, Aravind has the money to invest. But which is the best way to move forwards?

As Helen Hyde, former Acting Partner Counsellor at JLP and now Executive Coach, Consultant and Founder of Helen Hyde Associates noted:

“If your purpose is constant your strategy can move on. As long as purpose and values stay the same. You don’t need to preserve it forever in aspic as the model organisation. It must be allowed to breath and live. If the ‘golden thread’ of purpose runs through it then the business can go on modernising and changing. And that is what is happening with Aravind, albeit in a controlled and thoughtful way, that’s respectful to the foundations of the organisation and whole leadership team. This is obviously of prime importance for them culturally.”

India is changing

One of the factors that enabled exponential growth for Aravind is the organisation’s unique policy of recruiting and training large cohorts of young women to work as technicians. As these women were new to the workforce, they were a blank canvas for learning about and living the purpose of the organisation. Forty years ago there were limited opportunities for young women from rural areas to be trained and earn a living. However, India is changing and there is now a world of competition from other companies, paying as well or better than Aravind, in the cities. How will Aravind continue to attract the workforce they need? It’s just one of the challenges to overcome as the business grows and changes.

As one participant on the trip observed:

“It feels like the old model is close to maturity. And they know that they have some big decisions to make. Do they grow further into other regions of India and other countries using the same model with the same purpose? Or do they move sideways, expanding the breadth of special projects and scale them? At the moment they are experimenting outside their own boundaries in a controlled and measured way that safeguards their core business and their future.”

The reasons behind this care and consideration for future direction lie in the roots of the company and the frugality of the past. Now a rich organisation, the older members of the leadership team still remember a time when money was scarce. They have not lost their respect for money so steer the Aravind ship ‘with frugality and humility as their KPIs.’

Final thoughts from one of our participants...

“I was standing at Madurai hospital watching between 50 and 70 patients - all with eye bandages - waiting to get the bus home. I’ve worked in big public service organisations so I know the routine here in the UK. You visit your GP, then a letter, then an appointment with a surgeon, then a wait, then a letter, then a procedure, if you’re lucky, within 10-16 weeks. So many points of failure in the system. At Aravind, patients are seen at the field hospital for screening by live link, and seen at the hospital within a few days. The whole process typically takes 36 hours from screening to treatment.

And there they were - sitting in orderly lines waiting to go home. This thing that they have created. It just works.”

Find out more about Dr Aravind and the Aravind Eye Care System.

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