How has the Coronavirus pandemic impacted the Aravind Eye Hospital in India, and what have they learned that can be applied to businesses during the pandemic? Kamalini Ramdas, Professor of Management Science and Operations; Deloitte Chair in Innovation and Entrepreneurship was joined in conversation with Thulasiraj Ravilla, Executive Director of the Aravind Eye Care System, the biggest eye care system in the world, treating about 4.5million patients per year, in Tamil Nadu, India to discuss how patient care and staff support can be maintained during the lockdown.
- The key priority during the lockdown has been to ensure that the spread of the virus is contained, especially at hospitals such as the Aravind Eye Centre;
- However, the challenges posed by the lockdown has led to opportunities for innovation and improvements to the patient experience;
- Assessing which processes can be optimised, either through task-shifting or having them take place outside of the hospital setting through telemedicine, has enabled Aravind to streamline operations and provide effective services remotely;
- There may be the need to relax certain elements of patient privacy to ensure effective measures are in place to stop the spread of coronavirus;
Despite challenging circumstances, there is an opportunity to innovate during a crisis
While Ravilla considers the first priority during the pandemic to be containing the spread across society, other priorities include business continuity, especially within a hospital setting. The vast majority of treatments are elective, but there are still significant numbers of emergency operations that are required, which poses a challenge. For Aravind, the prevention of cross-transmission of the virus between patients and staff is a key priority, one which is the same for any business in developing countries.
Continuity of human resources is a key element of ensuring the hospital can continue to open and perform services for patients. Even though there may be a reduction in the number of operations being performed, as a staff-centric business it has been important not to impact the salaries of the employees, as given their salaries are not very high, this will become a major issue for them. Many of the hospital staff live on-site, which has helped during the lockdown, as public transportation systems have stopped. Those staff that cannot access work will still receive their salary because it is the staff that have created the hospital, so Ravilla says it is important to support them. Furthermore, the hospital has tried to occupy its people as much as possible, whether it be professional development or other activity in the community.
The clarity of Aravind’s purpose, ‘eradicating needless blindness’ has helped them through the short-term decisions they have to make during the crisis. Ravilla comments that having a long-term vision has given the organisation clarity over the decisions to take during the pandemic, such as prioritising staff. Being an outcome focussed enterprise, every action the leadership takes is linked to the purpose of the organisation, which has helped during the pandemic.
“Nothing is initially called a ‘good idea’; an idea that works becomes a good idea.”
In many ways, the hospital has had to react in the same way as a business during the pandemic, looking for opportunities as well as having to understand the limitations they are being subjected to and not allowing outcomes to be impacted by any resource restraint during the pandemic. One of the main innovations of the eye centre has been shared medical appointments. This enabled the hospital to make better use of its resources, as well as enhance patient outcomes. Social distancing has had to change the process through which patients receive care, primarily because they did not have sufficient capacity in the waiting rooms to allow for space between patients. They did not simply turn away half their patients as that would compromise the purpose of the hospital, so they have had to review their capacity and process flow to improve the number of chairs in the waiting room, so people can distance appropriately. Furthermore, patient contact means more attention has to be paid to maintaining the sterile process for patients. This has meant that sterilisation techniques from the operating theatre had to be transferred to outpatients. These process innovations are ensuring the hospital can maintain the same volume of care, despite the restrictions in place during the crisis.
Aravind has also reviewed steps across the hospital to identify how task-shifting leads to those who are qualified to undertake specific tasks while everything else is shifted to someone with the appropriate level of training so that the hospital can provide efficient, good quality and low-cost care. They have also explored which processes need to take place at the facility and those that can be done remotely, especially through telemedicine, including shared appointments. Steps such as insurance payment, health education, registration, counselling can all be done just effectively outside the hospital. It also means Aravind can obtain patient history on a more systematic and consistent basis.
Families have to give up an element of privacy in order to counteract the spread of COVID-19
According to Ravilla, there are some lessons to be learned from how families in India used to inform other people that there was a case of smallpox within their household by leaving neem tree leads in front of the house. That would mean people would avoid entering the house if they were vulnerable. While this leads to a loss of privacy, it ultimately benefits society and therefore is a public good. While within healthcare there are different instances where privacy has to be respected, Ravilla also thinks a higher level of maturity is required, because if privacy comes at a social cost then it needs to be questioned.
Ravilla also thinks that people need to ensure they are looking at both internal and external sources of motivation. How can you find your people’s passion during a time like this and help propel them to excellence. There needs to be joy in applying your skills, development and knowledge in order to find something meaningful.
*Please note, this conversation was recorded on 23 April 2020.
Kamalini Ramdas’ conversation with Thulasiraj Ravilla is part of the Wheeler Institute’s COVID-19 series – bringing together the expertise and experience of our extended community to understand, illuminate and offer solutions to the challenges created by COVID-19. Our differentiating factor is the role of business in addressing these challenges, with a focus on the implications and actions for those in developing countries.
If you’re interested in following the Wheeler Institute COVID-19 series, check out all our episodes.
Kamalini Ramdas is Professor of Management Science and Operations; Deloitte Chair in Innovation and Entrepreneurship at London Business School.
Thulasiraj Ravilla is one of the founding members of Aravind Eye Care System, he became the Administrator of Aravind Eye Hospital in 1981. He is currently the Executive Director of Lions Aravind Institute of Community Ophthalmology (LAICO) as well as the Director – Operations for Aravind Eye Care System. He is the Founder President of VISION 2020: The Right to Sight-India and now, one of the honorary member in Management Board. He is also the Board Member of Seva Foundation, USA; Aravind Eye Foundation, USA; Acumen Fund, USA, Indian Institute of Management, Kolkatta; Indian Institute of Health Management and Research, Bangalore and member of several National and International Advisory Committees on Eye Care. He is the President for Aurolab Trust and Trustee & Treasurer for DHAN Foundation.