Key Note Presentation of Dr P Namperumalsamy, Chairman-Emeritus, Aravind Eye Hospital at the first ever World Co-creation Day 2011, organised by FORCE in association with Park Global School of Business Excellence at Coimbatore, India
Thyroid function tests for MBBS, LAB. MED & BDS.pptx
World co creation day-cbe
1. ARAVIND EYE CARE SYSTEM
Aravind Eye Hospital
& Postgraduate Institute of Ophthalmology
Madurai, India
Dr. P. Namperumalsamy, MS, FAMS
Chairman Emeritus
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World Co-Creation Day 2011
2. A R A V I N D E Y E C A R E S Y S T E M
Prof. C.K. Prahalad
• Graduated from Loyola, Chennai 1960 and
IIM – Ahmedabad 1966
• DBA from Harvard – 1975
• Award winning articles on Business
• Books : Bottom of the Pyramid : The Future
of Competition
• Member : Many distinguished societies
• Honours and Awards
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3. A R A V I N D E Y E C A R E S Y S T E M
• Named among Top Ten Management
Thinkers of the World in every major
survey for over 10 years
• Introduced the concept of Co-Creation
Prof. C.K. Prahalad
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4. A R A V I N D E Y E C A R E S Y S T E M
Experience Co-Creation (ECC)
Emerging Relationship between customers and Companies
• Customers : More Demanding
More informed
More knowledgeable
• Companies : Products and Services
Commoditization Erodes
customer loyalty
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5. A R A V I N D E Y E C A R E S Y S T E M
Four Principles of Co-Creation
1. Stakeholders won’t wholeheartedly participate in
customer co-creation unless it produces value for
them too
2. The best way to co-create value is to focus on the
experiences of all stakeholders
3. Stakeholders must be able to interact directly with
one another
4. Companies should provide platforms that allow
stakeholders to interact and share their
experiences
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6. A R A V I N D E Y E C A R E S Y S T E M
Prof & Mrs. Prahalad – Discussion with
the Team at Aravind
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7. A R A V I N D E Y E C A R E S Y S T E M
• Prof.C.K Prahalad
‘Aravind eye hospitals is a company doing 40% of all
cataract surgeries in the state of Tamil Nadu. This is the
largest in the world. They see 1.2 million out patients
and operate 150,000 cataracts a year. And it costs $10-
12 for a cataract in India while it costs $1600 for the
Medicare patients in USA’
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8. A R A V I N D E Y E C A R E S Y S T E M
Aravind Model
“Inspiring Innovations / Expanding
Horizons”
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9. A R A V I N D E Y E C A R E S Y S T E M
• Worldwide 45 million people are
blind
• 12 million of them in India
• One million of them are children
• More people are blind in India
than any other country
• Cost of Blindness in India: US $ 3
billion annually
• 200 million need eye care in India
• Less than 20% have been reached
Magnitude of Blindness
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10. A R A V I N D E Y E C A R E S Y S T E M
Distribution of Ophthalmologists in India
Population Ophthalmologists
Ophthalmologists/
Population
In 56 Cities 10.9% 57% 21,000
Villages 89.1% 43% 2,19,000
Eye Care
• 11-12000 oph. surgeons for 1 Billion
• Available hospital facilities : Public & Private
• Inadequate care
• Quality of care
• Non-availability of care
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11. A R A V I N D E Y E C A R E S Y S T E M
The Fortune at the Bottom of
the Pyramid
Reference : C.K Prahalad and Stuart Hart 2002
Tier 5
Tier 4
Tier 2-3
Tier 1
Purchasing Power
parity in U.S. dollars
Population in
Millions
> $ 20,000
$ 1,500 - $ 20.000
$ 1,500
< $ 1,500
75 - 100
1,500 - 1,750
4,000
• Consider the global market as a
pyramid of consumers based on
economic strength
• The new and emergenic
opportunity in countries such as
China, India and Brazil is in the
lower - income segment : Tiers
2,3 and 4
• Serving these markets will
dramatically influence the
management process in transition
Create a “Consumer market out of poor”
capture the “Poor Market” there is a big money
in the poor
– by C.K. Prahalad
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12. A R A V I N D E Y E C A R E S Y S T E M
Challenges to serve the Base of the
Pyramid (Based on analysis by Prof. C K Prahalad)
Market Conditions
• Large unserved population
• Resource scarcity (Capital
and Doctor)
• Dispersed population
• Low Affordability
• Poor Logistics
Innovation Needs
• Scalable model required
• Optimize Resource
utilizations
• Remote diagnostics and
delivery
• Dramatic reductions in
Costs
• Different models to increase
access
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13. A R A V I N D E Y E C A R E S Y S T E M
If we STOP thinking of the poor as
victims or as a burden and START
recognizing them as resilent and creative
entrepreneurs and value conscious
customers, a whole new world of
opportunity open up.
- Prof. C.K. Prahalad
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14. A R A V I N D E Y E C A R E S Y S T E M
Effective Health Care System
• Reflects community’s needs
• Understands community’s constraints
• Provides easy access in terms of logistics,
timings etc
• Services are affordable and the charges reflect
the paying capacity
• Keeps abreast of relevant technological
advances
• Actively seeks the patients and educates the
community
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15. A R A V I N D E Y E C A R E S Y S T E M
Dr.V, feeling the urgent need, started an eye clinic
with 11 beds, to create an alternate, sustainable eye
care system to supplement the government’s efforts
In a developing country with competing
demands on limited resources, government
alone cannot meet health needs of all the poor.
Genesis
There is an urgent need to establish an alternate health care model
that could strengthen and supplement the efforts of the Govt and
also be self-supporting.
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16. A R A V I N D E Y E C A R E S Y S T E M
Aravind in Retrospect....
Began here - as an 11 bedded
clinic in 1976
Small team with a big mission
Money
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17. A R A V I N D E Y E C A R E S Y S T E M
Tamil
Nadu
Coimbatore (1997)
Amethi (UP)
- 2005
Kolkata (WB)
- 2001
Amreli (Gujarat)
- 2007
Lucknow
- 2008
Aravind Eye Care Network
Theni (1984)
Pondicherry (2003)
Tirunelveli (1988)
Madurai (1978)
Managed Eye Hospitals
Total – 47centres
Tertiary
Eye Care
Units
5
Community
Eye
Centres
14
Vision
Centres
36
Managed
Eye Hospitals
2
City
Center
1
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18. A R A V I N D E Y E C A R E S Y S T E M
Total Surgeries & Lasers till March
2010 : 3,701,580
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19. A R A V I N D E Y E C A R E S Y S T E M
Clinical Services Year 2009-10
Total Paying Free
Outpatients 2,539,615 1,341,582 387,582
Surgeries 302,180 141,030 161,150
“Aravind Hospitals perform 150,000 cataract operations in a year -
more than the whole NHS -UK” - Mark Tully (BBC) 2002
“Aravind Hospitals perform 150,000 cataract operations in a year -
more than the whole NHS -UK” - Mark Tully (BBC) 2002
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20. A R A V I N D E Y E C A R E S Y S T E M
Volume Handled Per Day
• 6000 Outpatients in hospitals
• 850 surgeries
• 4-5 outreach screening eye camps
• Examining 1500 people
• Transporting 300 patients to the hospital for surgery
• Classes for 100 Residents/Fellows & 300 technicians and
administrators
Making Aravind the largest provider of eye care services
and trainer of ophthalmic personnel in the world
ProductivityProductivity
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21. A R A V I N D E Y E C A R E S Y S T E M
Aravind Management Retreats
• Strong influence of Management principles
• Effective planning
• Envisioning the future
for reorganizing ourselves to become more effective and
responsive to the opportunities
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22. A R A V I N D E Y E C A R E S Y S T E M
Aravind Model.........
• Aravind work viewed from 4 dimensions
• Service model : Large volume, high quality
affordable eye care, self supporting
• Business model - systems and procedures that
make Aravind work
• Spiritual angle - the drive to reach greater
heights, to do more, to do better
• Innovations
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23. A R A V I N D E Y E C A R E S Y S T E M
Innovations
• Application of high standard clinical and management
principles
• Demand generation
− Social marketing by the community and for the community
− Outreach services
− Speciality eye care and camps – innovative methods of
approach
− IT enabled vision centers
− Mobile vans with satellite connectivity
• Development of human resources
− PG training
− Medical team – Recruitment and retention
− Mid level ophthalmic personnel
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24. A R A V I N D E Y E C A R E S Y S T E M
Core Principles in
Delivering Eye Care
Aravind Model
Community Based Eye Care
With Modern Technology and Quality
Affordable to All and Financially Viability
Under Efficient Management Systems
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25. A R A V I N D E Y E C A R E S Y S T E M
• Better approach to help the poor
• Involve partnering with them to innovate
• Achieve sustainable win-win scenarios
• Poor actively engaged and companies providing
profitable products and services
• Collaboration between poor, community service
organisations, Govt. local firms
Prof. C.K. Prahalad
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26. Developing the Market
• Principles
− Market driving (reaching the
unreached)
− Removing barriers
− Community participation
• Impact
− Growing the market
− Creating access
Outreach in 2009 - 10
No.of Screening Camps 2,148
Patients examined 455,378
Surgeries 76,081 26/54
27. A R A V I N D E Y E C A R E S Y S T E M
Impact – reaching the
unreached
• Increased awareness
• Influencing health-seeking behaviour
• Creating access
• Community participation
• Growing the market (reaching the
unreached)
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28. A R A V I N D E Y E C A R E S Y S T E M 28/68
Taking super-specialty care to villages
VSAT
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29. Dedicated Medical Team
• Full time : from inception
• Optimum remuneration comparable with any institution
• Professional satisfaction
• Academics and research
• Surgical experience
• Opportunities for international collaborations
• Participation in management
• Maximum retention
5% of Indian ophthalmic services we are able to do with
1%< of country’s ophthalmic power.
Maximum utilization of available resources with employee satisfaction
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30. A R A V I N D E Y E C A R E S Y S T E M
Teaching & Training
OphthalmologistsTechnicians Administrators
Affiliations: MCI, NBE, RCO-UK, JACHPO-USA,
MGR Medical & MKU Universities
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31. A R A V I N D E Y E C A R E S Y S T E M
Paramedics
Training
• Spirituality
• Core area in Aravind
• High school qualified girls
• Rural background to match
our clients
• Culture and values
• Value added training
• Doctor : Paramedics = 1:4
• Produce and viable
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32. A R A V I N D E Y E C A R E S Y S T E M
Innovations
• Utilization of available resources to the maximum
− “McDonald “way
− Assembly line effectiveness
• Patient Satisfaction
− Quality assurance
− Affordable differential pricing of the ‘Product’ -
Vision
− Standard protocol – systems development
− ‘State of the art’ technology
− Deployment of IT in eye care
Contd
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33. A R A V I N D E Y E C A R E S Y S T E M
• Powerful marketing devices
are used to sell products
like Coca-Cola, Hamburger.
All I want to sell, to market,
if you will, is a good eye
sight and there are millions
of people who need it
Dr.G. Venkataswamy
Founder AECS
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34. A R A V I N D E Y E C A R E S Y S T E M
The delivery system
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35. A R A V I N D E Y E C A R E S Y S T E M
Assembly Line … Efficiency
Surgical Productivity
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36. A R A V I N D E Y E C A R E S Y S T E M
Cataract Surgery with IOL Implant
• 40% of all cataract surgeries in Tamil
Nadu are performed in Aravind Eye
Hospitals
• A surgeon in Aravind performs more
than 2000 cataract surgeries a year
which is 5 times the number performed
by an average Indian ophthalmologist.
• Key factor: Monitoring
ProductivityProductivity
EfficiencyEfficiency
Ophthalmologists Tables Scrub
Nurses
Running
Nurses
Instrument
sets
Sur./hour
1 1 1 1 1 1-2
1 1 1 1 3 2
1 2 2 1 6 4-6
1-1 Resident 3 3 2 8 8
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37. A R A V I N D E Y E C A R E S Y S T E M
Quality – always current
• Early adoption of relevant
technologies
• Skills & Perspectives upgraded
through international visits and
exchanges
QualityQuality
Exchange of Residents with the leading US
institutions
Continuous improvements based on patient &
employee feedback
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38. A R A V I N D E Y E C A R E S Y S T E M
Giving Value
• Comprehensive Care
• End to End Solutions
• Patient Centred processes
• Focus on outcomes
• Compassionate Care
QualityQuality
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39. A R A V I N D E Y E C A R E S Y S T E M
Aravind - Service Model
• Fee for service: 35% of patient
care
• Free/Subsidized service: 65%
of patient care
• Separate facilities for the
paying and free patients
The patient chooses where to get his/her care. The care provided is of the same
quality but the facilities provided are different based on the pricing.
The patient chooses where to get his/her care. The care provided is of the same
quality but the facilities provided are different based on the pricing.
AffordabilityAffordability
High QualityHigh Quality
High VolumeHigh Volume
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40. A R A V I N D E Y E C A R E S Y S T E M
Aravind Model -
Pricing
• Different pricing for poor,
middle and upper class of the
community
• Transparency in patient
charges
• Services that match patient
expectations
• Pricing the services to match
the paying capacity of the
community.
Category %
Can pay any amount
Can pay reasonable charges
Can pay subsidized rate
Can’t pay any amount
5
40
35
20
Paying Capacity
of the Population
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41. A R A V I N D E Y E C A R E S Y S T E M
Innovations
• Product development
− Cost effective consumables
− IOLs, pharma, instruments to ensure
quality
• Financial viability and self
sustainability
− Service cum business model
Contd
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42. A R A V I N D E Y E C A R E S Y S T E M
Turning apparent disadvantages into
realized opportunities
Mission & Objectives
• Produce quality products : ISO Mark
• Provide at affordable cost : $2
• Support avoidable blindness effort
• Self sustain and grow:
• Export to 120 countries
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43. A R A V I N D E Y E C A R E S Y S T E M
Intraocular Lens
Division
Pharmaceutical
Division
Suture Division Blades Division
Instruments
Division
- Aurolab was established in 1992 to produce intraocular lenses (IOLs) to make
quality cataract surgery affordable in developing countries.
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44. A R A V I N D E Y E C A R E S Y S T E M
Making Eye Care Affordable
Used in 120
countries
Price of IOL came down from $ 100 to $ 2 –
making cataract surgery affordable
10 million people see the world
through Aurolab’s lenses
7% of global market
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45. A R A V I N D E Y E C A R E S Y S T E M
Prof C.K.Prahalad---
• I looked at Aravind as business. Their income is
about 230 million, expenditure is 12 and the
profit of 11. If I add to the lens manufacturing
arm it is 200% return on capital employed. But
60% of them are non-paying patients. This is
what this business is about
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46. A R A V I N D E Y E C A R E S Y S T E M
Financial Results
Free (Camp) 33%Paying 45%
Free (Direct) 22%
Surgery mix in 2008 -09
Year: 2008-09
Income: US$ 22 Million
Expenses & Depreciation: US$ 13 Million
EBITA: 39%
Through a unique fee system & effective management, Aravind
provides free eye care to 60% of its patients
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47. A R A V I N D E Y E C A R E S Y S T E M
Lions Aravind Institute of Community
Ophthalmology
To contribute to the
prevention and control of
global blindness through
Teaching, Training,
Consultancy, Research,
Publications & Advocacy
Spirit of Sharing
47/54
48. A R A V I N D E Y E C A R E S Y S T E M
Case Studies of Aravind
1. The Aravind Eye Hospital, Madurai, India: In Service for Sight - Harvard
Business School, March, 1993
2. From Market Driven to Market Driving - Nirmalaya Kumar, European
Management Journal VOL: 18 (2) APRIL 2000
3. Aravind Eye Care System: Giving them the most precious gift. -
Profs. S. Manikutty & Neharika Vohra of the Indian Institute of
Management, Ahmedabad, 2003.
4. Making Sight Affordable (Part I) Aurolab Pioneers Production of Low-Cost
Technology for Cataract Surgery - Mahad Ibrahim, Aman Bhandari;
Jaspal S. Sandhu; and P. Balakrishnan - Innovations VOL: 1 (1) SUMMER
2006 P.25-41
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49. A R A V I N D E Y E C A R E S Y S T E M
Aravind Case Study
• The Lofty Missions – Down to Earth Plans
Harvard Business Review, March 2004
Fast Company, a popular magazine in US declares Aravind
as one of the 50 most innovative companies of the world
http://www.fastcompany.com/fast50_09/list-all Check out No. 47
http://www.fastcompany.com/fast50_09/lists/the-most-innovative-companies-
in-India.html
• The Fortune at the Bottom of the Pyramid
C.K. Prahalad, Wharton Publishing, 2006
• Compassionate, High Quality Health Care at Low Cost. The
Aravind Model. In conversation with Dr. G. Venkataswamy
and R.D.Thulasiraj
IIMB – Management Review, September 2004
49/54
51. Spiritual Basis
The hospital is named after Sri. Aurobindo Ghosh and his teachings form
the basis for the work
P
O
W
E
R
F
A
I
T
H
If work is approached from a spiritual perspective, then it becomes
divine work. If in your actions, you allow the divine force to flow
through you, you will accomplish things far greater than you might
have imagined.”
- Sri AurobindoSri Aurobindo Aravind Eye Care SystemAravind Eye Care System 51/54
52. A R A V I N D E Y E C A R E S Y S T E M
- Sri Aurobindo
“Faith, more faith
Faith in your possibilities
Faith in the power that is at work behind
the vein,
Faith in the work that is to be done
and
The offered Guidance”
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53. A R A V I N D E Y E C A R E S Y S T E M
BOP Market
• Get products and services at affordable price
• Get recognition : Respect and fair treatment
• Building self-esteem
• Decision makers hear the voices of the poor
• High volume : Quality
• High Return on capital
• Self sustainability
ARAVIND MODEL
- Prof. C.K. Prahalad
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54. He has shown the way to
do it,
We believe it and
we “can do” it …
Aim High
Set Goal ...
Set an Example
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Hinweis der Redaktion
The pictures in this slide:
25 years back began as a small organisation
4 member team with a big mission
To deal with avoidable blindness at the national scenario and global level
Financial constraints-totally dependent on self generation of income
Efficiency at the core of systems development
This slide will be replaced by pictures-this is notes the 11 bedded hospital-where it qll strated
Photo of the first team
Financial prob-to show the $ sign or put Rs or some clip art