Spotlight

Mecca of Quality Eye Care

Aravind Eye Hospital, Madurai, which has gained global recognition by serving the bottom of the pyramid, is gearing up to become more competitive with focus on research and clinical excellence, says Sonal Shukla

There will be barely anyone in the healthcare industry today who has not heard about Aravind Eye Hospital's (AEH) scope of work and self-sustaining model. Kudos to the institute for providing quality eye care, with an upright approach towards teaching, training, research, clinical excellence and capacity building.

AEH has come a long way from 11 beds to close to 4,000 total beds today, with five hospitals within Tamil Nadu and four managed care hospitals in the Northern parts of India, not to forget the countless eye hospitals within India as well as overseas that have been given a new lease of life through capacity building, and the many primary eye care centres and community centres started by the institute, connected with telemedicine and wi-fi technology not just in Tamil Nadu, but all over India.

Systematic Approach to Quality

"Our aim is to reduce the number of people who can go blind due to diabetes" - Dr P Namperumalsamy Chairman Aravind Eye Hospital

"We see huge opportunity in developmental research, basic research and epidemiological study" - Dr S Aravind Administrator Aravind Eye Hospital

The main tertiary care AEH in Madurai is the best example of how an institution can reach the heights of clinical and quality excellence by resorting to methodical and scientific approach. It starts with the inquiry counter on the ground floor, where besides the basic details, the demographic details of the patients are tracked as well. "Such analysis of demographic details are tracked and reviewed on monthly basis. This gives us an idea about locations from where there is a heavy load of patients coming in the hospital, and also helps us track the number of patients coming for paid as well as subsidised treatment," shares Shavoz Philip, Manager-Patient Care, AEH. Based on this study, the teams assigned by the hospital go to visit rural areas to understand the quality of life of patients after they have undergone eye surgeries. Initially, the hospital found that the percentage of patients coming from rural areas was less. On exploring further, it was identified that the patients needed the help of attendants to come to the hospital, and therefore, when there was non availability of any person accompanying them, patients used to skip coming for the treatment. This is when the hospitals arranged for a fleet of 15 vans for the transportation of patients to solve this problem.

There are many such initiatives taken by the hospital on the basis of analysis done on a regular basis to improve the clinical as well as departmental excellence. One such example is of a calendar prepared to understand the approximate number of patients that will visit the hospital on a particular day. Based on last two year's data, the hospital has been tracking the expected growth pattern of each month of patients coming to the hospital. The integrated hospital management software of the hospital too tracks all the details of the daily patient load. Since the hospital does not follow an appointment system, such tracking of patient load helps to prepare the hospital employees according to the high and low pressure days. "We don't want to send any patients back because we don't have a place to treat them. Therefore, on peak days, we make sure that all staff is present and keep other activities to the minimum," says Philip. On the peak hours of the day, experienced staff manages the registration work, while during non peak hours, the trainees take over.

The hospital has been tracking the performance of different departments and eye clinics in the hospitals. AEH has developed in-house clinical management software, which it has sold to many eye hospitals. This clinical management software has helped the hospital in setting targets and analysing the results on certain parameters. Post operative vision is one of the important parameters to review the clinical excellence. The best practices are benchmarked, compared with international standards and shared between the five existing hospitals in Tamil Nadu.

Beyond Tamil Nadu

An eye camp

An ophthalmologist examining a patient

A glucoma clinic

Today AEH is known for not just initiating different eye care models, but also making them successful and self sustaining through consultancy and capacity building through Lions Aravind Institute of Community Ophthalmology (LAICO). The hospital has helped start four hospitals in Northern parts of India, namely in Amethi and Lucknow in UP, Kolkata in West Bengal and Amreli in Gujarat. AEH has been providing them help to set up the eye care facility at the operational level till they start functioning. The Amreli and Lucknow hospitals today are functioning independently. Lucknow is a tertiary care hospital and other three are secondary care hospitals, doing day care surgeries. "Depending on the volumes, we will upgrade the other three to tertiary care," shares Dr S Aravind, Administrator, AEH, and also the Director for these projects. Once the hospital becomes self sustaining, it shares a certain percentage of its patient revenue with AEH. AEH has stretched its consulting and capacity building beyond India, by giving assistance to different eye hospitals in countries like Nigeria, Guatemala, Congo, Paraguay and so on.

Optimum Utilisation of HR and Technology

AEH has always believed in optimum utilisation of human resource. That is what comes across as one visits the hospital where several mid-level ophthalmic attendants, (which constitutes almost 60 per cent of the total staff), are seen handling different tasks at various levels. "The system in this hospital is efficient because the key resource i.e. the ophthalmologist is made to do what he/she is required to do," says Philip. The hospital has been identifying 12th passed girls, training them in-house for two years and recruiting them at various levels. These attendants manage all the work where the skills and time of a surgeon is not required. For example, in the OT, the paramedics prepare the patients, which saves surgeons time, which he/she can utilise in doing more number of surgeries. Similarly, at the out patient area on the ground floor, the 45 counselors recruited by the hospital counsel the patients on the aspects like cost, treatment options, types of surgeries available etc. Thirteen periodical meetings happen in the hospital at different frequencies, where various operational and developmental issues are discussed using various statistical and evidential reports.

AEH is known for its IT-enabled approach towards eye care. The 33 vision centres, manned by paramedics and connected with telemedicine see about 600-800 cases a day, 20 cases per centre. Five such centres are handled by one doctor. These vision centres have germinated from the need to reach the far flung areas in rural Tamil Nadu. A rented place, basic instruments to check the condition of the eye, tele-connectivity between the base hospital and the centre— with these bare necessities, patients are investigated by paramedics. Images are sent to the doctor in the base hospital if the need be, where he/she gives optical prescriptions. Each such vision centre, manned with telemedicine, has been covering a population of 50,000. The hospitals recently initiated taking optical prescriptions through hand held devices also called PDAs. By typing the particular patient's medical record number, all the details come in the hand held device. By doing manual calculations, the attendant then suggests the particular power of lenses to the patient. The printer connected through wi-fi then takes the print out. This has helped in reducing the hand written errors. All the five hospitals are connected through satellite and the training and lectures happen through video conferencing.

Targeting Research in Eye Ailments

Started with an idea of reducing needless blindness, AEH is working incessantly towards achieving its goal. Shares Dr P Namperumalsamy, Chairman, AEH, "More than 80 per cent of the blindness can be cured by simple cataract surgeries and interventions. But that is not the only reason which is causing vision impairment." According to him, almost nine per cent of children can develop vision defect, only because of the absence of simple glasses. The hospital is vigorously taking efforts towards reducing this uncorrected refractive error in school children by reaching out to remote villages in mobile vans and educating teachers, parents and screening school children and providing glasses on the spot.

"One third of the diabetic people will develop eye problems, but they won't have any symptoms. Diabetes related vision impairment is preventable by proper examination at the early stage. And our aim is to reduce the number of people who can go blind due to diabetes," shares Dr Namperumalsamy.

The hospital has always focused on research and currently the research wing of AEH is concentrating on research on stem cell transplantation to clear the cornea affected due to chemical injuries. "This is an ongoing experimental research that we are doing," shares Dr Namperumalsamy. In basic research the hospital is looking at proteomics which has the ability to capture the genetic determinants of eye care. "We see huge opportunity in developmental research, basic research and epidemiological study. We are also keen on conducting clinical research; however we are guarded with this approach. We are trying to work with companies who have certain presence and values in the society," shares Dr Aravind.

In the Near Future

AEH has decided to reduce its emphasis on screening camps. The hospital analysed that only seven per cent of patients with eye problems are turning to eye camps. Therefore, it is willing to set up permanent set-ups in the form of primary eye care centres in different areas of Tamil Nadu. Currently, the group has 33 such centres in place. The hospital is also coming up with secondary care hospitals in tier two cities. The hospital is setting up three green filed secondary care hospitals in Dindigul, Udumalpet and Tirupur in Tamil Nadu, which will be ready by the end of this year.

With its eyes on research and growth, the group would continue to be the most preferred and prestigious brand in Indian healthcare.

sonal.shukla@expressindia.com