India Consequently, each surgeon at the Aravind Eye

India
holds about one third of the world’s blind population. In 80% of the cases, it
is cataract-related blindness. In 1976, Dr.Venkataswamy founded the
Aravind Eye Hospital following the “Aravind Model”. Over the last 36 years,
over 45 million of patients have undergone eye surgery at the Aravind Eye
Hospital. ( Thulasiraj Ravilla, 2014). The business plan of the Hospital
consists in providing large volume, high quality and affordable services in a
financially sustainable manner for both the patient and Aravind. This
successful model of the late twentieth century can be  seen as Mcdonaldization applied to a Hospital.
Mcdonaldization, a term invented by George Ritzer,  can be defined as a particular kind of
rationalization of production, work and consumption where every task is broken
down into smaller tasks to find the most efficient method for completing each
task. (Mcdonaldization.com, 2001). This essay will show that the Aravind Model
follows principles of Mcdonaldization, which will explain a boost in efficiency
from two to seven times. In order to prove the impact of Mcdonaldization of the
Aravind Eye Hospital, each main component of Mcdonaldization ( efficiency,
calculability, predictability, and control) will be linked to the Aravdind
Model.

          First of all, efficiency in the
context of Mcdonaldization means that every aspect of the organization is
geared toward the minimization of time. Mr V. set up an assembly line approach
in surgery similar to those found in fast foods. The goal was to find the
fastest method to perform each surgery. Therefore, each operating room has one
surgeon but at least two operating tables, as well as multiple sets of
equipment and multiple nursing teams to carry out all key non-surgical tasks
such as preparing the patient and administering anesthetic.  In other words, while one patient is
undergoing surgery, the other surgical and nursing staff is preparing another
patient on the adjacent operating table. This allowed doctors to finish a
surgery and going on to the next one right away therefore optimizing surgeons’
productivity. Consequently, each surgeon at the Aravind Eye Hospital perform
over 2000 surgeries per year whereas the average doctor in India performs in
average only 400 surgeries per year. In most developed countries, regulations
require surgeons to exit the operating room and change gowns and gloves between
cases. At the Aravind Eye Care system, the surgeon will spend most of his day
in an operating room and simply apply antiseptic to the gloves between each
surgery. Other staff and counselors are in charge of informing the patient of
the risks and benefits of the surgery and answer the patient’s questions. Moreover,
the Aravind Eye Care system has complications as low or lower than those in
developed countries. Aravind has developed standardized processes for key
operations, so as to ensure consistent and efficient delivery. Additionally,
the high productivity does not come at the cost of quality.

 

Secondly,
calculability can be defined as the assessment of outcomes based on quantifiable
rather than subjective criteria. In other words, quantity over quality. Dr V. needed a large volume of patients in
order for his model to work. He focused on those who were not seeking medical
care but needed it.

Aravind does this
by reaching out into the community through active partnership with social
organizations, local philanthropists, volunteers, the school system and
industries in the local community. 2500 outreach camps are organized each year
to reach out to the general population and over half a million people visit
them each year. Additionally, one third will receive a significant
intervention. Overtime, the camps boost the public’s awareness and therefore
increase the customer base for the hospital. Furthermore, the Aravind Eye
Hospital use different strategies to reduce patient costs while also being
timesaving and increasing the customer base and Hospital profit. For instance,
the eye care is made locally available, therefore reducing travel-time and its
associated costs. Secondly, all patients receive a diagnostic in a single
visit, and are offered a surgery slot immediately if one is needed. The patient
is therefore able to complete the entire care cycle in a single visit. In
addition, The Aravind eye Hospital can be labeled a hybrid business model, this
business model allows the Hospital to use the profit generated by the paying
customers to cross-subsidize services for the needy, poorer, non-paying
customers. While one of the main goals is to attract and bring in as many
patients as possible, Aravind’s model does not base quality of service on the
income of the people it serves. In the Aravind model, there is a standard
quality fir the surgeries, which equalizes the patients and keeps clients
coming for their services from both sides of the economic spectrum.

 

Thirdly,
predictability in the context of Mcdonaldization means that the production
process is organized to guarantee uniformity of product and standardized
outcomes. As mentioned previously, all patient visits are highly organized to
be quick yet efficient and all patients are given the same high-quality
services no matter their social class. There is a service sequence at Aravind
Eye Hospital where all patients go through seven steps: registration, vision
recording, preliminary examination, testing of tension, tear duct function,
refraction test, and final examination. Most often, doctors are not even
informed whether or not the patient is a paying patient or non-paying one, they
need to follow the same protocol regardless. Moreover, all surgeries are
executed in the same repetitive, predictable, and highly routine manner that
ensures a uniformity of service. Furthermore, The Aravind Eye Care System also recruits
and trains women from local communities and certifies them as technicians. The
trainees are rotted between the various Aravind Hospital units to ensure standardization.
The nurses and technicians are cross-trained so that they can preform multiple
routine tasks. In addition, 900 ophthalmic assistants are taken on and trained
each year to support the specialist doctors. These “in-house” trainings further
guarantee a standardized process equal for all patients. Similarly, and always
following the principles of McDonaldization, Dr. V once said, “Can’t we do what
McDonald’s and Burger King have done in the United States?”. He dreams of McDonald’s
style eye-care franchises around the world. Until then, there are 11 other
Aravind Eye Hospitals with a combined total of more than 4000 beds. Patient
care and treatment is therefore highly standardized and outcomes are the same.
Following the final examination, the patients can be sub divided into three
categories: the patients that will undergo cataract surgery, the patients
referred to other specialty clinics, and the patients for corrective actions
who are redirected to an optometry room for measurement and prescription of
glasses. Additionally, The Aravind Eye Care System has a successful
manufacturing unit, Aurolab, which produces affordable cataract surgery items
such as lenses, needles, sutures, blades and drugs. Everything in the Aravind
Eye Care System is meticulously planned and all aspects are heavily
standardized.

 

Finally, the last
component of McDonaldization is Control, which can simply be explained as the
standardized and uniform employees, and the replacement of human by non-human
technologies. The Aravind Eye Care System is equipped with an excellent IT
system that keeps track of all the patients. The system generates daily
schedules taking into account patient’s preferences and the pending work.
Moreover, to further understand the technology needed, it is best to fully
understand what a cataract is. A cataract is defined as a clouding of a
normally transparent lens that impairs vision. This lens is replaced during
surgery by an artificial implant known as an intraocular lens (IOL). Previously,
the Aravind Eye Hospital purchased intraocular lenses at around 100 US dollars,
but after the foundation of Aurolab, the new lenses dropped to 4 US dollars. Today,
Aurolab produces three different lenses and has also manufactures suture
needles, pharmaceuticals, and blades. Moreover, Aurolab developed a Green Laser
project for the future need for making diabetic retinopathy treatment
affordable and accessible. Although it can be hard to clearly recognize the
“Control” aspect of these initiatives  in
the context of McDonaldization, it is evident that in developed countries it is
more profitable to train the local community than to replace workers by more
advanced technology. Nonetheless, the workers are trained and taught to act in
very repetitive, routine, and almost machine-like manners.

 

To Conclude, the
direct influence of McDonaldization on the business model of The Eravind eye
Hospital was responsible for the boost in efficiency  from two to seven times. Aravind with its
mission to eliminate blindness, has been able to achieve this by providing
large volume, high quality and affordable services. Much importance is given to
equity and ensuring that all patients are accorded the same high quality
service, regardless of their economy status. A critical component of Aravind’s
model is the high patient volume, which he achieves with outreach camps.
Nowadays, the Aravind model has been partially replicated in more than 300
hospitals globally. Aravin still plans to expand to other parts of India and
other developing countries with large impoverished population. Through
innovative strategies aimed at minimizing costs without jeopardizing the
quality of care, The Aravind Eye Care System has developed a model that is
sustainable and should serve as example for health care professionals seeking
to improve the delivery of high-volume surgical care in India and elsewhere.