I have been fortunate to attend the BMJ/IHI International Forum this week thanks to 1000 Lives Plus. After day one of the Forum, I am really inspired after listening to ideas from around the world about healthcare improvement projects.
One session explored how you can improve both the quality and efficiency of a service, yet save cost at the same time. It sounded impossible to me before I learnt about the Aravind Eye Care System from Dr Ravindran, one of the keynote speakers.
40 million people in the world are blind – and 12 million of those are in India – and yet over 70% of blindness is preventable or treatable. With the growing population and inadequate infrastructure in India, Dr Ventakaswamy, founder of the Aravind Eye Care System realised the need for an eye care/health system that would prevent people in India from going blind. To cope with the hundreds of patients each day, patients were screened at an eye camp site, where all tests and measurements are performed by trained paramedics and optometrists. Glasses were prescribed and fitted on the day itself. They are then transported to the eye hospital where they are treated, with the majority of cases being cataracts.
To improve efficiency, the operating theatre is equipped with two operating tables. While the surgeon operates, the next patient is prepared and draped, enabling the surgeon to move to the next patient and start operating. This system has proved to save an enormous amount of time and yet the percentage of post-operation complication and visual outcome is indifferent compared to conventional cataract surgery.
Patients who could not afford to pay for eye surgery or spectacles are provided with free spectacles and treatment. Intraocular lenses used during cataract operations were manufactured onsite as a strategy to reduce cost. The priority in India was to provide an affordable and efficient healthcare system that would serve the people of India. Therefore if the priority is not addressed; if the service provided was not affordable and if it cannot meet the demand of the ever growing population, it is not a solution!
The Aravind Eye Care System was a success was because they understood the problem, set out the priorities and worked towards their priorities – not just designing a service delivery mechanism which is most convenient to the service provider.
The success of Aravind Eye Centre is just mind-blowing. The question is how can we make this happen here in the United Kingdom? How can we increase productivity and quality and reduce cost at the same time? The needs of this country might be different compared to India, but I believe there are loads we can learn from the Aravind Eye Care System. The case study highlighted great leadership in shaping a healthcare system which focused on priority and not convenience. Most importantly, quality improvement is not just about great innovation, it is about initiative, planning ahead and doing it!
Waikitt Chee is a medical student from Cardiff University and won a place at the Forum, by entering the Student and Person Centred care competition.
Using the Model for Improvement, Waikitt identified a small change he could implement that would make a big difference to his patients by introducing cushions. He proposed collecting data through a patient satisfaction survey before the change and afterwards to see if the change really was an improvement.