Mr Thulasiraj Ravilla_Scaling Up Quality
Scaling up Quality
(o
ur Perspectives & Lessons)
Thulasiraj Ravilla
LAICO - Aravind Eye Care System
Aravind Eye Care System
Quality is critical
• To scale up eye care services
• In scaled up eye care services - to sustain it
Aravind Eye Care System
Our Quality Paradigm
• Everyone in need gets care
• Gets appropriate care
• without gender, social, economic or location
• Clinical outcomes
•
•
Patient at the centre of
• service design & care giving process
• Patient friendly systems & facility
• Maintaining Patient
Dignity
• Timely care – reaching the patient before it is too late
• Eliminating waste
• Standardization
• Value for money
• Enhancing utilization
• Minimizing delays
• Do no harm
• Right Patient, right site
& right treatment
• Safe facility
• Communication
Aravind Eye Care System
Scaling up Quality
Design
Technology
DNA QA
Process
M & E
Aravind Eye Care System
Designing for Quality
• Understanding the “non-customer” and designing the eye care services
– Outreach with transportation
– Vision Centers
– Pricing & Free care: freedom to choose
– Closing the service loop
• Patient as a partner in the care process
– Empowerment & counseling
• Stretching the institutional boundary – to ensure ultimate impact, the Quality of Life
Aravind Eye Care System
Service Design: Customer in Focus &
End to end solutions
Creating
Awareness
Knowledge about the condition e. g: Spectacles
Diagnostic
Services
Counselling
Addressing
Access Issues
Empowering the customer
Prescription for Glasses
Benefits,
Cost, etc
Treatment
Services
Follow-up
Services
Addressing Access &
Affordability Issues
Outcome Assessment,
QA, Product Design
Aravind Eye Care System
On the spot dispensing
In schools &
Industries
Quality Assurance Process
• Building the “quality culture”
– Focus on process & not person
– Willingness to flag/record errors
• Systems to ensure quality (Safety &
Effectiveness)
– Review, root cause analysis & solutions
– Follow-through on actions
• Benchmarking – internal & external
• Continuous Improvement
Aravind Eye Care System
Standardization
Clinical protocols & Process
• Clarity in role
• Decision making easier
• Easy to train staff
• Better use of equipment
• Quality improvements
Start with common activities
• Cataract surgery
• Refraction Services
Aravind Eye Care System
Refraction Protocol – 13 steps
• Check preliminary vision PG power and vision with PG
• Patients complaints & vision needs
• Use torch light for finding eye condition
•
• Do pin hole test, Duochrome test, cross cylinder
If difference is
Bottom Line
0.25 not to prescribe
• Check diplopia, prescribe glass for BSV
• Right Process, Performed well
•
Results in
•
• Confirm the patients age, working distance for NV add
Good Quality & Outcomes
Compare present testing power& patients PG power
• Always do not over correct
• Satisfy your patient, by asking questions and counseling
• Check the final prescription
Aravind Eye Care System
Monitoring – process & outcomes
• Probably the most critical aspect in quality assurance
• What do we monitor: inputs, process, output & outcomes
• How do we monitor: timeliness, accuracy, completeness
• Monitoring to be integral to workflow
• Use of IT to make the process painless
Aravind Eye Care System
Aravind Eye Care System
Aravind Eye Care System
What we look for in
Technology / Techniques
• Will it minimize complications
• Will it Improve visual outcomes
• Will it enhance productivity
• Will it minimize follow up
• Will it reduce cost
• Will it improve comfort & satisfaction
Aravind Eye Care System
Using cutting edge technology
Less stress
Increased productivity
Doctors
Competitive
Advantage enhanced margin of safety
Reduced complications
Use only reliable, thoroughly tested technology that serves your people and process - Toyota
Aravind Eye Care System
Surgical Quality
2
Adverse Events During Surgery
Capsule rupture & vitreous loss
Incomplete cortical clean up
Iris Trauma
Persistent Iris Prolapse
Anterior Chamber Collapse
Loss of nuclear fragment into vit.
Aravind,
Coimbatore
N=22,912
2.0%
UK National
Survey
N=18,472
4.4%
0.75%
0.3%
0.01%
0.3%
1.00%
0.7%
0.07%
0.5%
0.2% 0.3%
Choroidal Haemorrhage -----0.07%
Aravind’s complications are less than half of those in UK
Loss of IOLinto vitreous 0.01% 0.16%
2
Aravind Eye Care System
“Fortune at the Bottom of the Pyramid” by C. K. Prahalad
300 000
250 000
200 000
150 000
100 000
50 000
400 000
Surgical & Laser Procedures
4.3 Million as of March 2012
350 000
Paying
Free
0
Aravind Eye Care System
Work Culture & Discipline
• Commitment of leadership
• Attitude for perfection
• Passion to eliminate needless blindness
Systems, Processes & Technology are critical to quality but they will fail in the absence of right
“Work Culture & Discipline”
Aravind Eye Care System
Aravind Eye Care System
