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Scaling up Quality (o ur Perspectives & Lessons). Thulasiraj Ravilla LAICO - Aravind Eye Care System. Quality is critical. To scale up eye care services In scaled up eye care services - to sustain it. Our Quality Paradigm. Everyone in need gets care - PowerPoint PPT Presentation
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Aravind Eye Care System
Scaling up Quality(our Perspectives & Lessons)
Thulasiraj RavillaLAICO - 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
• Do no harm• Right Patient, right site
& right treatment• Safe facility• Communication
• Patient at the centre of service design & care giving process
• Patient friendly systems & facility
• Maintaining Patient Dignity
• Appropriate clinical protocol
• Clinical outcomes• Eliminating
complications• Enhancing Compliance
• Eliminating waste• Standardization• Value for money• Enhancing utilization• Minimizing delays
• Timely care – reaching the patient before it is too late
• Everyone in need gets care
• Gets appropriate care without gender, social, economic or location bias
Aravind Eye Care System
Scaling up Quality
DNA
Design
QA Process
M & E
Tech-nology
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
Diagnostic Services
Counselling
TreatmentServices
Follow-up Services
Prescription for Glasses
Benefits,Cost, etc
On the spot dispensing
In schools &Industries
e. g: SpectaclesKnowledge about
the condition
Addressing Access Issues
Empowering the customer
Addressing Access & Affordability Issues
Outcome Assessment, QA, Product Design
Aravind Eye Care System
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 0.25 not to prescribe • Check diplopia, prescribe glass for BSV• Ask the patient profession • Advise at 33 cms for reading books• Confirm the patients age, working distance for NV add• Compare present testing power& patients PG power• Always do not over correct• Satisfy your patient, by asking questions and counseling• Check the final prescription
Bottom LineRight Process, Performed well
Results inGood Quality & Outcomes
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 14
Using cutting edge technology
Reduced complications
Less stressIncreased
productivity
enhanced margin of safety
CompetitiveAdvantage
Doctors
Use only reliable, thoroughly tested technology that serves your people and
process - Toyota 14
Aravind Eye Care System
Surgical Quality2
Adverse Events During SurgeryAravind,
CoimbatoreN=22,912
UK National Survey
N=18,472Capsule rupture & vitreous loss 2.0% 4.4%Incomplete cortical clean up 0.75% 1.00%Iris Trauma 0.3% 0.7%Persistent Iris Prolapse 0.01% 0.07%Anterior Chamber Collapse 0.3% 0.5%Loss of nuclear fragment into vit. 0.2% 0.3%Choroidal Haemorrhage ------ 0.07%Loss of IOLinto vitreous 0.01% 0.16%
Aravind’s complications are less than half of those in UK
2 “Fortune at the Bottom of the Pyramid” by C. K. Prahalad
Aravind Eye Care System
Surgical & Laser Procedures4.3 Million as of March 2012
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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
