Scaling up Quality (o ur Perspectives & Lessons)

1. Scaling up Quality(our Perspectives & Lessons) Thulasiraj Ravilla LAICO - Aravind Eye Care System

2. Quality is critical To scale up eye care services In scaled up eye care services - to sustain it

3. Our Quality Paradigm • Everyone in need gets care • Gets appropriate care without gender, social, economic or location bias • Timely care – reaching the patient before it is too late • Appropriate clinical protocol • Clinical outcomes • Eliminating complications • Enhancing Compliance • Eliminating waste • Standardization • Value for money • Enhancing utilization • Minimizing delays • Patient at the centre of service design & care giving process • Patient friendly systems & facility • Maintaining Patient Dignity • Do no harm • Right Patient, right site & right treatment • Safe facility • Communication

4. Scaling up Quality Design DNA Tech-nology QA Process M & E

5. 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

6. Service Design: Customer in Focus & End to end solutions Creating Awareness Knowledge about the condition e. g: Spectacles Prescription for Glasses Diagnostic Services Addressing Access Issues Benefits, Cost, etc Counselling Empowering the customer Treatment Services On the spot dispensing Addressing Access & Affordability Issues Follow-up Services Outcome Assessment, QA, Product Design In schools & Industries

7. 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

8. Standardization Clinical protocols & Process • Start with common activities • Cataract surgery • Refraction Services Clarity in role Decision making easier Easy to train staff Better use of equipment Quality improvements

9. Refraction Protocol – 13 steps Bottom Line Right Process, Performed well Results in Good Quality & Outcomes 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

10. 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

13. 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

14. Increased productivity Less stress Reduced complications enhanced margin of safety Using cutting edge technology Doctors Competitive Advantage Use only reliable, thoroughly tested technology that serves your people and process - Toyota 14 14

15. Surgical Quality2 2 “Fortune at the Bottom of the Pyramid” by C. K. Prahalad

16. Surgical & Laser Procedures4.3 Million as of March 2012

17. 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”

18. Thank You