‘Assembly-Line’ in Healthcare

Decades ago, Henry Ford implemented the principle of ‘assembly lines’ to produce cars in a more efficient manner which have tremendously boosted the automobile and manufacturing industry. Who would have known that the same principle has widespread use in the way patients are being treated in a hospital? Aravind Eye Care System, a leading eye hospital founded in Madurai, Tamil Nadu, India in 1976, is pioneering the use of assembly line phenomenon.

In Aravind Eye hospital, each operation theater consists of four tables where two doctors operate independently. As soon as the doctor walks into the operation theater, a cataract patient, which has been fully prepped by mid-level ophthalmic personnel (MLOPs) is brought in for surgery. The doctor quickly glances through the patient’s case history, replaces the lens and moves to the next patient which has been prepped by another set of MLOPs. The first patient is given post-operative procedures by MLOPs while the doctor is operating upon the second patient. In a similar cycle, a 3^rd patient is brought in and the doctor shifts his focus to this new patient. This process is continued till 3 PM every day where each doctor is assisted by two MLOPs.

This efficient assembly-line process provides the following advantages:

• Enables doctors to put entire focus on the critical aspects of the surgery while qualified MLOPs handles other aspects of the operation, thereby reducing errors and increasing doctors’ throughput.
• Reduces the time spent by doctor on each patient. An Aravind Eye Care doctor takes just 5 to 10 minutes per patient which enables him to perform, on an average, 50 surgeries per day and at least 2,000 a year (benchmark is 200 surgeries/year in developed nations).
• Scaling this to increase affordability for the patients for the medical operation.

In 2015, 22% of the 4.08 lakh surgeries performed by Aravind Eye Care were for free, 28% were heavily subsidised and only the balance 50# were charged fully. This has made this institution grow into a network of eye hospitals and has had a major impact in eradicating cataract related blindness in India.

This innovative model has been taught as a case study at Harvard Business School since 1993. The profitability is also not hampered. In 2014-15, Aravind Eye Care’s income was Rs 233.74 crore while its expenses were only Rs 162.98 crore, generating a surplus of Rs 70.76 crore. The hospital has also diversified by manufacturing and exporting lenses, sutures and other consumables required during and after surgery to over 140 countries.

Hospitals across the globe can try and replicate this model to provide affordable and quality care.