Throughout history, quality has been the focus for all researches and developments in patient care. Hospitals around the world have been called upon to provide quality health services to their clients. Due to the nature of medical practice, the provision of quality service cannot be overlooked (Bokhoven, Kok, & Weijden, 2003). As a result, many hospitals have setup frameworks to oversee the implementation and continuous improvement of quality services. This paper seeks to study the comprehensive framework that ensures provision of quality services by the Aravind eye Care hospital, India.
Summery of a quality healthcare framework and its effectiveness
This case study on health management is based on Aravind Eye Care Hospital, the world’s biggest eye care service provider (Braitwaite & Travaglia, 1999). “This is an ophthalmological hospital with several locations in India” (Hemamalini, 2010). Aravind Eye Hospital was founded Dr Govindappa to supplement Governments efforts in dealing with the issue of blindness in India. The project was established through the GOVEL trust to oversee basic eye care in 1976. Today the hospital has grown to become a “social organisation that is committed to the elimination of needless blindness through comprehensive eye services” (Ravindran, 2008). It has also established a center for ophthalmic training centre for both students in India and those from around the world.
“The Aravind’ mission statement: To eradicate needless blindness by providing appropriate, compassionate and high quality care to all” (Hemamalini, 2010).
The current management at the Aravind Eye hospital is overseen by Dr D Ravindran who is the managing director. Aravind’s mission and objectives underpin the production and provision of quality health products at an affordable cost; provide affordable quality services to its clients and finally achieve growth through self sustenance programs. The hospital’s core principles include the following: Market driving (reaching the unreached), Eliminating barriers and promoting community participation (Clinical Performance Analytics, 2010). The hospital aims at facilitating access to quality healthcare and increasing the market. The hospitals achieve these through; establishing screening camps in various locations to examine patients for eye problems and offer the required treatment (Braitwaite & Travaglia, 1999). The hospital has also developed newer strategies in order to boost people’s access to their quality services. For instance the hospital has established centres that provide primary health care. The centres are staffed with ophthalmic technicians and nurses who are instrumental in active case finding at the community level (Hemamalini, 2010). The hospital has also established eye care centres that are IT enabled. The centres are provided with wireless connectivity that links them to the main hospital. Every patient who undergoes examination at the centres is “discussed with the ophthalmologist through videoconferencing consultation at the Aravind Eye Hospital” (Ravindran, 2008). Thus patients who require special attention are quickly identified and referred to the main hospital. This strategy has led to increased patient’s access to quality eye care at affordable costs. The Aravind has modelled a financial sustainable value efficient service that reaches vast majority of the people in need of its services (Hemamalini, 2010).
According to its 2009 data, the hospital and its centres handle an average of 6000 outpatients a day, of which it examines 1500 and about 300 are transported to the main hospital for surgery (Ravindran, 2008). The hospitals management system aims at providing efficient and quality service through ensuring that clinical protocols are followed to the latter, all the protocols are standardized, use of up to date surgical techniques, keeping of medical records, and maintenance of a highly qualified and skilled team, reduction of patient waiting time (Currie & Watterson, 2007). The hospital has an efficient planning strategy that includes the following: proper planning for the next day’s activities such as “scheduling of patient, staff and equipment”; Planning for medical supplies and spares; releasing of weekly and monthly reports to ensure that high quality service is maintained (Hemamalini, 2010). For continuous quality promotion, the hospital readily adopts new technologies that are relevant, upgrades the skills of its work force through exchange programs with other leading institutions around the world, and conducts surveys on patients and staff which are then used for continuous improvement (Ravindran, 2008). The hospital also provides health services to the poor through a program in which the cost is subsidized to provide them with an opportunity to access quality health care.
Aravind also provides quality training of ophthalmologist technicians and has affiliations with world leading organizations such as the “MCI, NBE, RCO-UK, JACHPO-USA, MGR medical and MKU Universities” (Ravindran, 2008). The Hospital has other divisions that specialize in manufacturing of quality medical instruments such as intraocular lens, pharmaceuticals and surgical blades. The products have been approved for health use by US FDA and have attained the ISO 9001/CE Mark (Hemamalini, 2010). Among other products, Aravind makes the Aurolab implants which have enabled several millions of people around the world to see. It has also established a “community based medical research foundation that conducts epidemiological surveys and offers clinical trials” (Fitzpatrick, 2002).
The comprehensive quality framework used by Aravind eye hospital ensures that majority of the patients, who come from poor backgrounds gain access to quality health care (Harvey & Wensing, 2003). The establishment of centres to examine patients and provide feedback through internet connectivity was a good innovation that has really helped many people across India. The provision of health products, training programs for technologists and establishment of a research foundation has ensured that continuous quality improvement is achieved. The success of Aravind can traced to its committed leadership, financial discipline and willingness to learn and change what is not right (Hemamalini, 2010). The organization has also instilled a positive attitude in its employees. The outcome of the strategies is seen through the continual increase in the demand for health services from the institution. This implies that patients who seek eye care services from Aravind hospital and its affiliates are satisfied by the services they receive. “Aravind has less than one percent of India’s ophthalmic work force but accounts for more than five percent of all the ophthalmic surgeries performed nationwide” (Ravindran, 2008).
Analysis of the quality healthcare framework
From the above description, Aravind is an organization that promotes healthcare through provision of different services such as examination and treatment of patients with eye problems, training of ophthalmologist technicians, and production of medical instruments. Thus it takes a comprehensive approach to ensure that quality healthcare is provided (Taylor & Jones, 2006). The comprehensive framework consists of the following: Establishment of camps to investigate and treat patients with eye problems; Establishment of centres that are staffed with nurses, technicians. The centres are used to identify and treat cases in the communities they are located; the centres are IT enabled and are fitted with equipment for wireless connectivity and this is used to transmit all the patient cases to the main hospital; The hospital has an efficient planning system that ensures that all the activities for the following day are pre-scheduled and the appropriate resources allocated; The framework also entails the quick adoption of new technologies for continuous quality improvement (Ravindran, 2008). The organization also carries out regular training activities to ensure that its staff members have the required skills. This is specifically done through exchange programmes with other world leading institutions (Sirkin, Hemerling, & Arindam, 2008).
Thus, the organization boasts of a highly skilled team that provides quality service to patients; as a means of maintaining the quality of its services the organization has standardized its protocols and efficient record keeping. The comprehensive quality healthcare framework extends to manufacturing of health instruments such as the Aurolab implants. The organization is also involved in intensive research activities to improve health services (Kitson, 2000). The organization’s mission and objectives stipulate the provision of affordable quality healthcare services and products to clients and achievement of growth through self sustenance programs (Komashie, Mousavi, & Gore, 2007). The efforts put in by the management gives a clear indication of how the organization is striving to achieve the laid down objectives. Apparently, the organisation is based in India which has the highest population of blind people in the world. According to the available data, India has 1.2 Million crore individuals out of a worldwide population of 4.5 million (Hemamalini, 2010). Thus Aravind inception was primarily due to the populations need for affordable eye care services and the founding father vision was that the organization will grow to provide affordable health care to all (Nieva & Soro, 2003). The Aravind hospital is in a situation in which many people will consider difficult but has been able to achieve success through strategic planning. In summery the hospital keenly observes the following factors that are critical to its success: “quality, speed, low cost, familiarity, patient satisfaction, team spirit and efficient use of technology” (Hemamalini, 2010). The achievements of the hospital can be determined by client value proposition, appropriate technology and the general satisfaction between and within departments (Ovretveit, 2006).
To assess the quality of services offered by Aravind hospital, the following scorecard will be used.
|Table 2:Patient Management Scorecard – Output. SOURCE: Hemamalini (2010). Patient management scorecard. (Retreived September 12, 2010, from Six sigma).|
|Critical Success Factors||Objectives||Measurements||Values||Targets |
|First Choice of Eye Patients||>Improve patient satisfaction level||>Degree of out-patient satisfaction |
>Degree of in-patient satisfaction
>Number of complaints
>Number of patient surveys
|>Develop guidelines for optimal patient satisfaction |
>Formulate a patient complaints procedure in all the department and execute it routinely
|Quality||>Greater degree of trust from patients in the service provided |
|>Degree of patient loyalty |
>Degree of perception over the facilities provided
>Degree of patients understanding discharge instructions
>Number of cooperative efforts
>Number of eye camps
|>Benchmark with regard to patient loyalty |
>Conduct loyalty programs to the nurses and doctors
>Implement TQM principles
>Give training to the counsellors about discharge instructions
>Conduct more outreach programs
|Hospital Image||>Improve the familiarity level with public||>Degree of public that know about AEH |
>Degree of public that prefer AEH service for eye care treatment
|>Conduct more health awareness programs outside the hospital |
>Provide good quality service
|Low Cost Service Provider||>Provide service at an affordable cost||>Degree of patients who feel that service is provided at affordable cost||72.9%||90%||>Provide quality service to all without regard to their ability to pay|
|Pace of Service||>Reduce the service delays |
>Increase the number of touch points
|>Service time and waiting time of patients in ODP department |
>Number of patient contacts
|>Set up patient help desks wherever needed |
>Cycle time optimization
>Increase the service counter that holds more delay
|Team Spirit||>Inter-department satisfaction||>Degree of satisfaction |
– Patient counselor
|90%||>Execute inter-department satisfaction study between all the departments |
>Organize meetings for the employees to enable communication between them
The framework adopted by the above organization is facilitated by several factors inherent within the organization and others which have been developed by the management. This includes the dual functionality of the organisation. The Aravind eye hospital specializes in the provision of all round care for eye problems. The hospital manufactures instruments used in the treatment of eye problems and offers various specialized services to patients (Milligan, 2007). The hospital has grown to a large community organization through embracing technology and the utilization of innovative ideas. For instance, the use of wireless internet connection enables the widespread centres to makes use of the few ophthalmologists through video conferencing (Ravindran, 2008). The organization has a strong and dedicated management that oversees the implementation of its strategies. The leadership is committed to the provision of quality healthcare services to all the clients (Braitwaite & Travaglia, 1999). The establishment of a training centre and a research foundation ensures that the hospital stays ahead of the park through innovation and the readily available skilled work force.
The only barrier associated with the Aravind health system is the fact that it operates in areas that are mainly inhabited by the poor. It has however managed to maintain cost effective services that do not compromise the quality (Taylor & Jones, 2006).
This paper sought to analyse the provision of quality health services at the Aravind hospital. The findings indicate that the hospital has an efficient quality improvement and monitoring framework that enables it to achieve patient satisfaction. As a response to the increased demand for quality health services, hospital managers around the world should make efficient use of technology and innovation to ensure that the services provided are satisfactory (Bokhoven, Kok, & Weijden, 2003). The hospitals should make use of scorecards as shown to help solve management problems and improve performance regarding quality patient services.
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