Eye Care Institute Analysis

• Ishan Narma
• Jyotismaya
• Shabeer Pk
• Khayapam Raising
• Ujjval Rana
• Nahid Zafar
• Ipshita Prasad
• Usha Deepthi

INTRODUCTION:

The LV Prasad Eye Institute was established in 1987, with a mission to provide equitable and efficient eye care to all sections of society. Started with a goal to be a leader in combating global blindness through the direct impact of patient services and the indirect impact of training it provided to eye care professionals, LVPEI by 2011, had become a world class eye institute encompassing services such as clinical care, education, research, rehabilitation and high impact rural eye care.

LVPEI was the brainchild of Dr. GN Rao, who after working for 12 years in the United States, was greatly inspired by the quality of eye care provided there. Born in a small village of Andhra Pradesh, Dr Rao was very sensitive to the health problems of the poor and wanted to do something for them. His dream of serving the poor was shared by film producer L.V. Prasad, who wanted to support a project dedicated to enhancement of vision. L.V. Prasad donated a 5 acre plot of land to Dr. Rao to start an eye hospital, along with the equivalent of 1 million US dollars. Dr. Rao named the hospital after L.V. Prasad, to respond to his generosity. Additional funds were generated for the hospital from the United States through the Indo-American Eye Care Society and finally the hospital started operations in 1987.

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The hospital was built with a keen eye for aesthetics. Dr. Rao did not want the hospital to look or feel like one, instead wanting a sunny and pleasant place with wide corridors and soothing décor. Dr. Rao wanted to focus on the patient, keeping in mind his dignity, needs and comfort. LVPEI offered services for all types of eye care diseases, from routine cataract surgery to complex procedures such as retinal, corneal and oculoplasty services. Special service facilities were set up for the vulnerable age groups such as children and the elderly.

Since it was established in 1987, LVPEI had provided outpatient care to six million and surgical care to more than 585,000 patients, 52% of them free of charge. LVPEI had reached a total of 17 million people, and had built permanent eye care infrastructure in 16 districts of Andhra Pradesh.

Vision 2020 – The Right to Sight

In order to address the problem of increasing number of global blindness, WHO and the International Association for Prevention of Blindness jointly launched a common agenda for global action: Vision 2020 – The Right to Sight. Five conditions were identified as immediate priorities based on their high prevalence, and the affordability of interventions to treat them. These were Cataract, Trachoma, Onchocerciasis, Childhood Blindness and Refractive Errors.

PYRAMID OF EYE CARE

In order to attain the aim of making eye care accessible to everyone, Rao and his team developed the LVPEI Pyramid of eye care. The main emphasis of this model was to provide eye care at appropriate level, easily accessible and affordable without any compromise in quality. This resulted in the creation of facilities within the community which are linked to higher levels of care. The pyramid consists of 5 levels of care. They are, Community Level Care, Primary Level Care, Secondary Service Centres, Tertiary Care Centres and Centre of Excellence.

Community Level Care:

The community level care is provided by the vision guardians. They look after the health of 5000 people. They monitor the health of children and elderly by doing door to door campaigns and through other means. They monitor those patients who have had surgery and provide readymade near vision glasses. They also refer those who need eye check up to the appropriate centre.

Primary Level Care:

The primary eye care is provided at the Vision Centres, managed by the Vision Technicians trained by LVPEI. They screen people at the centre and children at school. They cover a population of 50000. They dispense spectacles as well as educate the people about their use. They also identify people for surgery & advanced eye care.

Secondary Service Centres:

At this level, outpatient services are provided where diagnosis of all eye diseases is done. They perform eye surgeries and also serve as the referral source for tertiary care. They serve a population of 1 lac. There are 11 secondary care centres and 9 partner centres.

Tertiary Care Centres:

They provide highest quality medical and surgical eye care irrespective of the socioeconomic status. They serve a population of 5 million. They offer finest medical education and surgical training to eye care professionals and also conduct innovative research.

Centre of Excellence:

It is situated at Hyderabad serving a population of 50 million. It provides services like management of complex cases, training to subspecialists and trainers, rehabilitation, research and capacity building of training centres.

This model of LVPEI is so efficient that the Government of India has adopted the same model for eye care service delivery in current five year budget plan.

EDUCATION AND TRAINING

LVPEI considers training and education as an important factor which can influence the quality of eye health service delivery. The training aims to upgrade the skills of ophthalmologists and equip new entrants to the field with the appropriate skills and knowledge. The institute develops human resources internally through training and education. All the clinical staff, support staff, ophthalmic technicians and eye care administrators undergo a training program before they are recruited for the particular post which helps to maintain quality care across all the levels of care. It has a comprehensive co-operative agreement of mutual benefit in education and research with the University of Rochester Eye Institute, Case Western Reserve University, the University of Wisconsin, Duke University and Bascom Palmer Eye Institute in the United States and the University of New South Wales and University of Melbourne in Australia. This gives great opportunity for those who would like to excel in eye care delivery.

RESEARCH AND ADVOCACY

LVPEI integrated research as a part of service delivery though it affected the clinical workload and productivity. It was 25 years ago, the research started at Hyderabad Eye Research Foundation (HERF), the research arm of the institute, with the support from Professor Brien Holden of the University of New South Wales, Sydney, Australia. The research concentrated on molecular genetics of inherited eye diseases, molecular diagnostics for early detection, microbiology of eye infections, biochemical features of cataract and stem cell technology for reconstruction of the damaged ocular outer surface. Research is spread over the centres at Hyderabad, Bhubaneswar, Visakhapatnam and Vijayawada. It not only conducts clinical research but also clinical trials. Each clinical research project and trial goes through a rigorous examination by Institutional Review Board (IRB), for its scientific and ethical aspects. Only those that are approved are taken up. The projects were supported by the grants received from the Department of Biotechnology( DBT), Department of Science and Technology(DST), Council of Scientific and Industrial Research (CSIR), Indian Council of Medical Research(ICMR), National Eye Institute(NEI, National Institutes of Health), USA.

HERF is one of the four pillars of the multinational research and development group called Vision Cooperative Research Centre (operating from Sydney, Australia). It conducts research on a series of clinical studies.

Research at the Institute aims to be “relevant, rigorous and cutting edge”, and hopes to become one of the most productive eye research groups in the world. Towards this aim, there are six initiatives. They are a new Academy for Eye Care Education, Child Sight Institute, Institute for Eye Care for the Elderly, Centre for Ocular Regeneration (CORE), Institute for Eye Cancer, a Centre of Excellence in Eye Banking. The start of SRUJANA (a Sanskrit term meaning creativity), centre for innovation was a milestone. It is a bilateral program between HERF and groups at the Massachusetts Institute of Technology (MIT), Cambridge, MA, USA.

INTERNATIONAL CENTRE FOR ADVANCEMENT OF RURAL EYE CARE (ICARE)

International Centre for Advancement of Rural Eye Care (GPR ICARE), LVPEI’s community outreach program, began in May 1998, with the aim of making high-quality, appropriate eye care accessible to all.

Objectives

LVPEI tried to develop high quality self-sustaining eye care services in neglected areas of India and other parts of the developing world and to train all cadres of eye care personnel for the provision of efficient eye care services. Its objectives include participating in planning eye health initiatives in the developing world to undertake operations and research projects. Also LVPEI collaborated with international NGOs like Operation Eyesight Universal (OEU), in turn to support the hospitals to scale up their capacity to perform affordable cataract surgeries and provide comprehensive eye care services around the world. This support of LVPEI helped the hospitals to increase the number of patients by 100 per cent.

Organisational Excellence

Rao gives the full credit of organisational excellence to the employees. It is achieved by constant nurturing of its employees by giving continuous education program and training activities at various levels. The culture of the institute is build around quality care. To instil quality consciousness, they conduct presentation once a month at 7am meeting on already audited files and will see how they had complied with the standards. This effort will reinforce the quality consciousness among the employees.

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Since the organisation is depending on their employees the biggest challenge in front of LVPEI is in finding right people at right position. According to them they don’t want to hire somebody to fill a slot, but need people with exceptional potential. Their recruitment process is unique as they try to bring young people from rural areas and train them both clinical teachings and the culture, which they are following in the institute. They always prefer to have fresh minds over personnel with previous experience, since the experienced people couldn’t follow the institute. LVPEI gives importance to individual growth and career development as well, as they allow doctors to allocate their time at hospital between patient care, education and research. LVPEI culture is highly patient centric, we can see it from their practices like, doctors directly go to the waiting room to fetch the next patient, instead of waiting for the nurse to do so. The closest parking area is reserved for patients rather than doctors and the staff members.

The founder of LVPEI, Gullapalli N Rao, did his graduation in medical science (MBBS) at Guntur, Andhra Pradesh and completed his post graduation from AIIMS, Delhi in ophthalmology. He then went to the US in 1974 and came back in 1986 and established LVPEI in 1987 in Hyderabad (Andhra Pradesh). The idea behind this institute is to help poor and needy people in terms of alleviation of blindness. By the technical knowledge and experience gained in India and US and his strong desire and passion toward the work for the poor and needy people develop his leadership quality.

DR. RAO’S LEADERSHIP SKILLS

As we are talking about the work done by Rao and his leadership under which LVPEI gets the highest level of honor in people’s mind, it is to be emphasized that this is achieved solely by strong desire. Dr. Rao displays basically three kinds of leadership –

• People oriented leadership
• Transformational leadership
• Contingency leadership

In People oriented leadership there is a mutual trust that exists between the leader and the followers. Leader is very much concerned about the desire, demand and welfare of his follower and this gains him respect and popularity among the followers. Dr. Rao’s patient- centric approach is clearly seen from his own quotation -“Patient is king; his dignity, needs and comfort supersede everything also , regardless of whether he pays for it or is treated free of cost”. His nature towards the patients can be understood with the help of certain scenario described by his staff member and patients.

For example, in terms of reducing the waiting time of the patient come for the treatment in OPD doctors of the hospital has to walk in the lobby to approach the patient. Another example is about the parking arrangement of the hospital where the area is clearly defined for the staff and the patients come for the treatment. Parking area of the patient is nearer to the hospital as compared to staff so the patient is given prior importance.

There are mainly three kinds of qualities which we have observed in a transformational leader – charismatic, inspirational and individual consideration. In case of Rao, he is a visionary in nature. He is totally devoted to his goal to alleviate blindness and plan and work accordingly to meet his desired goal. He is very professional and his communication skills are excellent and so people feel comfortable in approaching him. His long term planning quality makes him a charismatic personality. Rao is very good in technical knowledge and skills and these are built on the foundation of his hardworking and passionate nature. His hardworking attitude made him popular in the hospital under the name of ‘Task maker’ and he unwillingly became the inspirational model for many people. By rewarding the staff he motivates them to do best for the hospital and for the patients. He strives to resolve even the personal problems of his staff and provide moral support.

Contingency leader is the person who responds according the situation required. In case of Rao many people give different opinion; some would say he is autocratic in nature, some would say he is charismatic but democratic in nature, and further some would say he is very supportive in nature. Actually he responds differently according to the situation required. He becomes autocratic when matters of policy making, decision making, task completion and quality of work are concerned; becomes democratic when we are talking about long term projects and providing help to the staff and he becomes supportive when his staff have any issues may they be personal or professional.

Rao’s leadership might be different from other leaders but he is the one who has made LVPEI the pioneer institute for eye care in India. Apart from LVPEI, Aravind Eye Hospital has gained massive popularity among the people. All this has been possible by the transformational leadership of Dr. Venkataswamy, who started this not for profit institute on great Indian mystic Aurobindo’s philosophy.

QUALITY MANAGEMENT

LVPEI follows standard protocols and processes for providing best quality eye care. By having proper support from appropriate systems, the doctors are able to treat lot of patients in the OP. They are following data driven approach to monitor quality. They periodically review the programs to modify them accordingly and to implement policies.

FINANCIAL VIABILITY LVPEI is under the supervision of two not for profit institutes, Hyderabad Eye Institute and Hyderabad Eye Research Foundation. Even after treating a large chunk of patients at free of cost, they managed to generate profit. The main source of income for LVPEI was through cross subsidization of treatment where the treatment cost of poor patients is covered by rich patients. They are receiving donations from like-minded organizations, who support its work.

FUTURE OF LVPEI

The Indian health care industry is entering into new era with significant changes in greater affordability, increased awareness in patients, and presence of more health care providers.

The population opting for health insurance is about 2% in India and about 20-30% of insured patients visit urban hospitals for seeking health care services.

Now-a-days patients’ requirements have shifted from good quantity of vision to good quality of vision. There are more specialized clinics that educate patients on various methods of eye treatment and their outcomes. Due to all the above issue LVPEI has been forced to restructure and reorganize its system of delivering eye care facility.

ORGANIZATION LIFE CYCLE AND LEADERSHIP – A FUTURE PERSPECTIVE

Being a 27 years old organization, LVPEI has already reached a state of maturity in its life cycle, which is characterized by delay in decision making, being less proactive, less innovative and more risk-averse.

LVPEI has a functionally based structure that is primarily led by doctors and exhibits as fairly centralized. So for this LVPEI has developed a bureaucratic style of functioning and decision making. Its focus is mainly on efficiency rather than novelty.

The future head of LVPEI should to be an ophthalmologist having an outstanding track record and who could take forward the organization into a desirable state of its functioning. LVPEI prefers its future head to be a clinical scientist respected both nationally and internationally.

COMPARING DR. VENKATASWAMY’S LEADERSHIP WITH DR. RAO

Both the legendary leaders from India, who tried to held head up in the global eye care. The main attracting feature of Dr. Venkataswamy’s leadership was his clear vision about the hospital and its function, while Dr. Rao is very much concerned about the needs and welfare of his followers and this make him respectful among the followers. Dr. Rao put emphasis on quality care and highly patient centric approach in the institute’s culture, Dr. Venkataswamy believed in social marketing strategy for the development and expansion.

CRITICAL ANALYSIS WITH ARAVIND EYE HOSPITAL

LVPEI has got a clear cut strategy for community outreach programs, but Aravind eye care lacks clarity on it. LVPEI focused on producing human resources internally, while Aravind eye care preferred persons with experience. LVPEI’s focus is on quality care, Aravind eye care focused on quantity, by increasing the number of patients.

CONCLUSION

Facing great challenges from both environment and leadership change, LVPEI had set a few goals for itself in the next five years, such as, strengthening its brand as a cutting-edge eye care delivery system, providing good quality of services and education, strengthening the ability of the institute to conduct breaks through clinical research, improving the ability of LVPEI to provide high level community health services, and improving its ability to enhance the capacity of LVPEI to become a role model globally in eye care health delivery system.

Ultimately the main focus of LVPEI is to provide eye care facility to 200 million people directly by 2020. LVPEI also aimed to enhance the eye health policy across India and globally through providing quality eye health.

Finally Dr. Rao articulated in his dream that, “when people talk about best eye institutes globally, LVPEI must come up for discussion”

REFERENCES:

1. http://www.lvpei.org/