I Can See Your Tactics (from Madurai, India)

Our project is supposed to be about strategy, but after working with our client over the past few weeks, it’s clear that what drives their success is as much about tactics as anything else. Aravind Eye Care System is a network of five main hospitals and various clinics spread throughout the state of Tamil Nadu, India whose mission is to “eradicate needless blindness”. Sounds like a lofty goal, but over the past 30 years, Aravind has become the largest single provider of eye surgeries in the world. Its high-efficiency, high-volume model is the subject of numerous case studies, and doctors from all over the world come here to learn first-hand how Aravind operates. I knew all of this before coming here, but I didn’t really understand what it took to make this model work. The pervasive mentality of turning over every rock to find minute, detailed changes that can improve efficiency; these small things—the things so small they don’t merit mention in case study write ups—are what you need to build a sustainable (and growing) health services delivery business over three decades when 60%-70% of your patients need your services subsidized or completely free.

Our team was tasked with creating a five-year strategic plan for a new Central Operations Division. To inform our plan, we conducted interviews with Aravind hospital administrators, and we would routinely ask about past examples of operational improvements they could think of. Time and again, the answers we heard were not about new facilities, divisions, or technologies; they were about things like making sure the nurses always pulled case records from the bottom of the pile (it’s still mainly paper-based over here) to make sure that the patients who arrived first were served first, i.e. a FIFO system! One medical department chief told us that he prefers his department to work at, or over, capacity because that’s where you’re forced to find new efficiencies; basically, hiring new staff is for wimps (I’m paraphrasing). When we presented our preliminary deliverables to our main client contact for the first time, her main comment was that changes to the IT system (which was a big component of our imagined plan) were unnecessary. She wondered why they would invest time and effort to build out a new system now when they could just use what they already have and figure it out as they go. Bootstrapping, doing more with less, and sweating the small stuff are things many organizations claim, but it’s been amazing to see how pervasive this mentality is here, from the Chairman to the front-line staff.

In marketing class, Rashi quoted Sun Tzu about how everyone can see your tactics, but no one can see the strategy out of which victory is evolved. Aravind seems like the opposite case: the strategy is to eradicate needless blindness by providing selected eye procedures with sufficient volume and efficiency that they’re affordable to anyone who needs them. That much is clear, and Aravind is happy to tell that to anyone who will listen. What’s not as obvious are the countless ways that they achieve that efficiency on a daily basis; these tactics, and the institutional mindset that supports them, aren’t really visible until you see them first-hand.

With that said, here’s a bird that can tell your fortune. Apparently Vishnu is coming for me. While I generally get nervous when someone tells me that a god is “coming for me”, I was reassured that this is a good thing: bad stuff in the past is now over, and good karma is in my near future. Sweet!

—Jeff Williamson

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