Updates from IBD India – Team Seva

Spring 2014 IBD Team “Eye of the Tiger” is in Hyderabad, India working with LV Prasad Eye Institute (LVPEI), a pioneer in delivering world-class eye care to those in need, regardless of ability to pay.  The team—Christine Hamann, Dave Haas, Janel Orozco, and Bob Weishar—are working in partnership with LVPEI and the Seva Foundation to identify operational improvements to the non-profit’s existing Vision Center Model as they continue to scale in order to reach India’s most rural populations.

Welcome to India! Our team touched down in India—the first thing that hit us was summer. As in 100 degrees. At 1am. The first 48 hours were full of rapid introductions to life in and around Hyderabad: delicious food full of a new combination of spices, intense traffic, the need for much lighter-weight clothing, the reminder that our varying American accents are quite difficult to understand, twice-daily chai breaks, and an incredibly warm and welcoming team eager for us to jump into the last phase of the work we have been focused on since January.

Fortuitous timing… Our team feels especially lucky in the timing of our in-country work. First, mango season in India peaks in the months of May and June, and our team even managed to get a tour of a mango farm one evening after work. Second, and far more importantly, we witnessed the creation of a new state. For the last 50 years, factions of the state of Andhra Pradesh have petitioned for the separation of the Telangana portion of the state—and on June 2, 2014 (following the July 2013 official decision) the bifurcation of Andhra Pradesh occurred. Our team returned from eight days away from Hyderabad to the city decked out in celebratory banners, flags, and lights; the official birth of the new state was launched with music, official speeches, and an hour of fireworks.

Our work Our team is working for the LV Prasad Eye Institute, a 26-year-old leading eye health organization dedicated to serving anyone in need of eye care—from vision screenings to cataract surgery to vision impairment rehabilitation—regardless of a patients’ ability to pay.

seva1IBD team sees the management and reporting structures in action for a remote vision center without EMR connectivity

Since its inception, LVPEI has treated over 17 million patients from locations across India, with over 50% receiving free care. LVPEI employs an interesting business model: offer a tiered level of customer service but identical clinical care to all, meaning wealthy patients can pay for a private room with A/C, an faster check-in process, and more creature comforts—while subsidizing one or more patients who cannot afford to pay.

Our team was charged with two specific projects at the start of the semester, each focused on the primary care base of LVPEI’s pyramidal eye care delivery structure: the vision center. LVPEI has a network of 109 vision centers across the states of Andhra Pradesh and Telangana, with plans to expand to 150 vision centers by the end of 2015. Our two deliverables for IBD are 1) help LVPEI identify and implement operational improvements to the vision center layer of care and 2) build a case study of recommendations for the expansion of the vision center model within LVPEI and for other organizations looking to adapt the vision center model to their own work.

seva2An LVPEI vision technician assesses a patients’ vision at a Community Screening Program

Our in-country time has been focused on two activities: conducting interviews with as many vision technicians (the single staff members who each run one vision center) as possible, and visiting the larger clinical institutions that the vision centers feed into—regional secondary and tertiary care centers as well as the Center of Excellence in Hyderabad—to understand the vision centers’ role in the larger eye care delivery model. This has meant that we’ve spent time in Hyderabad, traveled to Thodokurthy, took an overnight train to Paloncha, and spent many, many hours traveling with the incredible LVPEI staff to remote locations that are often hours away from the nearest secondary center on small and (very) bumpy roads through rural India.

The design process Our team landed in India with ideas and hypotheses about the challenges the vision centers face—but needed a rapid way to see if our hypotheses were correct, obtain new information that was impossible to know learn working from Berkeley, and come up with recommendations for the local team. We chose to use the human-centered design process. By adapting our interviews with insights learned from each previous staff member we spoke to, we were able to build out a more complete picture of the challenges faced at the vision centers, as well as test new theories in rapid succession with feedback from the local team.

seva3Identifying our course of action through solution laddering

Part of the design process to truly understand the customer experience. Janel went beyond herself and had her annual vision checkup at the first vision center we visited in Nagarkumol. The vision tech, if slightly thrown off at the request, quickly moved into an efficient and thorough eye exam.

seva4Janel Orozco receives a comprehensive vision exam by an LVPEI vision technician

Combining this work with the operational analyses of data collected over the course of the semester and last three weeks, we have identified key recommendations (some that look very different from our initial hypotheses) for the team here at LVPEI. We are looking forward to presenting these final recommendations to the senior leadership team at the end of our engagement.

Team building…and cultural exchange? A key to working in India is adapting to local customs and the flow of work and life here.  It has not been difficult to fold the aforementioned chai breaks into our workdays—even better that chai time is a mandatory break from your computer and is used to socialize with colleagues. We might keep this tradition when back at Haas. However, we don’t think some of our traditions will live on following our departure. Thinking it would be a fun teambuilding experience, and certainly would mitigate work stress (and the delicious but endless supply of chapattis and rice), our team brought along the Insanity workout series. While we tried, we couldn’t get any of our new colleagues to join our daily workouts…

All work but some play… The healthcare sector in India works a six-day workweek, giving Sunday Funday a whole new meaning. Despite the shortened weekends, our team team managed to pack in a number of activities to round out our understanding of and experience in India. From a day-long riverboat adventure to a Hindu temple complete with a beach picnic and lots of people eager to see if a group of Americans could copy their boat party dance moves, to fire-roasted dinner at a Paloncha truck stop, to haggling prices for bangles in the market surrounding the Charminar in Hyderabad, to tucking into the famous biryani at Paradise Restaurant, we feel like we’ve experienced a range of life across central India.

seva5The IBD team with the Paloncha secondary center kitchen staff

Lessons from India 

As our team wraps up our work with LVPEI and the end of our first year of the Haas MBA, we have a few IBD lessons to share:

  • The design process works: while we certainly had inclinations for solutions at the start of our in-country time, our best ideas came through the processes of rapid ideation and customer interviews in the field.
  • Fans (and A/C) are your very best friends during summer in India.
  • Your clients are your greatest resource—make sure to get to know them as people, not just your clients!
  • Running for trains in 115 degree heat is not the best travel plan.
  • Related: train platforms can be really, really long.

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