ANALYSIS OF ORGANIZATION

Aravind Eye Care System

GROUP A2
AACHAL GARG 14F101
AMEENO PRADEEP PAUL 14F108
CHAITANYA JITENDRA GANDHI 14F118
JOE J KYNADI 14F125
KANIKA BANDOONI 14F126
SUDIPTA MONDAL 14F156

Contents Objectives 3 Organization Ecosystem 3 Organizational Context and structure 3 Structural Dimension 4 Formalization 4 Specialization 5 Hierarchy 5 Centralization 5 Professionalism 5 Organization’s Mission and Vision 5 Structural Context of Mission 6 Organizational Goals and Strategy 7 Porter’s Competitive Strategy 7 Miles and Snow’s Strategy Typology 8 Organisation environment and structure compatibility 9 Workplace Technology 11 Core and Non Core Technology 11 Technical Complexity 11 Relationship of Dept Technology to structural & management characteristics 12 Culture 12 Mission Oriented Culture 12 Cultural Strength and Internal Integration 12 Rites and Ceremonies 13 Control System 13 Value based leadership 14 Organizational Change (expansion) & Its Implications on Organizational Structure 14 A New Business Model 14 Aravind Today 15 References 17 Exhibits 18 Exhibit 1 18 Exhibit 2 19 Exhibit 3 19

Objectives The objective of this study is to analyze an organization by applying our theoretical knowledge of organization theory, learnt in classrooms. The organization we have chosen to analyze is Aravind Eye Care. The analysis is based on the following aspects: * Current organizational structure * Organizational goals & strategy * Organization’s relationship with the external environment * Work culture & managing changes
Organization Ecosystem
Aravind eye care is a respected and major eye care provider in the eye care sector of India. There are public and private players in the country who co-exist and provide services to the patients. Aravind eye care is a private player, who is respected for the services it offers for its precision and cost efficiency. They do a major chunk of the services for free and still manage to make a very healthy profit. It is does not receive any grant or charity and still can afford free surgeries. The founder of AECS Dr. G. Venkataswamy, fondly called as Dr. V wanted to remove needless blindness and reduce it. They are famous all over the world for the amazing price cuts brought into the cost and implementing the McDonald style of operations for a highly complex human sense organ, the human eye.
Organizational Context and structure

Exhibit 2 gives the organizational structure of the Aravind Eye Hospitals. The system works under a not for profit trust named Govel Trust of which Er. G. SRINIVASAN is the Chairman. There are senior Medical Officers, who usually head different clinics, residents, and fellows. The Medical Officers employed are mostly permanent employees at the hospital. The paramedical and nursing staff is headed by the Joint Director. Other units such as Coimbatore, Thani etc have their own heads who report to the director. All the heads of the hospital meet every week and discuss strategic and operational matters. The meetings are generally held face to face via video conference. Aravind Eye Care as an organization is very open and transparent. Every piece of information is freely circulated and is accessible to everyone who wants to have information on operational details. Dr. V. is who was inspired by Sri Aurobindo believed in the leadership style of “leading by doing”. He practiced humility and thankfulness by giving respect to every worker irrespective of the task he/she did. He would pick-up pieces of paper lying around and hand it over to the sweeper close by. He would never shout at the sweepers but by his action showed the value of humility and cleanliness. There is a conscious effort in bringing spiritual faith into the work place.
The Aravind Eye Hospital at Madurai also had a crèche for children of all hospital staff. The children were treated equally irrespective of the designation of the staff member to whom the child belonged to. The culture at the Aravind Eye Hospital completely rests on kindness, equality, humility, and service. Aravind Eye Hospital does not employee any visiting doctor or guest doctors, all the doctors who work at AEH are full time employees of the organization. The doctors employed were not allowed to carry out private practice as Dr. V. said that developing institutional loyalties was very tough in visiting professionals or doctors. They also may not develop the required skills. Doctors and medical staff were encouraged to do research work along with the surgeries they performed. But, no compromise on the surgical tasks was expected from them. However, they were allowed to give less time to O.P if they were pursuing research. Aravind Medical Research Foundation supported projects initiated by doctors; funding could also be sourced from outside organization for research and development purpose. The staff strength of the Aravind Eye Hospital is about 3000.
Structural Dimension The structural dimensions provide pointers to describe the internal fabric of an organization. It creates and benchmarks parameters for fair comparison between organizations.
Formalization
Aravind Eye Care is an old organization which was formed by Dr. V with a vision of eradicating needless blindness in India. With the McDonald model in mind for providing cheap and quality eye treatment to all the patients, formalization is very high in the organization. All the employees are told what to do and how to do so that eye surgeries can be carried in a planned and structured manner with impeccable success precision. Employees are trained and asked to behave well with all the patients and thank them for giving an opportunity to serve them.
Specialization
Aravind Eye care employees highly specialized medical practitioners. Specific roles are played by specific medical practitioners during an eye surgery or at a screening camp. The surgeons can take up research and development work and take time off from regular work as well if they are doing some sort of research. This helps them to improve their skills. The nurses play a very important role as well, there are more than one operating tables in an operation theatre and while the surgeons are operating a patient the nurses prepare the patient on other table. This increases the efficiency many folds.
Hierarchy
The organization structure is largely vertical in nature. The Chairman of Govel trust is at the top of the tree with two reports as Director and Jt. Director. Nursing staff, paramedics and senior medical officers at clinics report to director. PG students and fellows report to medical officers who work at hospital. The Medical officers report to senior medical officers. Exhibit 2 shows the organizational structure at AEH Madurai.
Centralization
The decision making process is highly centralized. All the treatment process at hospitals or camps are predefined and communicated to all the employees as per the task they are supposed to handle. Surgeons and doctors however treat the patient as per their prior knowledge on a case basis.
Professionalism
There is very high level of professionalism in the organization as majority of the employees are doctors. The organization uses research and technology extensively to increase its reach to people and its efficiency. A technical core team who has setup satellite communication channels so that treatment can be done in remote places also by the medical van. Organization’s Mission and Vision

Realizing the blindness problem and various predicaments associated like large population, inadequate infrastructure, poverty etc, with Indian healthcare scenario, Dr Govindappa Venkataswamy seized the passion of treating cataract blindness and hence providing quality eye care to rich and poor alike. This mission led to the formation of a non-profit trust namely, the Govel Trust which later named as Aravind Eye Hospital.
Mission: to eliminate needless blindness
Diversifying its branches to Theni, Tirupur, Tirunelveli, Coimbatore, Dindigul and Pondicherry; this vision of better eye care amongst the people, is passionately taken by the employees at Aravind Eye Care. The hospital maintains high quality service and services at affordable price to rich and poor alike. Hospital are said to be conducting as many as an average of 2000 operations per year. Despite conducting high number of surgeries, hospital doesn’t compromise on quality. So success of the model The enthusiasm for cataract eradication can seen through their encouragement of creating awareness and extending activities of Aravind Eye Care, through training, teaching, publications, research, to areas beyond southern regions of India and other countries.
Structural Context of Mission
As discussed, adhering to McDonald model for strictly following the mission,Aravind Eye Care system is highly formalized i.e. all operations are planned and employees have to abide by the rules for carrying out surgical procedures. This shows the dedication and passion to carry out operation with precision and successfully in order to eradicate blindness, which is the mission of the system.
Highly centralized decision making procedures are followed at Aravind Eye Care Hospital to make sure voluminous cases are solved. This shows their eagerness to follow their vision of better vision and spread it to as far as they can.
Highly specialization followed at Aravind Eye Care by medical practitioners, surgeons, nurses, screening camp practitioners etc. help in maintaining efficiency of the system and serving voluminous patients at the same time. This shows the firm faith of employees in their mission statement and dedication towards it.
Predefined rules regarding what to do, to everyone make Aravind Eye Care Hospital’s decision making more centralized. For example, patients are closely monitored by nurses and administrative staff, so that they don’t spend hours for treatment. This shows the zeal towards serving people and hence practicing humanity.
Organizational Goals and Strategy

We can all serve humanity in our normal professional lives by being more generous and less selfish in what we do. You don't have to be a 'religious' person to serve God. You serve God by serving humanity.1
- Dr.G.Venkataswamy

The primary goal of AECS is the elimination of needless blindness by providing compassionate and high quality eye care for all.2
All organizations have milestones. Some are planned far ahead of time and achieved only through strategic goals and objectives, and careful resource allotment. As the awareness and need for eye care increased, so did the demand. In order to meet these expanding needs and improve access to the masses, Aravind created a series of smaller eye hospitals in areas of high demand, based on current trends in patient load.
One of the most important lessons for AECS has been that eye care is a product and can be operated on high volumes. They also wanted to reduce the travel for its patients while consolidating on its base of paying customers so that its social goals could be met too.
Porter’s Competitive Strategy

AECS follows focused low cost leadership strategy. The key to their success was to keep the cost low in order to cater to the poorest section of society facing the issues related to eye. For this they pursued cost reductions and used tight controls to produce products. Though 60% of the patients do not pay for the service, AECS still achieves its goal because of its efficiency and low operating costs. Refer Exhibit 3.
AECS strategy can be viewed as internal strategy which is designed for successfully navigating the deceitful waters of organization change. AECS gradually underwent internal refinement and scaling up with the establishment of LAICO and Aurolab. Educational and training programs were developed into the full fledged scale. It even scaled up going outside the boundaries in a more proactive manner through the establishment of Aravind Managed Eye care services and Dr G Venkataswamy Eye Research Institute as well as growth and development of specialty care service.
Miles and Snow’s Strategy Typology
The innovation is the key for the success of Aravind Eye care system (AECS). Internally, since its inception, the organization structure has continuously evolved as per the environment. Aravind Eye Care Hospitals desires a path to grow without altering its vision of reaching quality eye care service to the needy either for free or at nominal costs. This led to various practices to cut cost while still improving the quality of care using practices associated generally with mass production and lean production. It received inspiration from McDonald’s, the fast-food chain which has also been able to standardize food delivery using high volume methods. A similar idea is at the core of AECS management philosophy and it is used in their hospitals and other facilities. 1. A Hub and Spoke design
Although the need for eye care in India is great, it was challenging to ensure that it had high patient volumes. So an outreach program called eye camps was organized and held on weekends that often attract large numbers of people. But it was found that only 7 percent of the people who needed eye care took advantage of the camps. Later, 40 local vision centers were set up and each centre covered a population of about 50,000 people and is staffed by a family technician. These technicians undergo training to enable them to conduct eye exams (including refraction tests) and to use grinding machines, handle lenses, and fit spectacles. The centers are connected to our base hospital via video conferencing so that each patient also gets advice from a qualified doctor. About 650 to 800 of these teleconferences are held each day. In addition, online health records were used to ensure quality of care. About 91 percent of the patients seen in the vision centers are able to get the care they need there. This reduces the time and expense involved in providing eye care services to the people of rural areas. Also they have free transportation facility to the base hospital for people who need further surgery as the costly machines are only at the base location instead of in all the centers in the villages.

2. Task Division
AECS used methodology to transfer the responsibility for carrying out routine activities to lower skilled workers by which the expert doctor need to now just handle only the most complicated procedures. Due to this surgeons can now focus only on the most technical and critical aspect of an operation which improves their productivity. In fact, surgeons can now perform 6-8 procedures per hour which was previously as low as 1-2 per hour. 3. Workforce Cost
To lower workforce costs, AECS focuses on letting doctors do what they are best at — diagnosis and surgery. So nurses perform various tasks in the operating room that do not require a surgeon’s skill. To further support doctors, AECS recruits several hundred women from local communities each year and gives them two years’ advanced training, after which they are certified as eye care technicians. These women make up 60 percent of our workforce, and they really are the backbone of the company. As they perform all the routine tasks, they free up surgeons to operate at a high volume.

4. In House Lab (AuroLab)
Intraocular lens manufacturer were not pricing for the Indian market, even though they reduced the price to $70 still patients could not afford it .So in 1992, AECS setup AuroLab, a nonprofit charitable trust that makes intraocular lenses and other ophthalmic consumables. The cost of this lens was $2 which was significantly less than $70 charged on the ophthalmic supplies that were imported. 5. Good, Old-Fashioned Frugality
AECS are known to use their resources wisely. They had researched on various surgical products and equipments and had found that they can be reused safely. Thus many surgical products and equipments that in most developed countries were used only once were used multiple times in AECS.
Organisation environment and structure compatibility

Organizational environment is defined as all elements that exist outside the boundary of the organization and have a potential to affect all or part of the organization.
Aravind eye care works in the health care sector with their main objective being to get rid of blindness and reach out to the poor who can’t afford to these services. Normally in the field of eye care the services offered by other competitors are priced higher and not up to the standards set by Aravind eye, this has made them really successful in reaching out to all levels of the society. Even though they do a lot of community service initiatives like free surgeries and all they make profits due to fact that they have structured there organization in such a way that its fits perfectly into the environment they work in.
There is a strict hierarchy of authority and control which enables the management to control and coordinate even though the clinics are widespread. Knowledge and control of tasks are centralized at the top of the organization. The management decisions are taken by the board consisting of people who have had experience in running clinics and hospitals. This makes the management efficient enough to take decisions and change strategies of the work as and when required. Management team of Aravind eye care is one of the major reasons why they have been able to establish themselves in the way they have.
It’s a top down formalized structure wherein the orders are made at the top and centrally distributed to the lower levels. The tasks within the organization is broken down into smaller separate parts and assigned to the employees, so that they get specialized in these tasks. This leads to better efficiency in there working .They have adopted the McDonalds style of operations wherein they have opened a large number of mobile clinics in a wide range of geographies to tap into all kind of consumers. They try to earn their profit through economies of scale wherein when the output is higher the costs incurred naturally comes down, and due to the specialization the work done by an average employee is usually higher as each task is subdivided. Aravind eye care has also invested a lot in their research and development in order to develop technologies so that they can lower their operating costs which will in turn help them earn more profits. To an extent they have been successful in this aspect and right now for most of the eye care services they offer the best quality service at the most reduced rates.
The entire communication system in the organization is vertical wherein the decisions taken by the top management is final and many rules haves to be adhered to by the lower level in the management line and employees. The management takes decisions based on the statistics and results of the performance. Since the company is offering services satisfying the customers are one of the major objectives, there are a lot of procedures and rules which are already there in the functioning of the company which makes sure of the satisfaction of the clients. And based on the feedback by the clients new and better ways of consultations are made.
Some of the innovative ideas introduced by the management is there fast pace of services, this attracts a lot of clients as in this modern age all are time deprived and anything which saves time people are ready to accept. There objective is to provide the best service in the least time and cost possible, they are well on their way to achieve this because of a structure and strategy that is well suited for the organizations environment.
Workplace Technology

Technology adopted at the workplace of an organization prefers not only the technological methods used but also talks about the organization’s production process which includes procedures and machinery.
Aravind Eye Care Hospitals has transformed into Aravind Eye Care System. At Aravind Eye Care System technology aspects can be classified as: products and services used for treatment, departmental technology, complexity etc.
Core and Non Core Technology
A core technology for an organization is the procedure that is directly related to the mission followed by the organization. For Aravind Eye Care System, the focus is upon serving medical facilities to the patients. Aravind Eye Care system, despite serving a lot of patients and conducting mass operations, uses qualitative products and equipment for treatment. For this they take help from non-core technology department.
Non-core technology department for an organization is the department where work procedure that is important to the organization but not directly related is carried out. Aurolab, the manufacturing facility for manufacturing intraocular lens; can be termed as non-core technology department, which helps patients to avails lens at very low price. Though the primary focus is on serving patients, Aurolab helps to attain that rather than directly helping in treatment.
Technical Complexity
Taking into consideration of technical complexity according to Joan Woodward, Aravind Eye Care System can be classified as Group-II category, where there is large-batch and mass production. Comparing AECS to Joan Woodward model, it can be inferred that patients are operated in large numbers. Operations and treatment follows assembly line type scenario where each department and personnel is communicated regarding what to do and how to carry out every segment of the treatment.
Relationship of Dept Technology to structural & management characteristics

Comparing with the four classifications as provided, AECS can be regarded routine technology. Refer Exhibit 1.
Routine technology follows high standardization and formalization which is exactly the case for AECS. Doctors, nurses, medical practitioners, workers, IT service providers, all are communicated with the exact procedure to be followed so that patient, right from their entry into the hospital, waiting for treatment to getting the treatment; everything is effectively and efficiently done. Their mission is followed strictly even when adhering to the technology to serve people with their best.
Culture
Mission Oriented Culture
In Aravind eye care, each employee works towards a single, unified goal. The organization is created on the sound & solid foundation of understanding the lives of its employees. The motive of the organization has been very clear not just in the minds of the founders but it has been nurtured into all its employees, to cure needless blindness.
Cultural Strength and Internal Integration
Patients who cannot afford to pay are given cataract surgery for free. Eye care is made extremely affordable through cross-subsidization i.e. charging patients able to pay (30% of patients) and using the collected fees to subsidize poor patients (70% of patients). Dr. Venkataswamy was deeply influenced by Mahatma Gandhi and Sri Aurobindo Ghosh, who founded the famous ashram at Pondicherry. A strong desire to give back to society was imbibed in Dr. V. The name ‘Aravind’ in the Aravind Eye Hospital was selected to honor Sri Aurobindo. The photographs of Aurobindo and the Mother could be seen everywhere inside the hospital. On joining the work, each employee quickly realizes the importance of the founder’s values. This forms a spirit of involvement and accountability amongst each employee. This sense of purpose and vision which imbibed in every employee has meant that they work beyond the usual desire of just making a career or earning an income, they see themselves as improving the lives of people & bringing a large impact to the society as a whole. They have a unique culture based on service.
Rites and Ceremonies
They also organize various events and celebrations for the employees like Annual Day Celebration, Graduation Day for the Staff’s Tiny Tots, kodai Kondattam, celebrations of various festivals Pongal, Navarathri celebrations, etc. Sangamam a celebration to recognize employee’s collective contribution and joint efforts which led to winning of prestigious international awards. Also Aravind celebrates AUROUTSAV for bringing out the team spirit and zeal of the staff. This helps in firming up team spirit. All employees, from the last grade worker to the chairman take part in it.
Control System
During recruitment process the organization look for potential employees that show capability to get along with the organizations culture. The basic value that they look for is compassion and they take out time to talk to the parents of applicants to find out about the candidate. Parents’ attitude and different aspects from home have a direct effect on how people behave, react & work. This is accounted for in the selection process. Once an employee joins AECS, AECS takes care of the expenses of their education, training and stay and provide them with employment. Even after joining the organization, AECS makes sure that they along with their family are well taken care off. Many especially the senior staff makes sure they take time to get to know their staff and their problems. They also make sure that the staff has the necessary training to be adept with the latest technology. An example of this is that they send 900 of their ophthalmology assistants for further training to better help the doctors and be more independent. Along with training they also provide various other facilities for the employees like top of the line child care facility.
The organization is very open and transparent. All information is freely shared with the employees or anyone who wants to have the information about the details regarding operations.
There is a conscious focus on bringing spiritual practice into the work place. All the doctors speak softly to patients and nurses. If a doctor behaves in an inappropriate manner, a word goes around the hospital immediately, and the doctor will be in trouble. AECS believes in mutual respect as a core value. In AECS, they recruit normal average people to work along with them and, their culture and ethics will make them work in a cohesive manner and so they get brilliant results from average people thereby developing them in a huge manner. The system is such that it allow employees to be accountable and empower them to lead the way in their own respective work
Value based leadership
The passion & energy which Dr. V had, provides an excellent example of the rationale that there is no age limit to entrepreneurship. Dr. V was one of the most respected eye surgeons in the whole world in spite of his physical limitations. In Aravind, senior executives have extended sense of leadership and control which is highly value based. It is not just about imparting the valuable sense of purpose, but guiding the employees to achieve small goals to make the big vision happen. Whether it’s the outpatient unit, camps, hospital reception or vision centers each and every employee is encouraged to achieve Aravind’s goal.
Organizational Change (expansion) & Its Implications on Organizational Structure

In 1976, Dr Govindappa Venkataswamy started an eye care clinic with 11 beds in Madurai with his personal savings & partial support from government. Initially it was 4 close family members (all doctors) with whom he started the clinic and its operations. Over the years, other family members too joined in and many of them have taken leadership roles. Broadly, on an average, medical officers perform 60 percent of the clinical work, 20 percent research and 20 percent teaching
A New Business Model

In 1992, Aravind faced a key trial in terms of the increasing costs and availability of intraocular lenses, IOL required for eye surgeries. With collaboration from American entrepreneur David Green, Aravind started Aurolab, a manufacturing set-up for lens production, which lowered the cost of lenses to 2$ from 150$. By introducing high quality IOLs especially to the poor people, Aurolab enhanced the market size and to make IOL surgery mainstream. It then ventured into the field of ophthalmic pharmaceuticals and became India’s very first nonprofit drug company.

Then in 1995 Indian Government along with World Bank funding formed a cataract blindness control program such that patients were offered a subsidy at camps. The number of beds as of 2000 increased to the 1468 beds (268 paid and 1200 free) in the hospital at Madurai. In addition, other hospitals in Tamil Nadu were also being opened. As of 2003 five Aravind Eye Hospitals carried a total of 3649 beds, consisting of 799 paid beds and 2850 free beds. Basically over 36 years of Aravind journey, they underwent expansion of the hospitals from one region to another. Aravind founded training and consulting institute internationally called LAICO (Lions Aravind Institute of Community Ophthalmology) in addition to eye-surgery related innovations. LAICO has consulted 213 hospitals in India. Aravind also trains paraprofessionals; many of them later become a part of the Aravind eye care team. To keep Aravind paced with the global and to provide information technology services, technological service provider center Auro iTech was created as well

The main divisions –

* Aurolab, the manufacturing facility set up primarily for manufacturing intraocular lenses;

* Centre for training Lions Aravind Institute of Community Ophthalmology (LAICO)

* Centre for ophthalmic research Aravind Medical Research Foundation

* Centre for women and children Aravind Centre for Women, Children and Community Health

* A worldwide renowned eye bank The Rotary Aravind International Eye Bank
Aravind Today
Aravind began as one small eye hospital, but now through its creative delivery and strategic business model with Aurolab, it has grown to five eye hospitals and two managed eye hospitals in south India. Aravind also creates eye camps for rural patients who cannot access the eye care facilities in major cities with the help of promoters & sponsors. At these rural Eye Camps, patients are examined, provided vehicle support up to the camp. Aravind Eye Hospital also has plans to establish its eye hospitals in, Udumalpet, Kovilpatti, Tiruppur, and Tuticorin, in the near future.

References
1. Aravind Eye Care System. [ONLINE] Available at: http://www.aravind.org/aboutus/genesis.aspx
2. M Neelam Kachhap , (2012). Sharpening India’s Vision. Express Healthcare. (1), pp.6
3. Tracey Vickers,Ellen Rosen, (2011). Lessons from the Aravind Eye Care System. Driving down the cost of high-quality care. (1), pp.10
4. S. Meera (2012). A bifocal strategy. [ONLINE] Available at: http://www.thesmartceo.in/cover-story/a-bifocal-strategy.html.
5. Profs. S. Manikutty and Neharika Vohra, (2010). Aravind Eye Care System: Giving Them The Most Precious Gift. Aravind Eye Care System: Giving Them The Most Precious Gift. 1 (1), pp.37
6. Joe Tidd, John Bessant, Keith Pavitt, (2005). Aravind Eye Clinics. Managing Innovation.

Exhibits

Exhibit 1
ENGINEERING
ENGINEERING
ROUTINE
ROUTINE
NONROUTINE
NONROUTINE
CRAFT
CRAFT

Exhibit 2

Note: The above is the structure of the Madurai Hospital. The structure of the other hospitals is similar.
Exhibit 3