University of Iowa

With an eye toward greater efficiency

December 2nd, 2015

UI students to help vision clinic in India expand services for poor patients

By Tom Snee, Iowa Now

A team of University of Iowa students will visit India in January to help a world-renowned eye doctor provide vision care and cataract surgery to more poor patients.

The 12 students will spend two weeks at the Aravind Eye Hospital in the city of Madurai, looking at the organization’s operations and suggesting cost saving improvements. The clinic is known around the world for revolutionizing eye surgery to remove cataracts by turning the procedure into what is essentially an assembly line, says Bob Walker, a lecturer in the John Pappajohn Entrepreneurial Center who is co-organizing the trip. The process creates efficiencies and reduces expenses so that clinic has been able to perform 4 million surgeries since it opened in 1976, many of them for little or no cost to poor patients.

“The doctor who founded it was inspired by mass production techniques, and he calls it the McDonald’s of cataract surgery clinics,” Walker says. “His goal is to provide eye care to everyone and eliminate blindness in India.”

Blindness is an especially acute public health problem in India, Walker says, as the country has more people with vision problems than any other, especially among the poor. Nearly 19 million people are considered blind, and about 9.5 million of those are blind as a result of cataracts, according to the U.S. National Institutes of Health. Those are especially frustrating because cataracts are easily fixable with modern technology and surgical techniques, but Walker says poverty and culture keep many Indians from undergoing the surgery.

The students taking the Health Care and Entrepreneurship class are from the College of Public Health, College of Engineering, and Tippie College of Business, most of them studying for careers in logistics and process improvement. Their task will be to find further operating efficiencies that will allow the hospital to expand its services further, in particular to make eye care more accessible to the poor. Finding efficiencies will be a challenge—the hospital has a gross margin of 40 percent, even though 70 percent of the patients pay nothing or close to it, so it’s pretty efficient already. But Walker says that will be one of the learning opportunities for the students, who will face similar efficiency-wringing situations once they’ve started their careers.

“They’ll observe operations and intake procedures, patient processing, post-operation follow-up, and visit the hospital’s field clinics in cities outside of Madurai,” says Walker, who is co-organizing the trip with his wife, Kristy, chief information officer of UI Health Enterprises who teaches health care informatics in the College of Public Health. “They’ll also analyze how the use of telemedicine can make the clinic more efficient.”

Walker says the students will present their findings and proposals to the clinic’s managers before returning to the United States.

The students will be in India from Dec. 27 to Jan. 17. Caitlyn Hagarty is one of the students taking the trip. An industrial engineering major in the College of Engineering, she is also interning in the University of Iowa Hospitals and Clinics’ office that oversees its continuous improvement and LEAN management programs. She’s looking forward to seeing how the India clinic manages to achieve such a high success rate with so few resources.

“They’ve revolutionized cataract surgery by providing higher quality and doing it more safely than anyone else,” says Hagarty, a senior from Colfax, Iowa, who’s planning a career in health care process improvement. “Our health care system is broken in the United States, and I want to see what we can learn from what they’re doing in India and if we can make it work here.”

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