I had the privilege of meeting Dr Ravindran, Ophthalmologist
and Chairman of Aravind Eye Hospitals, India, at the International Forum for
Quality and Safety in Healthcare London 2013. I had a general informal
conversation but it was of course an eye opener - you bet he has experience in
that!
I share some of the conversation here.
Clinicians' Selection processes at Aravind
Doctors
It is well known that Aravind has processes that are
followed really well by the staff, especially doctors who work there. Protocols
and processes are very important for their pathways and systems to work. It is
also well known in healthcare that it is very difficult to get doctors to
follow organisational protocols. I asked Dr Ravindran on how they do that.
Aravind appoints doctors after a 3 day selection process. Applicant
to appointment ratio is a minimum of 3:1. Fellows and residents work and spend
time with staff on those three days. Doctors then provide feedback to the
appointments panel on the suitability of applicants. Anyone blackballed by existing
staff are not selected. The main if not the only criteria for appointment is if
the doctor is 'suitable for our culture and basic values'.
They obviously get people who are already high flyers with
research credentials, publications, etc but Aravind's attitude seems to be that
they want only normal average people to work with them and their system and
culture will then make them do good work. (This sounds very similar to Toyota
Chairman Cho's statement that they get brilliant results from average/normal people
when other car manufacturers get average results from brilliant people). These
high flyers, if they are not suitable for the Aravind culture are told that
they are likely to be very successful outside the Aravind systems.
Chairman Ravindran says 'we want everyone to be pleasant
and professional to each other. If we detect even a small amount of arrogance
during the selection process, we will not appoint the person. Arrogant people
can offend and upset others which will disrupt team work and increase staff
turnover - we cannot have that'.
Nurses
Student Nurses are selected after a written test and an
interview. The test is a hand written test where they answer a question on a
social concept. Hand writing is thought to be important (if you cannot read a
person's writing the value of their documentation and written communication
becomes a future problem). As for the content, it is thought that if a young
aspiring nurse cannot write with genuine empathy about a socially important
issue they would not fit in with Aravind's culture and communication.
Now comes the interesting part of the process. While
interviewing the applicants is what everyone does anyway, Aravind interviews
the parents of the applicants. They see this as very important. Attitudes of
parents and aspects from home have an influence on how people behave and work.
This is accounted for in the interview and selection process.
Once they are selected to be nursing students, Aravind pays
for their training, accommodation etc. These students after graduation get to
work for Aravind.
I probed their thinking - I said that the society will have
many different types of people and their organisation will/should have
different type of people; including and excluding some types will not reflect
the society. Dr Ravindran was very clear with his answer, he said that of
course the society will have many types
of people but in his organisation they only want the type of persons who can
share their basic value.
Their basic value is compassion.
He also said that many in the organisation including the senior
people continue to engage with the staff and their lives, he said 'I know a lot
about many people who work with us, what they enjoy, what problems they have at
work, what issues they have outside work and in general a lot about their
lives. Due to this we are able to support them very early.'
Learning
I specifically asked him about where and whom he and his organisation learns from. He says that their main learning is from within their organisation, they try to improve everyday and share it with their internal colleagues - mutual learning within the organisation. (This blog has in a previous post stated this as the fourth fundamental condition if healthcare is to be successful
http://successinhealthcare.blogspot.co.uk/2012/01/hemadris-four-fundamental-questions-for.html )
No external consultant has even been contracted. No lean specialist, no management consultant. They get regular visitors trying to learn from the Aravind system. Aravind staff do visit hospitals
around the world to explore what might be suitable for adaptation.
Attitudes
When asked about how they deal with the high volume of patients Dr Ravindran said 'If we have more patients we simply start early - all of us.
We do not put patients on a waiting list, we do not turn patients away'.
I asked about being lean and quick and his response was 'It is not about being quick. It is the attitude of not
wasting anything. So if we don't waste time it looks like we are quick. We do
not throw away anything; if a bed sheet is torn you can be sure it will
re-appear in some other form to help with some other function'.
I think my commentary is not really needed as the conversation is very illuminating and self-explanatory. Their website shows that eight out of ten directors of their board are doctors - does that say something? I think we can learn a great many things from Aravind Eye Care and their practices. I wonder what we can actually adapt and use for healthcare delivery in the western world?
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