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Creating an Enabling Environment for Eye Care Service Delivery
The global initiative, VISION 2020 The Right to Sight has set a goal of eliminating needless blindness by the year 2020. Today we are in the midway mark with just another decade to go. If we are to truly achieve this goal we have to step up our current performance in the developing world ten-fold. And this will also have to contend with the doubling of the population above 50 in the developing countries. The current output levels especially of cataract surgeries is dismally low in most of the regions which is further aggravated with emerging blinding but preventable eye problems such as glaucoma, diabetic retinopathy, Paediatric eye care, low vision, etc. There is also an increase in the need felt for addressing refractive errors. Having identified the clinical solutions to such problems the challenge still remains in bridging the gap between the service and those who need it. While eye care programmes have devised intelligent strategies to overcome the obstacles of access, affordability, sustainability and quality, these programmes are frustrated at the level of execution. Factors that impede the achievement of desired levels of service uptake especially in the developing countries are not related to ophthalmology. Low utilisation levels of existing facilities and resources are caused not by a lack of demand but because the two are not appropriately choreographed. The focus has been mainly on ensuring that the right amount of resources is in place to address the issue of eye care for a particular area. We also need to design and develop an enabling environment at each level to ensure that execution of the intended service delivery happens effectively (good visual outcomes in the long run for all patients) and efficiently (maximum number of patients are served with optimum resources ensuring that the costs are low and the service, sustainable). This consultation was convened with the intention to bring together eye care workers to deliberate on what determines an enabling environment in the four dimensions of eye care service delivery:
An Enabling Environment for Reaching the Patients: Learning from the Cell Phone Industry Mr. T.V. Ramachandran, Director General, Cellular Operators Association of India Prof. Manikutty, Indian Institute of Management, Ahmedabad If hi-tech products like cell phones could penetrate 40% of the Indian market in less than a decade, why not something as simple as eye glasses? A decade ago there were a negligible number of cell phones in the country. Today, every third Indian has a mobile. And the penetration is high even in the rural sector. And this sector has had more than its share of issues to contend with policy restrictions, limited spectrum to operate within, a product that demanded that the user be knowledgeable to use it, a relatively expensive product. Yet, the sector seemed to have done things right to offer the product in a way that it is easy for the common person to avail of its services. Lessons for Eye Care: Penetration of eye care services will of course come from making the offering user-friendly in terms of awareness, access and affordability but patient experience will also influence uptake. The design of the service will have to allow for better patient experience. This is possible only if the services are inherently designed and offered with the patient at the focus. At a broader level, this can be fast-tracked by leveraging partnerships by developing healthy competition to compete against the disease, developing a common minimum programme and developing service partners at different levels of service delivery to ensure maximum coverage. An Enabling Environment through a Comprehensive Approach: Addressing the Enormity of an Issue Mr. Sudipta Mohanty, Programme Officer, Sightsavers International, India Dr. Pararajasegaram, Former WHO Consultant The 1994 plague gave Surat a bad name. Today, it is one of the cleanest cities in India. How did they bring about such change at this level? Surat was a trade hub with a dense population. Uncleared garbage and sewers in bad condition was part of the landscape. In September 1994, Tapi River flooded Surat and left 51 people dead this was attributed to be because of plague. This was attributed to the unhealthy conditions. The Government realized the need to develop and provide the people of the city with better health facilities. Mr. S. R. Rao took charge as Municipal Commissioner in May 1995 intended to make Surat as Indias second cleanest city in twenty months. Daily review meetings with implementation team, a citizen complaint redressal system, regular cleanliness checks on markets, hotels etc., penalising littering, creating awareness on hygiene, instructions to use disposable glasses, streamlining garbage disposal, demolishing illegal encroachments in the city formed the range of activities he pursued in order to succeed in this attempt. Bihars primary health service ranks second to last among the states of India. How did the district of Kishangunj fix its primary eye care service? With a population of 80 million there are an estimated 0.6 million people blind. Lack of ophthalmologists and ophthalmic assistants make the problem worse. Kishanganj District in Bihar fixed this problem taking a comprehensive approach based on an initial survey of the available facilities and their current level of performance, identifying human resources and the extent of support from funders and the government. In order to strengthen the primary eye care services Kishangunj focused on all aspects of the service awareness creation, designing the service to ensure uptake, human resource and systems to ensure full utilisation of the services. Today they do over 80 surgeries each month. Lessons for Eye Care: Taking a comprehensive approach to eye care delivery demands an understanding of the scenario and working from all angles to correct it. Any change cannot be sustained if it provides only a part of the solution it is essential to set right all elements of the whole and to address the root causes of the problem. A comprehensive approach to any public issue usually demands the forging of partnerships with several agencies such as the government and developing good community support. An Enabling Environment for a Successful Eye Care Provider: Organising for Excellence Mr. Sanjeev Kotnala, Vice President, Brandcomm, Bhaskar Group of Publications, Mumbai Mr. N K Sharan, Chief -Business Excellence, TATA Quality Management Services On the day the newspaper was launched, Divya Bhaskar became the number one daily in the state. How can you orchestrate such a success? In 1996, the Bhaskar Group operated in 1 state with 5 editions and 3 million readers. In 2009 it was circulated in 10 states, 48 editions and 43 million readers. The day they launched the Gujarati version, Divya Bhaskar, they were the no. 1 daily in the state. In little over 10 years, Bhaskar has achieved growth and readership figures that others even in the global newspaper business have taken nearly a century to achieve. This was done in a highly competitive sector where loyalty to a newspaper is hardest to change. They involved the target audience in designing the newspaper they met EVERY Gujarathi speaking household and asked what they would like their newspaper to be like and what was lacking in the current newspapers 1.2 million households! For this they organised a workforce of 1050 surveyors. They prepared to do this in just 40 days! Part time college students were put through a 20-day training and all processes were standardised. There was always a senior member on the field ensuring support was provided to these surveyors and they were kept highly motivated. All data analysis was complete by Day 42. Dainik Bhaskar also worked on building a good relationship with the hawkers. This survey initiative helped develop an inclination towards the paper before it was launched every Gujarati felt part of the design process. Lessons for Eye Care: Good management systems are important to deliver low cost quality eye care on an everyday basis. With adoption of a comprehensive approach and sound organization of the tasks this is possible. Some of the lessons that eye care providers can learn from the Bhaskar Group include:
The Tata group has demonstrated that organisations can sustain high levels of energy over a long period of time. These fundamental principles of excellence can be applied beyond a particular industry or sector. One of the globally most reputed brands, TATAs are domestic leaders in many verticals and are globally competitive. The Tata group companies all share a similar story of excellence. This requires a formal structure to drive excellence. Lessons for Eye Care: Good Eye care service delivery, too, needs a formal process and system to drive excellence a mechanism to:
Keeping our Workforce Engaged Mr. Pankaj Pipariya, Associate partner Gallup India Ms. Preethi Pradhan, Senior Faculty, LAICO Aravind Eye Care System, Madurai Despite all training and planning, it is the quality of each patients actual experience with our staff that contributes to building his trust and loyalty. How can we drive success by effectively managing these moments when our employees interact with customers? Patient engagement is vital to ensuring organisational success for any service provider is your patient strongly attached and loyal to the organization or is he neutral and likely to jump to another organisation given a chance? In order to ensure that your workforce creates an enabling environment where your patients can feel engaged it is important to keep your employees engaged. The world's top-performing organizations understand that employee engagement is a force that drives business outcomes. Gallup has observed that world-class organizations make employee engagement a priority by focusing on the following: Strategy, Accountability and Performance, Communication and Development. Taking employee engagement one step further, Gallups Human Sigma offers an innovative, research-based approach to the toughest challenges businesses face today having an engaged workforce. It combines a proven method for assessing the health of the employee-customer encounter with a disciplined process for improving it. It helps us become conscious as employers when we define the a hospital as not only a place that treats patients but also as a place of work how can we make it a great place to work? An assessment of cataract surgeons trained in Eastern Africa showed that the productivity of the surgeon depended largely on the hospitals ability to ensure a good inflow of patients through community outreach, availability of cataract surgical sets, condition of the operating microscope, reliability of supplies. A study of the influence of HR practices on employee satisfaction (of doctors, nurses and support staff) in eye hospitals, showed that remuneration played a less influential role in all categories of staff (doctors, nurses and support staff) than others such as congenial work environment, supervisory consideration, job design etc. Lessons for Eye Care: Eye care service providers can keep their employees engaged by creating better role clarity and alignment to organisational mission. Employees feel an ownership to their work and the problems they face when they are involved solving them. Creating channels for feedback from employees is also important. It is important to provide a congenial work environment and facilitate continuous learning and improvement. To ensure your staffs provide patient centred care, the leadership should continuously communicate and demonstrate the values and the culture that create the organization. Create open communication systems so they can voice out the patients concerns to the management. Empower you employees to give the best care to their patients. |
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