Background:
A key strategy adopted by several organisations either to achieve their goal or to create better access is to expand their services geographically by adding more facilities. Such geographic expansion extends the services to a wider community and redefines their service area as well; it also can bring in a positive momentum within the organisation such that it continues to reinvent itself to address the growth challenges. Not-for-profit eye hospitals are no exception to this growth process which is largely driven by the desire to reach the eye care services to all. In India, an early example of this is the Sitapur network of eye hospitals developed by late Dr. Mehrey. He fostered a network of 34 eye hospitals including the tertiary centre at Sitapur. We now have several eye hospitals expanding their services to other areas and thus

• make services available to a larger population
• cover underserved areas and
• increase penetration levels in the service area by creating easier access.

Such geographic expansions include all levels of care such as adding tertiary level hospitals, secondary level hospitals, ambulatory surgical centres, outpatient clinics and Vision Centres (primary eye care centres). While some of the hospitals might have had a strategic plan towards this, most such expansion seems to be happening organically, driven by donations, internal suggestions, community pull, etc.

Challenges:
Such organic expansion starts throwing up several challenges, more so as the number of facilities in the network increases. There are concerns about the dilution of the passion towards the purpose; maintaining quality and efficiency, etc. With increasing number of facilities, the operational issues also increase, some of which escalate into crisis. The local ecosystems and work culture bring in their own set of challenges. Most of us managing multiple facilities are likely to be dealing with the following challenges:

• There is a constant struggle to percolate organisation's core values to the staff at all levels in both base hospital and peripheral centres
• Resistance while sharing key resources - e.g. staff transfer from one centre to another sometimes even for short durations as required
• The local leadership at peripheral centres not taking the initiative to deal with issues and having to step in to solve even operational issues
• Staff does not know who they should approach to discuss their problems or when to escalate to who?
• Accountability of peripheral centres on performance - clinical outcomes, patient satisfaction, efficiency, financial viability, etc.
• Many a times, care delivery is affected at peripheral centres - for example, due to lack of supplies, staffing, critical equipment breakdown, discipline, delayed approvals etc.
• Maintaining uniformity and harmony across all facilities
• Creating synergy across facilities within the network through information and learning from each other; competing and yet collaborating

Solution to these challenges would lie in governance structures; communication channels; empowering and mentoring leadership at different levels; evolving organisation-wide policies in core areas such as clinical protocols, pricing, HR management, monitoring systems and review processes. In today's context, one can leverage IT systems to a great extent to simplify and automate several processes to bring in desired level of uniformity and adherence to policies.

October summit consultation:
All of us are dealing with these challenges to varying degrees of success or satisfaction. By coming together, we hope to surface all such issues and through a process of mutual discussion and sharing of experiences, bring greater clarity and solutions to addressing these challenges.

Expected outcomes:

• Gain better clarity on structures, systems and policies that should be in place to effectively manage network of eye care facilities that really enables organisations to consolidate and grow further
• A monograph on preferred practices for managing network of eye care facilities for the existing networks

Methodology:

• Peer learning - sharing and learning from each other's experience - what challenges were faced and what solutions were implemented.
• Learning from other industry - inviting an organisation outside eye care to share their experience as a case study, that might offer some insights in managing network of facilities

Target group:
This consultation is for hospitals that already have an established network of eye care facilities - hospitals, clinics or vision centres. To get the most out of the consultation, it is recommended that each organisation is represented by its head and senior leaders representing different facilities (three to four participants from each network)

Contact
Ms. Sasipriya M Karumanchi,
Senior Faculty,
LAICO - Aravind Eye Care System
(sashi@aravind.org).