Aravind (E)

0:00If Coca-Cola can sell billions of sodas, and McDonald's can sell billions of burgers, why can't Aravind ari-bend sell millions of site-resting operations? That's the great Dr. G. Venkataswamy talking about the hospital he built, beginning at the age of 58. Hey, it's Arav, and this is a special archived episode of Akimbo.

0:35If you add up the population of Chicago, Los Angeles, and Detroit, it's fewer than 30 million people. The Aravind Eye Hospitals have already saved the eyesight of more people than that. Aravind is a chain of hospitals in India that offers life-changing surgery to people who would otherwise go blind. Every year in India, 4 million people go blind from cataracts and other illnesses that are relatively straightforward to address. And what Dr. V figured out is that with the right leadership leading to the right management, one person can plant a seed that changes the world. The truth is, management changes the world.

1:35It might be the only thing that does. Management and leadership aren't the same thing, and we need both. Leadership is what happens in between the moments that we are managing. Managing is helping people do what they did yesterday, but faster and cheaper. Management is staying the course. Leadership is taking the leap, doing something that might not work, pointing to a problem, a challenge, an opportunity, and saying, I'm going over here. Who wants to come? So yes, Ray Kroc at McDonald's was a leader. He saw the opportunity to franchise a business around the world. He saw a way to run a business that was efficient.

2:22But once Ray had done that, it was generations of managers at McDonald's that drove McDonald's to become what McDonald's is. These are choices. Management is a choice. The side effects, the downstream, the impacts. These are choices. I only met Dr. V once, shortly before he died. And I didn't realize, because he was so self-effacing, with no drama, no announcement, what an extraordinary human he was. But the institution that he built persists as a model for what happens when we get straight about what we're seeking to do when we manage. In the year ending March 2018, Aravind handled 4 million outpatient visits and did 478 ,000 eye surgeries.

3:16They did this from six eye care centers and another six secondary eye care centers. They did this by having 67 facilities where they can do primary eye care examinations. and astonishingly, they set up 2 ,500 pop-up shops, which they call camps, where they were able to screen 500 ,000 patients and perform 92 ,000 surgeries in the field. How do they do this? Why do they do this? How is it that one man's work in one of the poorest countries in the world has led to more than 30 million successful eye surgeries? If you're in London or New York or L.A. and you go to see an ophthalmologist, there's an excellent chance that she has trained in India at Aravind.

4:12And the reason is they do so many eye surgeries there that a surgeon in training gets better much faster. And more important, learns methods and procedures that not only make them more efficient, but actually makes the work safer. A simple example when Dr. V looked at the problem of why it was so expensive to deliver cataract surgery is, as you might expect, cataract surgery involves getting someone sterile, wheeling them into an operating room, and then doing surgery on them. Dr. V wondered, why can't we have the second person being prepared while the first person is being operated on? So all the surgeon will have to do is turn her back and operate on the person ready right behind her.

5:05No downtime. Skeptics said, well, that'll never work because there'll be infection, cross infection from one patient to another. They did the math. They did the studies and they found that in the typical Western eye hospital, six out of every 1 ,000 surgeries lead to an infection. At Aravind, it's four out of 1 ,000. 35 % better. This all comes down to management. Dr. V is no longer in the building. He's left us. But the management persists. What are we managing for? What does a good day look like? At many companies, it's how much extra money did we make for the CEO? How much did the stock price go up?

5:54What's our yield? What's our margin? How do we beat the competition? None of those things are being kept track of at Aravind. Instead, the primary goal is to make eye care accessible for all. That's the guiding light. So when you get to an Aravind hospital, they offer you a choice. Would you like to pay? It's about$130 to have cataract surgery. Or is it that you can't afford it, in which case it's free? And despite those low prices and that option for free, Aravind works in the black. They make a profit that they reinvest every year in getting better at what they do. The rest of the principles.

6:43Quality and continuous improvement. What does continuous improvement mean? It means how do we do better today than we did yesterday? In the most recent annual report that Aravind published, they announced somewhat sheepishly that the number of screening visits and patient visits they had were steady this year. It didn't go up. But then they explained the reason is they've improved their methods so that patients don't have to return. They've turned people who needed to come three times or two times into people who only needed to come once. The next principle, patient centricity. When in doubt, do it for the patient.

7:29When in doubt, make it better for the patient. Number four, self-reliance. Aravind discovered that they needed to buy machines and drugs from out of country, and they were costing a lot of money. What did they do? They came up with a better device on their own. A better device, a better drug, a better procedure, and then, keeping in mind one of the next principles, sharing. They took those ideas, they took those devices, and they offer them to people around the world. Next, staff centricity. They understand that work is voluntary, and if they can't serve the people who work there, those people won't choose to work there.

8:18Frugality, which seems to fly in the face of staff centricity, except it doesn't. Because the staff isn't motivated by making as much money as possible. If they wanted to do that, they'd set up a private practice in Shaker Heights. No, frugality means spend money wisely to achieve your other goals. With these principles in mind, without worrying about how to get more, but instead focusing on how to be better, Aravind sets up a standard. That in less than 50 years, this institution has gone from one person with debilitating arthritis, who persisted in doing ophthalmology anyway, with a vision, with leadership.

9:07It has grown into an institution that, since I began talking to you today, has already performed dozens of surgeries on people who will now no longer be blind. Management changes the world. It's the only thing that does. I'm not talking about a mission statement here. I'm talking about the practical steps that organizations take that they manage for. Coke and Pepsi have spent 50 years managing toward one direction, increased the number of gallons of their products that are consumed every day by every person they seek to address. The car companies spent 50 years trying to get as many people to drive as many miles in as new a car as possible.

10:02The ratchet of management says that once we build an industrial system, we can make it better. It takes far less time to make the pieces of an automobile than it used to 100 years ago. We are way more efficient at pumping oil out of the ground. that when we build a bureaucratic system where we can measure something and we incentivize the people in that system to make the numbers get better, the numbers often get better. If they don't, a different institution is likely to take their place. So we must begin by understanding what is being measured. If you want to understand how social media works, Just look at what is being measured.

10:57At Facebook, Twitter, Instagram, and the rest, they're keeping track of how many things did you click on? How much time did you spend? By seeking to optimize those metrics, they, the engineers that are trying to take your time and attention, put bait in front of you. How many followers do you have? When was the last time you boosted something? How many people read this? How many people clicked on this? By creating these metrics, a cycle is put in place, a cycle that pushes the metrics to go in one direction. Add to that what happens when a company goes public. When it goes public, its ownership is dispersed, but the ownership, the people who own the stock, are keeping track of metrics.

11:49That's why there's a movement that says, let's get rid of quarterly earnings. because if quarterly earnings reports are the metric that people use, the organization will rally to make those numbers go up. Fortunately, for all the people who aren't blind, Aravind doesn't pay attention to quarterly profit reports. If they did, they never would have invested in the continuous improvement that has enabled them to change the world. So when we go to work, we are measuring something. And this brings us back to the idea of leadership. Because after a while, management hits a speed bump. After a while, the next decision isn't that easy.

12:39Continuous improvement isn't always continuous. We can't keep going on this road because it's a dead end. Which direction should we go now? And it's in these leaps that each of us, as a manager or a leader, as anyone with a career, has to make the real decisions. So when you've been going to your job every day for two years and you don't see the career path where you can believe in what you're doing and where you are going, you need to make a new decision. It's a leadership decision about where will you leap next? Where will you contribute next? Will you do the short-term thing and get the next job that comes along?

13:24Or will you dig deep to discover where you are truly needed, where you can be seen and where you can see, see the problem that needs to be solved, and do it in a way where you can contribute something that's unique and generous? I think of Aravind almost every day. There's this myth, the Milton Friedman myth, that the highest purpose of an organization is to make money for the short-term interest of the shareholders. This idea that an institution or a person that makes more money is somehow better than one who doesn't. Well, money has one thing going for it, which is it's super easy to measure.

14:10But money isn't the point. The point is the change that we are able to make, change that we are proud of. And lots of organizations, ones that are measuring money, are leaving behind a trail of obesity or disease or discomfort or unhappiness. They're creating systems that can't sustain for the long haul. And then there are other institutions, some non-profit, some for-profit, that have a different ratchet, that are moving in a different direction. What we know is that modern education, the education of the last hundred years, as practiced around the world, has trained billions of people to ask, will this be on the test?

15:00Billions of people who wonder, what am I supposed to do next? Boss, please tell me, I want to do a good job. We spent 10 or 20 years of people's lives training them to act that way. And so when people get to work, they're asking to be managed, managed to do the right thing, the right work in the right way, because we want to be a contribution. So it's on leadership to decide what we're going to measure, what are going to be the seven principles. We make hard decisions every day. In which direction should we make those decisions? because management can change the world. The opportunity that each one of us has as we wake up from our matrix-induced, be-managed slumber is that we get to manage ourselves.

15:58We get to pay attention not only to what the boss is measuring, but to what we are measuring. And many people are middle managers. They have a boss and they have people who work for them. How are we engaging with them? because we are their manager. Are we managing for the hour or the day or the week or are we managing for the year or the decade? When we point to the work we did, when we say, did I have a good day today, what exactly are we keeping track of? Because it doesn't take a crazy wide-eyed leader to change everything. What it takes is putting the right metrics on the table to decide what we think is important.

16:46Is our goal to make the thing we sell cheaper and more efficient? Or is our goal to make it more profitable? Because they're not always the same thing. Is our goal to make a product that needs to be replaced? Or is our goal to make a product that will last? Are we trying to grow market share or are we trying to grow the market? What story do we tell ourselves? What do we tell our coworkers? And what do we tell our customers? These are all choices. And fortunately, they're choices that each of us get to make.

17:33Warm greetings from Curacao. Hey, Seth. My name is Nick Ryan from Pittsburgh, Pennsylvania. Hey, Seth. This is Rex. Hey, Seth. Hi, this is Vasilis from Greece. Hi, this is Roberta Perry. My question is... And that completes my question. As always, we truly love to hear from you. You can ask your own question at akimbo.link, that's A-K-I-M-B-O dot L-I-N-K, and look for the appropriate button. You can ask about this week's episode or anything that came before. We've got two this week from prior episodes. While you're at the site, don't forget to look for the show notes. Hi, Seth. This is Carol Frazee from Bellingham, Washington.

18:17I loved your episode on being supple. And my question is, what is the difference between being supple and just chasing the next shiny object? Thanks, Seth, for giving us permission to go make a ruckus. Thanks, Carol. This is a really good chance to clarify because it is super tempting to keep looking for the next shiny object. That supple could imply that what we ought to do every time the going gets tough is to get going, to run away, to find the next thing. And I am trying to propose something very different than that. What I am saying is that we commit to the big change we seek to make, and we commit to the people we seek to change.

19:09Those are anchors for us. The tactics? The tactics don't matter so much. The tactics will shift as time shifts. So in my case, my tactic was a CD-ROM. My tactic was an almanac. My tactic was big book-packaged projects, not necessarily with my name on them, test prep books or books about gardening, for the kind of person who was going to a bookstore to seek to make change happen. Well, we all know what happened to CD-ROMs and we know what's happening to bookstores. So I have shifted my tactic, but I remain a teacher and I have relied on the authority and trust that I have built over time because I can shift my tactic in a supple way without having to restart where I'm going.

20:03That is really different than the person who says, I'm going to be an actor. And then after a year of being an actor says, I'm going to be an oil wildcatter. And then after seeing the impact that oil is having saying, oh, now I'm going to become an entrepreneur who's selling solar panels. because what has shifted is not just the work you do, but your reputation and the people you serve. Committing to that, that's hard because there will be difficult times. There will be dips ahead. And what you've got to do is live with the commitment you've made, not because it's a sunk cost, but because it matters to you.

20:44And then when the tactics change, welcome that, embrace that, dance with that, and get back to work. Hi, Seth. My name is Nolan from Nashville. I recently discovered your podcast and I have been binge listening to it. So my question is related to status roles, but also a lot more. What happens when you acquire status that you don't desire? I'm a freelancer in a technical creative field. And by all measures, I have succeeded and have status in my niche market. Most of the times I have no shortage of work and I am occasionally asked to write, train, and speak on the work that I do. But my favorite culinary analogy to describe my situation is that I'm like a classically trained French chef that got successful because everyone likes my chocolate chip cookies.

21:31And now that's all I do. I'm happy to make the cookies. I'm happy that I'm making a living with the cookies, but this isn't what I set out to do. I'm currently pursuing a project that has a potential to scale and allow me to switch from a freelancer to real entrepreneur. I would love nothing more than to drop all my current freelance work and put all my energy into this project. But that doesn't seem like a smart business decision because I've spent years building my freelance work and reputation where I'm at. So what do I do with this lack of fulfillment? And how do I move my current freelance work from the place it is to the place I'd like it to be?

22:05What questions can I ask myself to correctly prioritize the work that I currently do with the investment of time that my entrepreneurial project needs? Thank you very much. Thank you for this question, and I appreciate your candor. Congratulations on your success. You are highlighting something that comes up really often, but people don't usually say it as clearly and honestly as you did. And it goes like this. I have worked super hard to get to a place I couldn't imagine getting to. But now that I am there, now that I am paying the bills, Now that I am respected, now that I have status, I've discovered this isn't really the work I want to do.

22:50There are a couple of reasons that could be. One, super common, is that many of us like the quest more than we like the destination. And it could very well be that, as Pressfield would call it, resistance is kicking in, and you are looking the status in the eye, feeling a little bit like an imposter, and making the decision to blow it up because you liked getting there more than you liked being there. But setting that aside for a moment, it's entirely possible that the place you are isn't fulfilling because you aren't doing as much work as you could be proud to do. To use the French chef analogy, it makes you proud to create a cutting-edge coca vin that no one has ever made before.

23:36But when you're making those chocolate chip cookies that are selling by the barrel, well, you feel a lot like a fraud. You'd rather not do that work. And so we hesitate. We hesitate because there are sunk costs. Actually, sort of the opposite of sunk costs. There's sunk success. You have a thing, a gift from your previous self, your reputation. You don't have to accept the gift. If you don't want the gift, don't take the gift. Clint Eastwood could have accepted the gift over and over again of doing another Western where he played a certain character. He didn't take the gift. He became a director.

24:17He directed movies that had more depth and variety than the movies he could have gotten by leveraging his reputation for what he used to do. You have the choice to not accept the gift. So if it matters to you to go build that other thing, you need to say, no thank you. No thank you, I can't do this panel. No thank you, I can't take this client because I don't do that the way I used to do it. And one way to get there, which might bridge the gap, is to get better clients along the way. Double your price. Be really clear about what you do and what you don't do. Ratchet yourself up even more on the status side.

25:00Don't take gigs to stay busy, take gigs because you're a professional. And at some point, you will take a deep breath and say, I used to do that. I don't do that anymore. I'm sorry, I can't do that. But here's someone who does what I used to do. They'd be happy to help you. And that's scary. It's scary to walk away from that thing you've worked so hard to earn. But if it matters to you, you have no choice. On the other hand, if once you've seen it, you don't want to make the leap, then stop torturing yourself. Stop pretending you're not in exactly the right place at exactly the right time and embrace what you've got because you worked hard for it and you really are good at it and you like it.

25:47So there's no need to create this other narrative, the one that's fueled by your belief that maybe you're a fraud. Be in the moment. realize that the people who are hiring you are hiring you because they want to, and that your status is well-earned because it's your chance to make a contribution. Thanks again for listening. We'll see you next time.