Dyson College of Arts and Sciences

Pache & Chowdhury, 2012). Using the lens of "high reliability" (Weick, Sutcliffe & Obstfeld, 2009), such resilience can be examined across five distinct processes at Aravind which are key to its functioning: (1) preoccupation with failure; (2) reluctance to simplify assumptions; (3) sensitivity to operations; (4) continuous learning and knowledge-sharing; and (5) under-specification of structures. Preoccupation with Failure: Minimizing Medical Errors One of the recurring themes for organizations that operate at high reliability is a high degree of concern regarding the potential of built-in errors in existing organizational routines (Weick, Sutcliffe & Obstfeld, 2009). When these errors go undetected, they have the potential to be amplified as a result of stresses to the overall organization system that may result from unintended shocks or oversights in execution. These worries about failure give high-reliability organizations a distinctive quality, one that leads to the development of procedures which try and bring the level of error down near zero, thereby increasing the overall resilience of the organizational system as well. Schulman (1993), in his study of the Diablo Canyon nuclear power plant in New Mexico, outlines some of the procedures that have allowed this development in a particularly sensitive environment where errors must be minimized: "As of May 1990, there were 4,303 written procedures at Diablo Canyon covering administration, operations, maintenance, radiation protection, and chemical and radiological analysis as well as surveillance and other testing activities… Each procedure in turn has a multiplicity of specified steps. The average procedure has undergone well over three revisions (one has 27). There are formal procedures for the drafting of procedures as well as separate procedures for altering procedures." At Aravind the management of errors as a path to increasing the organization system's overall resilience is based on its key strength, an efficiency model of cataract surgery which is highly inspired by the mass production principles of fast food chains such as McDonald's. The system works as follows. In the operating room, a single ophthalmologist is assisted by four medical assistants, most of whom have are young women from villages across Tamil Nadu and who have undergone two years of in-house training in preparation for the job. These assistants make sure that the doctor, who is operating on a patient while another one waits at a table several feet away, maximizes her concentration on the procedure itself, and has very little to do in terms of patient preparation and servicing. As the ophthalmologist finishes up a surgery, she moves immediately to the next patient, who is steps away. This new patient has been prepared by their team of two medical assistants, and the patient who has just undergone surgery is removed from the other operating table by the other set of two medical assistants and a new patient brought into place. In this manner, Aravind has managed to create a tremendous amount of redundancy into the process of cataract surgery. While this means that the doctor, the most valuable human resource for the system, attains maximum efficiency, it also means that errors are reduced as the process of surgery is separated into medical and non-medical components, with specialized staff for each. Aravind, in this sense, is preoccupied with the failure to achieve efficient, quality eye care, and has built systems to continuously ensure that these services are indeed delivered. In addition to the structure around the operating ophthalmologist, a series of internal processes, including a thorough analysis of near failures and continuous training for all staff, help the organization to continue its compelling record of success and to develop an innate resilience against environmental shocks. 21

• Cover