Dyson College of Arts and Sciences

shocks, is the organization's LAICO division, which is the in-house center of excellence devoted to training, continuous development, and knowledge dissemination. This mini- organization within the broader organizational system has allowed Aravind to not only share its knowledge of efficient eye care delivery with hospitals and medical personnel throughout the world, it has also allowed the development of managerial capacity and human resources within the organization. By sending out consultants from Aravind's various medical and operational divisions to work with other hospital systems, the organization has managed to train a cadre of mid-level managers who are in place for future senior management roles within the organization. At the same time, these individuals, via their exposure to problems at hospitals throughout the world, provide a kind of "early warning" system for the organization. They are able to anticipate problems that may happen in the future and work with managers to correct them. In this sense Aravind's knowledge sharing serves the purpose of knowledge development within the organization, and makes it more robust to future shocks and unanticipated contingencies. Under-specification of Structures: Maintaining Operational Flexibility One of the paradoxes of high-reliability organizing is that companies which adopt specific procedures to reduce error quite often achieve a contrary result: while errors in the area where these procedures are adopted may decrease, they may increase in other parts of the organizational (Turner, 1978). For instance, in Turner's (1978) study of a medical-supply manufacturing firm, the efficient distribution system developed for getting sterilization fluids to hospitals turned out to be an extremely efficient method of distributing contaminated fluids when one inadequately sterilized batch of the fluids was improperly prepared by the company. Similarly, the "O-ring" problem for the space shuttle at NASA went undetected because an over-specified system for detecting deviations from normal was in place at the agency (Vaughn, 1996). Aravind addresses issues around over-specification of routines by putting in place strong structures for oversight which leave considerable flexibility at the implementation level for front-line medical managers and employees involved in patient care and diagnosis. In this sense, the organization loosens the designation of who might be the most important decision maker in the medical care process, substituting a deference to the medical or care authority of front-line personnel in place of a reliance on hierarchical position. The result of this substitution is that a broader range of solutions and capabilities are accessed by the organization as a whole when problems arise, meaning that managers have real access to the expertise of front-line personnel who are unafraid to voice their concerns and opinions in an environment in which they know that their voices will be heard (Hirschman, 1970). Conclusion Taken together, Aravind's systems and processes offer important lessons for other organizations in the fields of social enterprise, health care, and beyond. Aravind's stable core of activities, which are built around delivering high-quality eye care to large volumes of patients, are supported by a range of activities which both enhance this core and offer the organization opportunities to expand and further solidify its overall functioning. For instance, the development of Aurolab—which can be tied to the organization's focus on continuous quality improvement and applied research and development in its service—and LAICO—which extends the organization's learning 24

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