Dyson College of Arts and Sciences

Reluctance to Simplify Assumptions: Granular Understanding of Context One way in which organizations deal with complex tasks is by developing simplifying frameworks which reduce the complexity of their operational environment. In doing this managers at the focal organization can get employees to focus on the task at hand, thereby minimizing or ignoring data which might militate alternative courses of action (Weick, Sutcliffe & Obstfeld, 2009). For organizations developing resilient systems, however, this general organizational process can pose numerous challenges, as simplifications may result in a decrease in the level of precautions that organizational members take, and thereby lead to unimagined and unintended consequences with potentially significant impacts on the focal organization. While traditional organizations may tend to overlook the question of what they are actually ignoring in their environment, this is not an option for organizations developing resilient processes; these organizations make fewer assumptions about their environment and induce organizational members to have a greater awareness of the events, activities, and particularities of their operating environments. Aravind's approach to eye care challenged a number of the assumptions inherent in the field. First of all, the organization decided fairly quickly that they wouldn't be a high-cost / high-quality treatment facility as found in major cities such as New Delhi and Mumbai. On the other hand, the founders didn't see themselves as a traditional charity hospital either, relying on government donations and targeting only the poorest of the poor. Instead, they decided to build a system that was low-cost but financially sustainable due to a high-volume approach to care; at the time, this was unprecedented in the field of eye care in India (Sezgi & Mair, 2010). Indeed, Aravind charges below- market prices or takes no fees from the majority of its patients, the numerous rural and urban poor who cannot afford to pay for the full cost of cataract surgery. However, it cross-subsidizes these patients with income generated from individuals who can pay full price. This commitment to patients is grounded in a value system that puts patient care first and emphasizes "treating rich and poor people alike" as a core principle of Aravind's organizational culture. A second major assumption challenged by Aravind's approach is that business principles cannot be used in the health care realm, where patient care is seen as the primary driving force. While patient care does come first at Aravind, the organization has pioneered the use of social marketing techniques to generate the level of patients required to sustain its high-volume patient-care model. Thus, it regularly engages physicians and auxiliary medical personnel in "vision camps" which target rural areas of Tamil Nadu and seek to bring in as many people as possible for free vision screenings. While the majority of the individuals at these camps require no treatment or perhaps are prescribed a pair of glasses, some of them end up requiring surgery for cataracts and other diseases. These individuals are brought into Aravind's base hospital in Maduri, at no cost to themselves, for treatment. The system thereby generates a large volume of patients as per the requirements of its business model, but at the same time manages to reach people who might not otherwise have access to eye care in the first place (Sezgi & Mair, 2010). Taken together, these two distinct processes at Aravind, developing a high-volume / high-quality/low-cost model combined with an application of business principles to generate demand, are reflective of its more general approach of developing internal systems that match the complexity of its external environment (Weick, Sutcliffe & Obstfeld, 2009). In this manner, the organization is able to cultivate and retain deep 22

• Cover