Sankara: Where Vision Meets Impact
Sankara Eye Foundation is a not-for-profit organisation with a mission to eliminate avoidable blindness among the poor in the remotest parts of India. I had the good fortune to spend eight weeks during the summer at Sankara’s headquarters located in the calm of Coimbatore, Tamil Nadu (South India).
My goal was to find opportunities to make operational improvements – using technology as much as possible – to reduce costs and increase productivity without compromising on quality of patient care or employee satisfaction – with an overarching ambition to propel Sankara towards the milestone of performing 400,000 free surgeries annually by 2030.
To understand Sankara, you have to understand its operating model, which has two aspects: paying and non-paying. On the paying side, it is one of India's top three hospital groups with world-class eye care services. As for the non-paying side, Sankara performs over 210,000 surgeries yearly, and has performed over 2.6 million surgeries since its humble beginnings in 1977.
It applies a unique approach whereby it re-appropriates profits from paying patients (20% of total eye operations) to fund cataract surgeries for people on low incomes free of charge.
The group has 14 hospital chains spread across all major hubs in India, each covering a radius of 100km to 200km.
Using a hub-and-spoke model, each hospital functions as an operational nucleus, with vision centres and camps sending patients for surgeries after screening or preliminary checkups and serving as post-op care touch points.
Both paying and non-paying units are located in the same building to benefit from shared resources (equipment, doctors, staff, etc.). The hospital is designed to offer a premium experience for the paying side while serving non-paying patients in an efficient manner.
I was able to contribute to the following areas:
Diversifying revenues
To fund non-paying surgeries, Sankara depends on profits from its paying vertical, government grants, and corporate donations. Grants and donations are often renewed but are not a recurring source of capital and often require significant collaboration and stakeholder management. To increase its capacity and fund long-term expansion, Sankara needed to deepen its profit base either through new service offerings or diversification.
Operational improvements
The productivity and capacity of the system are determined by three things: the hospitals, transportation, and camps. The first two have been meticulously developed over decades to optimise resource utilization.
Examples include operating tables being placed side by side to allow doctors to switch patients in seconds and avoid downtime, the use of colour coding and processes to optimise the flow of patients in an efficient manner, and pooling transport needs to cover multiple drop and pickup locations in a single trip.
To maximise the impact, my focus covered planning and camp operational improvements.
Functional improvements
The third dimension for improvement I noticed was in Sankara’s marketing efforts, especially at the level of vision centres. These are unique because they serve as touchpoints for paying and non-paying patients.
On the one hand, they compete with national optical chains, relying on traditional marketing means such as advertising and branding. On the other, they serve as satellite centres, and often as a first point of contact to screen patients for free surgeries and focus on targeted reach and mass screening. Aligning the two missions was crucial to their success and self-sufficiency.
Although I had a free hand to focus on either side, my primary goal was to focus on recommendations for the non-paying side.
From my time at Sankara, I distilled a list of eight unique areas for improvements, from making a business case for a new revenue stream to simple operational improvements to reduce waiting times at reception.
I spent the first two weeks interviewing as many people as possible, such as ground staff and/or unit heads, to understand the organisation's structure and challenges at various levels. I had the opportunity to visit two stay camps in the remotest sections of Tamil Nadu and Bangalore Hospital as part of my exploration phase.
With the aforementioned insights in mind, I wanted to first deliver high-impact practical solutions that the team could easily adopt.
I used consolidated financial statements to further pinpoint primary cost drivers and started brainstorming and experimenting with solutions early on. Bi-weekly sessions with the management team and continuous check-ins with the function heads were crucial to ensure that I was heading in the right direction.
Some of the key solutions included:
- Making a business case for aligning Sankara’s access and network to tap into regulatory momentum generated by the emergence of the carbon trading market in India
- Camp process tweaking to shift bottlenecks and increase productivity for various expected participation levels
- Use of a custom AI-based satellite imagery tool for planning, expansion, and tracking purposes
- Expanding existing technology into more use cases, using newsvendor models for spectacle inventory management and predictability, etc.
It was an eye-opening internship…I learned lessons that I will keep with me for the future.
Lesson one was understanding the friction between profit maximization while serving a critical social mission. Seeing the friction first-hand helped me realise how crucial it was to define what success looked like early on.
In the context of Sankara, it was impressive to see how the public viewed it as a world-class specialist eye care service, whereas internally almost everyone spoke passionately about their sole purpose being to serve the underprivileged.
Lesson two was the importance of culture as a binding force for the long-term success of an organisation.
Despite having a hub-and-spoke model from which individual internal corporate identities naturally emerge, I often wondered about the reason behind Sankara’s phenomenal success over four decades.
One of the primary explanations was the strong cultural integration and propagation, all the way from the steering committee (board of directors) to the entry-level optometrist.
While each hospital had cultural and operational freedom within local boundaries, the core cultural identity was identical at each hospital across various levels of the organisation.
Sankara achieved this by tapping its own network – its educational institution is the primary source of hiring doctors and other medical staff. Moreover, it invests heavily in the continuous education, training, and development of its employees. This impressive feat was eye-opening.
I learned lessons that I will keep with me for the future.
INSEAD is grateful to the donors of the Hugo van Berckel Award, the Moondance Foundation, and the Andrew Land Fund, for their generous support.
This is supported by the INSEAD Healthcare Management Initiative.
