Tackling sight loss in Mexico through social enterprise

In a country with high levels of visual impairment, two Mexican entrepreneurs are bringing cataract operations to the masses with a business model drawing on Lean, Six Sigma… and Disney.

In Mexico, poor eyesight is the second-largest cause of disability, with an estimated 2 million untreated cases. Blindness is common and often leads to an increased risk of falls, depression and severe economic hardship. But around 50% of cases are caused by cataracts, which can be treated through a relatively simple procedure, restoring people’s sight and quality of life.

It was this paradox that attracted the attention of Javier Okhuysen and Carlos Orellana – two young Mexican investment bankers working in London and New York. After reading CK Prahalad’s book The fortune at the bottom of the pyramid: eradicating poverty through profits, the pair returned to Mexico to develop a social enterprise.

Having no background in healthcare, they decided to model their initiative on the Aravind Eyecare System, featured as a case study in the book. ‘We wanted good chances of success without many years of trial and error, so we decided to replicate something that had been done elsewhere and combine it with our management capabilities, to achieve quick results,’ explains Javier. To this, they added inspiration from some rather less orthodox sources, looking to Disney for customer service ideas, kids’ camps for outreach events, and budget airlines for pricing models, offering cheaper services at less popular appointment times.

Javier and Carlos launched salaUno (‘Room One’) and developed an ambitious plan: to treat 25% of the annual cataract incidence across the whole of Mexico by 2016 – around 75,000 each year. Their model draws heavily on engineering processes, and employs more engineers than doctors. ‘We use Lean, Six Sigma and Kaizen to streamline processes and make sure that when there’s an error we can really understand it and correct it,’ explains Javier.

Economies of scale

The central premise is to make care affordable through economies of scale. ‘Once you start getting sufficient volume, you can begin reducing prices, which in turn allows you to bring in more volume,’ Javier says. Prices currently stand at around £300 for a cataract operation – less than half the national average of £800 – ‘though we wish it was less,’ he admits.

But expansion must not come at the expense of quality, he emphasises: ‘Even though it has been hard to match supply and demand, we prefer to let unsuitable staff go than to reduce our quality.’ The enterprise has a rigorous selection process, with surgeons allocated to different procedures depending on their stage in the learning curve. ‘This is mostly due to high specialisation,’ explains Javier. ‘Our doctors are doing around 100 cataract operations per month, compared to the average of around 7–10 per month in private hospital settings in Mexico, so they’re learning quickly.’

The fast turnaround is also reflected in consultations, with a first-come-first-served system in which doctors see around 60 outpatients a day for 7–8 minutes each, compared to the standard 10–12 patients per day in private settings in Mexico. ‘It’s the only way to do a high-volume system,’ says Javier. Following the consultation, the average wait for surgery is about five days.

Ambassadors

To meet its aims, salaUno needs to keep on expanding. A big part of this involves developing partnerships – ‘When you’re a social entrepreneur you have to build strong connections,’ says Javier. But many referrals come through former patients, known as ‘ambassadors’, while others are identified through community outreach in remote areas. Customer relationship management software ensures that if patients don’t come back, they receive a phone call ‘to increase our batting average,’ Javier says, ‘converting opportunities into surgeries to change people’s lives.’

Behind this focused business model lies an evident passion for the work. ‘I’m very happy, waking up every day at 6am and leaving the office at 10pm,’ says Javier, ‘because I can see the impact on people’s lives. That’s my main motivation. We have big pictures up in our hospitals of the moment when the nurses take the patch off people’s eyes. This is the moment we all work for.’

For more information, contact Javier Okhuysen, Co-Founder and CEO at: javier.okhuysen@salauno.com.mx