Aravind Eye Care System (AECS) is globally known for its efforts in curbing the spread of blindness in India. However, little known is its persistent fight to retain its core staff. After hiring generic doctors from the industry, which resulted in high attrition rates, AECS decided to convert all its hospitals into part-time medical colleges to train doctors and paramedics. Eventually, AECS stopped advertising all together, preferring to absorb all its postgraduate students, as “they are more in tune with AECS’s work culture and ethics”.

1) The Backstory

Dr. Govindappa Venkataswamy created the first Aravind Hospital in 1976 with just 11 beds in his rented house and a dream to treat poor, sightless Indians free of cost. Three decades later, the hospital has flourished into a chain of one of the largest and most successful eye care facilities in India. AECS, as we know it today, includes more than the six well-known Aravind hospitals and their 4,000-odd bedding capacity. AECS also offers its patients a bouquet of inexpensive services such as eye exams, surgeries, health care training, eye research and even in-house eye products. The efficient service of its doctors and staff has brought down the number of blind people in India by 25 per cent between 1990 and 2002.

2) The Problem

AECS’s recruitment problems were three-fold. The first was to attract simple and humble (and talented!) doctors like Dr. Venkatswamy, another was to hire a helping and loyal paramedical staff to support these doctors and the third was to retain the group’s core staff over a number of years. To resolve these challenges, the management tried numerous strategies, one of which was to hire doctors and paramedical staff from the market as and when needed. The results, however, were far from satisfactory. “Slowly, as doctors and staff began to leave within a year or two of joining, we realised that the new staff was simply not at home with the work culture and values at AECS. If anything, they felt out of place and uncomfortable by the clientele they were required to serve—the poor and the disadvantaged. It was then that we realised that to flourish, we must grow organically and not just exponentially,” says Dr. S.R. Krishandas, human resources head at AECS.

3) The Next Steps

As a result, the management decided to take four steps to ensure that the quality of its staff and services was not compromised. First, it decided to focus on bringing in and training young, fresh talent from the industry and offering them continuous growth opportunities. Secondly, it decided to double up all Aravind Hospitals as part-time schools and workshops where these doctors and their support staff could study and practice as much as they wanted. Third, it decided to shift focus from hiring new talent to retaining its core group of talent. Finally, in the context of the fact that the medical community in India has always suffered from a serious deficit of skilled and trained paramedical staff, AECS decided to create numerous community outreach programmes targeting rural areas and their socially disadvantaged population who after vigorous training, could become trusted, trained paramedical staff.

4) The Decision

AECS took students from all over India and trained them at various Aravind Hospitals where they were not just encouraged to practice, but to pursue their interests—whether that was research in AECS’s international lab or specialising in more than one area. They were also given the responsibility of training their paramedical staff, a leadership responsibility they cherished. The community outreach programmes involved two-year paid training of girls fresh out of school, wherein apart from medical care, they were also taught soft skills. Once trained, they were hired by Aravind Hospitals. Finally, to ensure their core senior doctors and staff didn’t leave in a hurry, the company paid its doctors high salaries without performance-based incentives. The management also instituted a retention bonus for putting in five years of work with them which kept increasing after every five years of work.

5) The Aftermath

Since the campaign was launched, the attrition rate at AECS has been close to zero. “Rarely do our people leave us because they are unhappy. In fact, in the last couple of years, doctors and staff who had left Aravind years ago for better pay have come back to us,” says Krishandas.

Today, AECS does not need to advertise when it needs to hire. As the volume of patients has increased so has the number of courses offered at Aravind Hospitals (45 long and short-term courses). AECS simply dips into its pool of doctors and paramedics who are already in tune with the hospital’s work ethic and culture, and absorbs almost 80 per cent of all its postgraduate students and almost all of its in-house paramedical trainees.

6) The Takeaway

Having an in-house resource pool of skilled personnel has helped sustain AECS’ finances. According to Dr. Krishandas, around 26 to 28 per cent of the company’s overall expenditure is on salaries. “We hardly mind that, as it has helped increase our productivity, our reach and ensured that our model of health care stays cost effective,” he says. So, his appeal to every company facing talent retention issues is: show respect to all your employees and treat them with dignity. “It’s the real reason why people who join us don’t leave.”