How McD changed eye-care in India. Could France adopt it for elderly care?

Earlier this week, the first holiday week of the year for the kids, I met with a minor accident while taking bath in the mediterranean sea in Cagnes-sur-Mer near Nice in France. Cagnes-sur-Mer is in Cote d'Azur (the blue coast aka the French Riviera) between Nice and Cannes. I ended up with a fracture in a finger in my right leg. What has a fracture in the leg got to do with McDonalds, Eye-care, India and France? You may certainly see the connection to France. This article is an attempt to connect three seemingly disparate, random incidents into one insightful story and generate three action items for improving elderly care in France.

Incident 1: Upon landing in Nice and before getting into Nice Riquier to board the train to Genova, we jumped into a McDonald's shop to get some quick takeaway as we had only 25 mins left to board the train. I was disappointed with a staff who was getting distracted by a previous customer. I complained to my wife that McD service efficiency is going down as we didn't get our order on time. We moved out fast and we were rushing to the station when we hear that McD staff shouting and running towards us. She was short of breath and quickly handed over my wife's iPhone, which my wife had forgotten at the counter, and ran back. Her service efficiency went down but the quality of her service and her compassionate care had sky rocketed up. I apologised internally and took back my words.

French educational system produces compassionate and top class professionals while McDonald's teaches the world how to deliver excellence at low cost.

Incident 2: After I got hurt, I was taken by an ambulance to the hospital in Cagnes-sur-Mer. Before that, we had to make a decision on whether to go to Nice or to go to the hospital in Cagnes-sur-Mer. My wife has a few health issues and so, I decided to take my 13 year old son to support me. This will also be easier to drop him back at the hotel, in case, if I had to stay at the hospital. I was taken into the emergency and there were many 'terminally-ill' patients waiting there. The hospital staff were so compassionate but at the same time, they were sticking to the rules religiously. It took more than 3.5 hours to get the radiology done and another 1 hour to complete the dressing. The actual time it took for the radiology and for the dressing was less than 20 minutes. One of the elderly ladies (seen in the picture below behind me) didn't get a chance at all and she yelled at the staff & walked away. But the staff were helpless as they were fewer in number dealing with a lot of elderly patients adhering to a stringent set of processes. My 13 year old son was irritated by the long wait and it was understandable. While the hospital works to alleviate the pain of the patients, the system creates new pain for people accompanying the patients.

The French people are compassionate but the well-oiled system hinders their ability to be compassionate. It is a paradox, not a problem.

Picture Credits: Nitin Aditya VijayAnand, my son.

Incident 3: Yesterday, I went to the hospital here in Switzerland through the emergency section to get their opinion. It took around 1.5 hours (2.5 hrs less than France) to meet the doctor. While waiting, I was watching a video of Dr.Venkataswamy (Dr.V), the inspirational Founder of Aravind Eye Care, about whom I had written a post a few months ago. Aravind Eyecare is in my hometown Madurai and is the world's biggest provider of eye care services. During a trip to US, Dr.V was inspired by McD's service efficiency and their ability to train people from all over the world irrespective of different culture, different religions to produce a product in the same way and deliver it in the same manner in hundreds of outlets across the world. He even took a training at Hamburger university because he strongly believed that this level of service efficiency, if brought to eye care, could transform the lives of millions of Indians who lose their vision through cataract, which he called 'needless blindness'. This model could work only if doctors were freed from activities that will affect their core focus area - surgery. He recruited lot of young people and trained them to do all the activities like diagnostics, counselling and even started producing eye lenses at a lower cost. A doctor at Aravind Eyecare does 1500 - 2000 surgeries a year as against the India national average of 400 and this will be much lesser in the western world because of many structural and monitoring mechanisms.

India has neither a good educational system nor a good social system but it has great resilience and an unbelievable creativity to deal with any challenge.

A logical mind would still struggle to see the connection between McDonald's, India and France. The McD staff at the frontline chose to break the rigid system and instead, 'serve' the customer. McDonald's restaurants are found in 120 countries and territories around the worldand serve 68 million customers each day. McDonald's operates 37,855 restaurants worldwide, employing more than 210,000 people as of the end of 2018. If every staff spends one extra minute with the customer, their business built around an assembly line model might collapse. But as Dr.V mentioned, they have trained their staff so well that the staff is empowered to spend an extra minute 'serving' the customer better even at the cost of another customer like me complaining. France has an educational system that allowed the staff to even forget McDonald's and her job to run and hand over the iPhone to my wife. She could be fired for leaving the workplace and one could argue that she prioritised the wrong things. She could have kept it in 'Lost & Found' etc. She let her heart and values triumph over her brain. Both McDonald's and France won me over that day because of her. In my mother tongue Tamil, there is a saying '???? ??????????, ??? ???? ????' which means 'You can use a single grain of rice to test whether the pot of rice is cooked'.

You may say that I chose the wrong data point. You may be right as my following example touches upon that point. India has 1.3 billion people and I love India. It is one of the most happiest countries in the world and I only partially agree that Denmark or Finland is the happiest country in the world. Most of these 1.3 billion people choose to follow their heart at the cost of the law or rule and that is why you see the chaos that you see in the Indian roads. It has both positives and negatives. You will find people without homes smiling and laughing with one another. You may be surprised at the paradox. That is why India is one of the greatest countries and I will write an article on this topic in detail. Now, let's get back to France.

Below is a quick synthesis and hypothesis of the problem in the healthcare system in France.

McD's service efficiency, their ability to deliver a product at low cost and most importantly, their training was adapted by a compassionate Indian doctor for eye-care which resulted in giving vision to 29 million patients in India and beyond. If world class and compassionate eye-care can be delivered at low cost in a chaotic system like India, it is possible that France, a country with compassionate people and top class system, can deliver world class and compassionate care to elderly people. If a developed world success can be adopted in a developing country, why can't a developing world success be adopted in the developed world?There are three things that France could consider as a starting point.

1.Leverage Telemedicine: While dealing with elders, it is lot easier to treat them from their home. These elders are technology literate, independent and follow the rules really well. Aravind Eye-care used tele-medicine effectively even in rural areas in India and so, for France, this is very much doable and cost effective.

2.Create Community Clinics: If community clinics can be created with paramedical professionals to treat elders for simple ailments, then the load on doctors in hospitals will be reduced. In India, the state government of Delhi has successfully created Mohalla clinics and has achieved great results. Freeing primary care from hospitals will be a relief to the system.

3.Prioritise human welfare: The compassionate French healthcare professionals are forced to take a hard stance by the system. Every decision at the worm's eye level taken by a staff involves a dilemma - follow the system vs follow their heart. The dilemma can be resolved if the system helps them to prioritise human welfare at all costs.

Isn't it timely for France to take a few lessons from McDonald's since McD earns its fortune selling burgers and 'French' fries?

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Bibliography:

• Christophe Lestang, whose name is attributed to the paradox mentioned in the image, is my amazing French teacher who is helping me to understand the structural complexities of the French system. I was lucky to witness this firsthand because of the injury. Thank you, Christophe!
• J Sudhakar, my school friend, who works as a Software Engineer in Chennai, India questioned the logic between the 'service efficiency' and 'individual discipline' which created a breakthrough insight on India. He suggested that the post could have more clarity while I criticised someone's efficiency. Thank you, Sudha!
• I made two sketches of the visual representation and I ran a poll in the WhatsApp group of my school friends. This one was chosen by K Vijai, my best friend in my primary school and the topper in my class. He holds a PhD in Civil Engineering from Anna University, India and is a Professor at the Department of Civil Engineering, St Joseph's College of Engineering, Chennai. His response was the first and I closed the poll immediately after I got his response. Thank you, KV!
• Raghu Parthasarathi, my school friend, who works as a Software Engineer in Australia corrected me with the choice of words around old vs elders. Thank you, Rags!
• Dr.Venkataswamy is the Founder of Aravind Eye Care in Madurai and you can learn more about him through this beautiful and enlightening video. Every word that you hear from him in this video is priceless and divine.