The Perfect Vision of Dr. V.

"In America, there are powerful marketing devices to sell products like Coca-Cola and hamburgers," he says. "All I want to sell is good eyesight, and there are millions of people who need it." The idea for Aravind was born from that vision of McDonald's.

"If Coca-Cola can sell billions of sodas and McDonald's can sell billions of burgers," asks Dr. V., "why can't Aravind sell millions of sight-restoring operations, and, eventually, the belief in human perfection? With sight, people could be freed from hunger, fear, and poverty. You could perfect the body, then perfect the mind and the soul, and raise people's level of thinking and acting."

In the eye of the cyclone, then, we get our first glimpse of the answer to the mystery of leadership: Leadership is a personal quest you undertake, one based on a mission that troubles your heart.

An hour into the storm, the sky clears. The driver delivers us to Aravind Eye Hospital, on a wide, dusty street in Madurai. Vara, Dr. V.'s niece, is waiting to greet us. "How I envy you," says Vara, 45, to me, "seeing the hospital for the first time. The thrill you'll get." She's right, I'll soon find. The cyclone is nothing compared to this.

In India, the big word in health care is "OM," not "HMO"

It frustrates the folks at Aravind that Tuesdays are always slow. It means that they can't do all that they could do. "We will see maybe 400 patients today," says Dr. Natchiar. "That's because for Hindus, Tuesdays are not propitious days to begin a new venture, so the people here will be emergency cases." It means that in the work of spreading perfection, Aravind will be a little behind schedule.

How do you achieve perfection in the never-perfect and always-compromised world of business? It helps to have a service that you can't sell. That way, you have to give it away. Your toughest customers are always the people who don't need you. Many of Aravind's patients can't afford cataract surgery. Most don't remember what good vision is -- and don't understand why it would offer any benefit. So Aravind has to keep educating them -- and perfecting its own service.

"In the third world, a blind person is referred to as 'a mouth without hands,' " says Dr. V. "He is detrimental to his family and to the whole village. But all he needs is a 10-minute operation. One week the bandages go on, the next week they go off. High bang for the buck. But people don't realize that the surgery is available, or that they can afford it because it's free. We have to sell them first on the need."

It's 7:30 AM on a typically slow Tuesday. But a slow day at Aravind would drive most American hospital officials mad. A few hundred people fill the hospital's driveway -- friends and families who have delivered the 400 patients who are already inside. They spill out of the waiting rooms and onto carpets, passing the time until they can take the patients home, back to villages hundreds of miles away.

The free patients, whose medical services (including food and room) are covered entirely by the hospital, have a separate building. Paying customers are charged 50 rupees (about $1) per consultation and have their choice of accommodations: "A-class" rooms ($3 per day), which are private; "B-class" rooms ($1.50 per day), in which a toilet is shared; or "C-class" rooms ($1 per day), essentially a mat on the floor. Paying customers choose between surgery with stitches ($110) and surgery without stitches ($120).

"You don't have to qualify for the free hospital," says Dr. V. "We never question anyone. We sometimes give rich people surgery for free, and we don't question them. I don't run a business. I give people their sight." The next clue to the mystery of leadership: To achieve perfection, it helps to respect money -- but not to be motivated by it.

Since opening day in 1976, Aravind has given sight to more than 1 million people in India. Dr. V. may not run a business, but it's important to note that Aravind's surgeons are so productive that the hospital has a gross margin of 40%, despite the fact that 70% of the patients pay nothing or close to nothing, and that the hospital does not depend on donations. Dr. V. has done it by constantly cutting costs, increasing efficiency, and building his market.

It costs Aravind about $10 to conduct a cataract operation. It costs hospitals in the United States about $1,650 to perform the same operation. Aravind keeps costs minimal by putting two or more patients in an operating room at the same time. Hospitals in the United States don't allow more than one patient at a time in a surgery, but Aravind hasn't experienced any problems with infections. Aravind's doctors have created equipment that allows a surgeon to perform one 10- to 20-minute operation, then swivel around to work on the next patient -- who is already in the room, prepped, ready, and waiting. Post-op patients are wheeled out, and new patients are wheeled in.