Sometimes it takes a visual cue, a short reference, or a good analogy for one to grasp the philosophy of a place. This was certainly so when I visited Aravind Eye Hospital in Madurai, South India. As a Ghanaian born, British trained ophthalmologist, I have always had a yearning for developing country eye care work, and one of the institutions that has made a name for itself in this field is Aravind. Their eye care system has been well described, however what is always difficult to conceptualise in these institutions is the ethos or spirit of the place. Why is it that per doctor more cataract surgery is done in Aravind than anywhere else in the world? How can they keep the cost so low, yet have fantastic quality indicators?

The visual cue that made me understand how high quality care could be offered at such a cheap price of £10 per person for cataract surgery was a coffee mug. One of the managers of the hospital explained to me how he had witnessed a person in another hospital drink from a large coffee mug and waste a third of the coffee. He saw this happen a couple of times and then worked out the amount of coffee and water that person was wasting. He then had a discussion about how much money could be saved if the amount of coffee prepared was reduced by a third or indeed if a smaller mug was used. The reason he was so concerned about this was the fact that the amount of money saved could go directly into patient care. Everything that is done in this charitable group of hospitals in South India is done to improve patient care, the patient is the centre of all that is done, every decision made is taken with respect to how many more patients can be treated. Furthermore and more importantly all members of staff have bought into this way of thinking, one could say it was in their DNA.

We in the UK are blessed with immense healthcare resources, however we still need to make efficiency savings of £22 billion by 2020. Most of the time as doctors we tend to argue about how things cannot be done, we are often resistant to change of almost any sort. Several colleagues and I have had umpteen arguments with managerial staff in different hospitals about how one thing or the other cannot be changed, as it would compromise patient care. After visiting this institution and realising that as long as any monetary savings gained are channelled back into the respective department, doctors will buy into the necessity for this change and indeed facilitate it. The challenge for the NHS in my humble opinion is not to come up with fantastic grand proposals designed centrally for efficiency improvement, but to empower each individual in the organisation to think about the bottom line and how it directly affects patient care. As the old adage goes, every penny counts. Though simple in concept, my perspective on efficiency savings since visiting Aravind has now altered, I now feel that change has to start at the individual level, my new thought process is this: how many things can I change in order to protect and improve patient care.

Kwesi Nyan Amissah-Arthur is a senior lecturer and consultant ophthalmic and Vitreoretinal Surgeon at the University of Ghana Medical School in Accra Ghana. He was until very recently at the Manchester Royal Eye Hospital and prior to that at the Birmingham and Midlands Eye Centre.

Competing interests: None declared.