Insights January 2020

A Model of Efficiency From the Eyes of a Resident Physician

Dr. Amrit S. Rai


As I enter the pre-operative area at the Kensington Eye Institute (KEI), I spot Ms. Reid, the first patient of the day being prepared for surgery. Our eyes meet and I detect a sense of unease. She describes the challenges she faced due to her recent vision loss and her fears leading up to surgery. As I listen, I’m reminded of the reasons I chose to pursue ophthalmology. I address her questions and reassure her that she has come to the right place.

As a resident physician in the Department of Ophthalmology and Vision Sciences at the University of Toronto (U of T), I often reflect on the value of a centre such as KEI and how it contributes to my training. Speaking with my mentors, I have learned that it wasn’t always the way.

In the early 2000s, the Ontario provincial government identified a growing public health concern regarding prolonged wait times. From a patient’s perspective, “wait time” is the total time from the initial referral to a specialist to the date of surgery. For patients like Ms. Reid, this would have waiting up to two years for her sight-restoring operation due to a huge backlog with the aging population.

At the time, while there were surgeons capable and willing to perform additional surgeries, there was no capacity in the healthcare system or operating room availability. Recognizing this growing problem, Kensington Health submitted a proposal to the Ministry of Health to establish KEI as a not-for-profit independent health facility focused on addressing the cataract wait time issue in a safe, cost-effective manner. And so, with a $3.4 million grant from the Kensington Health Foundation to cover the capital costs, a state-of-the-art eye surgery centre was developed.

In 2006, during KEI’s first year of operation, 6,700 cataract cases were completed by 33 U of T-appointed ophthalmologists and four anesthesiologists. By 2012, most Toronto teaching hospital cataract cases shifted to KEI, and it was formally established as a cataract teaching centre. Through consolidating care, a greater number of patients received services, professional experience accumulated thanks to dedicated teams and more tailored facilities, and hospital resources were freed up for higher risk procedures.

Since then, without increasing the number of operating rooms and fixed physical resources, KEI has increased its annual cataract output to 10,000 cases, while adding more than 2,300 specialized eye surgeries. This increased efficiency came while maintaining the quality and safety of care at the level of a hospital. There is a misconception that procedures performed outside of a hospital setting are inherently less safe; the model at KEI proves that this is not true. In fact, the rate of post-operative infections at KEI are 50% below the industry standard.

While KEI continues to address the growing backlog, it also creates a unique and tailored training opportunity for new ophthalmic surgeons to meet the ophthalmology needs of the future. Every year, more than 25 ophthalmology residents and 35 clinical fellows train in cataract, glaucoma, corneal and retinal surgery at KEI. We all gain from the efficient model KEI has created.

After her surgery, Ms. Reid told me she was pleasantly surprised to have remained in her own clothes instead of a hospital gown, and liked not having to awkwardly shuffle onto a surgical table like she had for previous surgeries. KEI uses modified surgical chairs in the preoperative area that transport patients into the OR then recline when ready for surgery. While these simple changes improve patient comfort, they also improve efficiency. Each added efficiency results in reduced turnover time between cases. Turnover refers to the time between the end of one case and the beginning of the next. At present, KEI has an average turnover time of under 7.5 minutes.

In its mission to reduce vision loss, KEI has continued to innovate and expand. As a student, I am fortunate to have the opportunity to train in a modern, leading edge facility. Every day, patients like Ms. Reid tell me how grateful they are for the compassion and care they received. I, along with my colleagues and patients, look forward to seeing KEI continue to evolve and be a leader in the future of ophthalmology in Ontario.

About the Author(s)

Dr. Amrit S. Rai is a fourth-year resident in the Department of Ophthalmology and Vision Sciences at the University of Toronto. He is passionate about health policy and medical education.

For more information about the Kensington Eye Institute, visit

The patient name in this piece has been changed to protect the privacy of the individual discussed.


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