At an Aravind hospital in Madurai, a city on India's southern tip, the waiting room is packed. Aravind's surgeons average about 2,000 operations a year. The average for eye surgeons in the U.S. is 125. R.D. Thulasiraj, a top Aravind official, says that early on the organization embraced the simple idea that if it wanted to have a real impact in reducing blindness, its surgeons needed to work as efficiently as possible."We want to make sure they're not idle because we didn't get our act together," he says. "They're not waiting for a patient, they're not waiting for a staff ? they're not waiting for a lens." That attention to process has made Aravind surgeons quite possibly the most productive in the world.