A different way to measure success in health care | Andrew Bastawrous

Summary

TED Talks Daily: "A different way to measure success in health care"

Guest: Andrew Bastawrous
Host: Lily James Olds (TED Fellows Director), with TED Team
Airdate: February 6, 2026

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Overview

This episode explores a provocative shift in healthcare measurement, led by Andrew Bastawrous, eye surgeon and CEO of Peak Vision. Instead of prioritizing speed and efficiency, Bastawrous argues for measuring compassionate, deep, and human-centered care—suggesting this approach yields better outcomes for both patients and healthcare workers. The episode blends Bastawrous’s personal stories, insights on scaling health tech globally, and a thoughtful conversation on the need to redesign both our health systems and mindsets for greater presence and connection.

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Key Discussion Points & Insights

1. The Dilemma: Efficiency vs. Compassionate Care

• Traditional Healthcare Models: Overwhelming pressure for speed and volume means practitioners see patients repeatedly and superficially.
  • “Currently, the pressure on the healthcare system means we'll choose to see someone three or four times superficially rather than once or twice deeply.” (Andrew Bastawrous, 03:34)
• Bastawrous’s Alternative Proposal: Deep, meaningful engagement with patients, even if less frequent, leads to better outcomes for all.
  • “I'd like us to show the evidence that once or twice deeply actually leads to better outcomes for both the patients and the health workforce.” (03:45)

2. The Power of Presence: A Personal Anecdote

• Story of Jackie (Patient):
  • Bastawrous recounts a patient encounter that shifted his perspective. Jackie, who delayed cataract treatment to care for her dying daughter, found more value in being listened to than in the clinical result itself.
  • “The greatest gift I could give her was not her sight, but to have her be truly seen.” (05:32)
• Insight: Active listening and genuine presence changed the patient’s healthcare experience profoundly—a theme Bastawrous urges should be systematically measured.

3. Scaling Compassion: The Evolution of Peak Vision

• Technology for Scale:

  • Peak started in Kenya with mobile eye clinics. Realizing the impracticality of scale, they shifted to a smartphone-based system for screening and referrals, now reaching a million people every two months.
    • “In 2014, we'd seen 7,000 people over two years, but today we reach a million people every two months.” (06:58)
  • Unintended Consequence: Technology that optimizes efficiency may compromise human connection—the very reason Peak was founded.
    • “There was all of these metrics that allowed people to know how many seconds it took them... and it was tracking everything around efficiency, performance. And we've decided...we started this not as a means of efficiency, but as a means of compassion.” (07:26)

• Redesigning Metrics:

  • New trials in India: half the screeners are given extra time and measured on how many patient stories they remember rather than throughput.
    • “Their key performance indicators are going from how many people they've screened and referred to how many stories they remember...” (07:54)
  • Preliminary Results: Fewer patients per day seen, but significantly more show up for treatment overall, with higher satisfaction and less staff burnout.

4. Barriers & Levers in Global Eye Care

• From Diagnosis to Treatment:
  • The biggest global barrier is not diagnosis but patient “completion of journey”—people often aren’t aware that treatment is possible or don’t know how to access it.
  • Peak’s solution: intuitive tech for non-specialists, automated parent/caregiver notifications, behavioral “nudges” for headteachers to support child follow-through.
    • “We built in an automated messaging service... but content, frequency and the recipient (like headteachers) made an even bigger difference.” (13:29–15:44)

5. AI: Double-Edged Sword

• Potential and Peril:
  • AI can amplify both good and bad trends. Current drivers risk increasing inequality, with tech and productivity gains benefiting the already-served, while a billion people still lack basic glasses.
    • “I don't see people talking about how are we going to use AI to close that gap.” (18:06)
  • Design Principle Needed: AI should prioritize inclusion and service to the neglected, not only efficiency and novelty.

6. Slowing Down to Speed Up: Personal and Workplace Practices

• Practices Bastawrous Follows:
  • Calendars: Starting his workday later to allow unscripted neighborly connections and presence with family.
    • Story: “I just moved my day to start at 9:15...in those unscripted moments, some really beautiful conversations have happened.” (21:59)
  • Headphones: Sharing the Joshua Bell experiment as a parable about the costs of constant rushing and inattention; most passersby failed to notice musical genius in plain sight.
    • “It's a story about us. It's about what speed does to our souls and how we're constantly, constantly rushing and we miss...obvious, beautiful moments.” (25:31)

7. Designing for Care: Hard Evidence and Organizational Recommendations

• Early Results from India Pilot:
  • When care environments emphasize story and empathy over throughput, more patients participate, fewer staff burn out, and trust in health systems increases.
    • “The outcome that matters to us is that that person turns up and gets treatment that works, as opposed to how many people were tested.” (29:53–31:23)
• Advice for Leaders:
  • Remove distractions, model undivided attention (e.g., phone away during conversations), and design for clarity not certainty.
    • “You have to work hard at creating the space to not be busy. I think a lot of that comes from...clarity. Clarity comes from doing the deep work...” (33:37–34:59)
  • Small structural changes—no-meeting days, deep work blocks, and planning periods—can add up.
    • “Having a planning week per quarter, having a day every fortnight where there’s no meetings, having an hour and a half every day where you just get to do deep work...” (34:58)

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Notable Quotes & Moments

• "When we enter the healthcare profession, none of us actually ever go in with an aspiration of productivity or efficiency. It's called healthcare for a reason. We go in because we care."
  —Andrew Bastawrous (03:23)

• "The greatest gift I could give her was not her sight, but to have her be truly seen."
  —Andrew Bastawrous, reflecting on patient Jackie (05:32)

• "People aren't inherently not caring or not compassionate. If the environment is one that doesn't allow people to stop and care, then people don't live to their values."
  —Andrew Bastawrous (05:58)

• "If patients are given more time to be heard and doctors have more time to listen, everyone will be happier and the results will improve."
  —Andrew Bastawrous (08:48)

• "AI is going to amplify human behavior...that could be for good or less good."
  —Andrew Bastawrous (18:06)

• "It's a story about us. It's about what speed does to our souls and how we're constantly, constantly rushing and we miss the kind of obvious, beautiful moments."
  —Andrew Bastawrous, on the Joshua Bell story (25:31)

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Timestamps for Important Segments

• [03:23] Entering healthcare: care vs. efficiency
• [04:00]–[05:32] Jackie’s story: presence matters
• [06:58]–[07:56] Scaling Peak Vision: from efficiency back to compassion
• [11:39]–[15:44] Global eye health barriers and technology-driven solutions
• [18:06]–[19:50] AI's risks and opportunities in healthcare
• [21:59]–[25:31] Personal practices for presence; the Joshua Bell anecdote
• [27:23]–[31:23] Early trial findings: compassion yields measurable results
• [32:51]–[34:59] Advice for designing compassionate work/home environments

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Closing Reflections

Andrew Bastawrous’s central message is a call to action for both individuals and systems: true success in healthcare—and in life—should be measured not solely by throughput, volume, or efficiency, but by the depth of our connection, empathy, and presence. By redesigning systems and personal practices for slowness and clarity, the outcome isn’t just a happier workforce or more satisfied patients, but a fundamentally more just and humane society.

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For further info about the TED Fellows program and more talks, visit fellows.ted.com.

Transcript

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[Andrew Bastaurus (Eye Surgeon)]

When we enter the healthcare profession, none of us actually ever go in with an aspiration of productivity or efficiency. It's called healthcare for a reason.

We go in because we care.

Currently, the pressure on the healthcare system means we'll choose to see someone three or four times superficially rather than once or twice deeply.

I'd like us to show the evidence.

That once or twice deeply actually leads to better outcomes for both the patients.

And the health workforce. My name is Andrew Bastaurus.

I'm an eye surgeon, a professor of.

Global health, and founder and CEO of PeakVision.

Years ago, when I worked as an eye surgeon in the uk, I was running a really busy clinic. I knew that I had at least another four patients to see that day, and I was already at time for the end of the clinic. We had a clock on the wall. I could just hear ticking, and that tick seemed to be louder and louder. I'd also be more tuned in to everyone outside complaining that they hadn't been seen yet. And a lady came in to see me. She looked weary, like life had been hard. She'd also come in very late for someone with cataracts. In the uk, most people don't come in near blind. And she shared that the reason she hadn't come was she'd been nursing her daughter for four years and her daughter had had cancer and she'd only just died. In that moment, it felt like she'd shared something sacred with me and just to pass it by, felt like I was doing her an injustice. I didn't really have to say anything. I just listened. I think it was maybe around 10 minutes, but that 10 minutes, I know.

Meant more to her than the 10.

Minutes I spent operating on her eye. Her cataract operation went well, and a couple of days after that, I saw her in my clinic. So I expected her to come in pretty happy. She did come in with a bag, but it wasn't a box of chocolates. It was a photo album. And one by one, she showed me these pictures of her with her daughter. And the whole time I looked at her and I realized she hadn't mentioned that she could see. So I Waited for her to mention something. I even prompted her and I said, jackie, how's your eyes? She said, oh, it's fine, it doesn't hurt. And then she finished showing me the photos, she closed the album and she said, thank you. You were the only person that listened to me. The greatest gift I could give her was not her sight, but to have her be truly seen. I think there's very few things in life that are as joyful as being able to help a fellow human being. People aren't inherently not caring or not compassionate.

It's.

If the environment is one that doesn't allow people to stop and care, then people don't live to their values. Peak vision started as a concept in 2012, whilst I was living in Kenya and we were setting up 100 temporary eye clinics, taking equipment and trained staff to all of these remote locations. And it dawned on me that this would never solve the problem at scale, that there had to be a way to reach more people. And so we built ways of being able to screen and diagnose and refer people, all on a smartphone. In 2014, we'd seen 7,000 people over two years, but today we reach a million people every two months. One of the questions my team and I have been asking is, what are the unintended consequences of scaling? And I went back to that experience I had with Jackie, where there was pressure to see as many people as possible. And we realised we were potentially creating that same pressure. There was all of these metrics that allowed people to know how many seconds it took them to identify a person with vision loss, how many seconds it took to refer someone, and it was tracking everything around that efficiency, performance. And we've decided, well, we started this not as a means of efficiency, but as a means of compassion. And this idea that compassion is actually inherent, provided the environment is conducive to people being allowed to care. And so now we're trying to encourage that when a screener finds someone with a vision problem, that they stop and they slow down and they listen. We want to move from having soft evidence that being compassionate is a good idea to hard evidence that actually it yields better numbers. So we have run this trial with our partners in India, where half the group of screeners are given extra time and different measures of outcomes. Their key performance indicators are going from how many people they've screened and referred to how many stories they remember of.

The people they've seen.

You'd expect if you're spending that much more time with people, you'll get through much Fewer people per day, and we.

Expect that to be true.

However, we expect many more people overall to turn up for treatment. For many people, even going to see a doctor is a huge step of courage. And a decision to take treatment that you don't necessarily understand or have evidence that works is all down to the.

Relationship that you have with the person who suggested it.

And so if that person's under pressure just to diagnose and send the referral, we think that's one of the reasons why not that many people turn up who need it. So if trust is built, then we think they're much more likely to take up the care. The secondary effect is the doctors and the nurses providing the care will burn out less because they're more connected to the work that they're doing and they'll feel less pressure to see numbers and.

More pressure to see people.

If patients are given more time to be heard and doctors have more time to listen, everyone will be happier and.

The results will improve.

We tend to measure progress or success in terms of who's got the most. And that could be measured in market share or the most dollars or the most power. But we all deeply resonate with there being something more than that. There's got to be a different game that we're playing. The measure of a life well lived isn't how much we do, but how much we connect with one another, with the people that we love and the people that we serve.

[Podcast Host/Producer]

And now a special conversation between Andrew and our TED Fellows program director, Lily James Olds. Andrew speaks with Lily about why smart technologies like his matter in healthcare, how slowing down has reshaped the way he sees and experiences the world, and why this shift in pace is fundamental. That's coming up right after a short break.

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Okay.

[Lily James Olds (TED Fellows Program Director)]

Hi, Andrew, Welcome. What a treat to get to talk to you today.

[Andrew Bastaurus (Eye Surgeon)]

Hi Lily. Great to be here.

[Lily James Olds (TED Fellows Program Director)]

So over the next four years, Peak Vision aims to serve 1 million people every week. It's really incredible.

[Andrew Bastaurus (Eye Surgeon)]

Thank you.

[Lily James Olds (TED Fellows Program Director)]

I'm curious, in your experience as an eye surgeon and professor of global health, what urgent challenges are we facing globally when it comes to eye disease? And how does Peak Vision's technology specifically help address those gaps?

[Andrew Bastaurus (Eye Surgeon)]

The problem people face with eye health is that across the age spectrum, people are losing vision and are largely unaware of it unless somebody intervenes. So if you take children in school, many of them have a level of vision impairment that's undiagnosed. Much like I was living at school with vision impairment failing, being very clumsy, and all I needed was a pair of glasses. So there's a huge number of children who can't see the board. And a pair of glasses can unlock their education and hugely increase their future potential. The short sightedness or myopia epidemic is growing in huge numbers, particularly if you live in a low or middle income country, and particularly in Asia.

And then you take the next age.

Group, kind of working age people, once you hit 35, 40, it's normal to start losing near vision. And so people struggle to do basic tasks because they can no longer make out near objects. And so that affects huge numbers of people where the fix is a $1 pair of reading glasses and half a billion people or more still can't access that very simple treatment. And then in older age, you have people who start to lose their sight from cataract, which is a natural aging of the lens of. And it's estimated close to 100 million people have vision impairment from cataract and the majority of them live in low middle income countries. And if you are in a context where access to care is low, the likelihood is you will die before accessing treatment.

[Lily James Olds (TED Fellows Program Director)]

And so how is Peak able to meet these people where they are in a way that definitely wasn't possible before for doctors?

[Andrew Bastaurus (Eye Surgeon)]

When we started doing this work, we.

Were setting up all these clinics and doing pretty comprehensive diagnostic assessments. And what I realized when embedded in these rural communities in Kenya was the issue was not actually diagnosing somebody, it was them completing their journey. Once they had been identified with a vision problem because the majority of people are not even aware that treatment is possible. And so they're not seeking to access care. And if they are made aware, they don't know where to go. And if they do know where to go, they have major barriers in terms of accessing it. And so we set about trying to solve for that by building technology that could be operated in the hands of anyone that's smartphone literate. So no need to have any healthcare background or eye care background, but just be able to use a smartphone. And we redesigned everything that I was running in that clinic so that people could do simple tests, could do basic assessments that would help us identify those with a vision problem or an eye health issue and determine where they need to go next. The very first implementation of this was in a school based program where children were being screened and a good 5 to 10% of them had a problem, but only one in every five turned up for treatment. So we started to try and understand what is it that's stopping them access care? And the first realization was the child doesn't decide whether they get treatment. And so we realized we needed to connect with their parents or their carers. And we built in an automated messaging service that would notify the parent or carer that the child had been tested and that they had a problem and where they needed to go. And that started to make a real difference. But interestingly, the content of the message made even more difference. So the language used, the way in which it was sent, the frequency, all of these things started to increase the chance of them coming. And one time we noticed that actually headteachers could be a key person in this system that we might be able to influence on this. So we started sending them messages, telling them how their school was performing in terms of completed referrals compared to neighbouring schools. And when they started receiving that message, headteachers would organize minibuses, start taking all the kids that had a problem straight to, to the hospital.

[Lily James Olds (TED Fellows Program Director)]

You made it competitive.

[Andrew Bastaurus (Eye Surgeon)]

And it was just these lessons. And we learned so many lessons. How do you basically nudge people's behavior, whether it's the person who needs the care, the person who looks after that person, the person who has a vested interest in them being able to see. And over time we started building this data platform that was connected from household and school to health centre, eye clinic, vision center, eye hospital, and really connected the whole network of possibilities in terms of where that person might go and then increase the likelihood of them attending the place they needed to go to get the treatment they needed.

[Lily James Olds (TED Fellows Program Director)]

The technology that Peak uses, does that open up more time for doctors to then do other things?

[Andrew Bastaurus (Eye Surgeon)]

Yeah. So the assessment that was needed to determine if that person needed to come for treatment could only be made by someone with specialist skills. That specialist had to make a choice of either work in the hospital or go out into the community and find people, but they couldn't be in both places at once. And so you were decreasing their productivity in the hospital.

And the challenge that you face when.

You'Re in, in a context like this is you've got known need sat in the waiting room. You know, you've got people who've come because they have a problem.

[Lily James Olds (TED Fellows Program Director)]

Right.

[Andrew Bastaurus (Eye Surgeon)]

But then out in the community, you've got many, many more people that have a problem and they're not asking to come. And so that's, that's the challenge health services face, is if you just focus on who's already there, you're already busy, you've already got a workload, but then there are all of these people who will never come unless you go and go to them and do outreach. And so we try and make that challenge less painful for people so that they can increase their efficiency and throughput at the hospital level, whilst also having non specialists go and do the screening and bring the appropriate people to the hospital.

[Lily James Olds (TED Fellows Program Director)]

And I'm curious to hear your take on AI. What else? It's all everybody's talking about. I'm curious one, how you think about it as it relates to Peak and, and that particular technology. And also as it becomes more embedded in healthcare, do you see it as a tool that could give clinicians more time to slow down and be present with patients, or do you think it could push us, you know, even further away in the other direction?

[Andrew Bastaurus (Eye Surgeon)]

So my shortest version of the answer is yes. And I think there are so many angles we could take on this. But my view is that AI is going to amplify human behavior, particularly our behaviors, which are online. And that could be for good or less good in terms of its utilization. And my view is that the current kind of forces driving AI adoption and acceleration are moving in a direction that.

Does concern me and equally excites me.

On one side because I look at some of the amazing new augmented or extended reality glasses that are out there, that all the big companies are starting to push now, and they're phenomenal in terms of being able to get an overlay of a map or interpretations and all of these other things. Yet as we're pushing the boundary in terms of extended reality glasses. We have this tragic reality that close to a billion people live without a basic pair of glasses, which is a 700-year-old invention, which is older than most nations, and it still remains out of reach for them. So this is negle on a global scale. And I don't see people talking about how are we going to use AI to close that gap. So although it has huge potential, I don't see an incentive at the moment which is utilizing this hugely powerful capability to serve those who are being left behind. I completely get its potential in terms of productivity gains, breaking new lines. But unless the underlying principles against which we are building these new capabilities serve everybody, I think those who are currently being left out are going to be left even further behind in the future, I guess.

[Lily James Olds (TED Fellows Program Director)]

Let me ask this to you personally. Since it's a moment when your organization peak is reaching more people than ever, do you hear any pushback about choosing to pause and slow down rather than just continuing to build more and more? Which, of course, whether it's with AI or anything, is really what we are hearing again and again that success is always about just doing more.

[Andrew Bastaurus (Eye Surgeon)]

The feedback I'm getting is that it resonates with people, I would say, not even limited to healthcare.

I think everyone just feels that they're.

In a hurry and that they're busy. You know, you ask anyone how you're doing and the usual answer is, I'm busy. And it's become the thing of our time to be busy. And I think we've created this kind of false idea that if you're doing lots of things and that's good, and it comes down again to what, what are the incentives? So if within healthcare, everything is measured against activities and throughput, then whatever somebody wants to do in terms of be a caring human being, there's a lot of pressure on them to do the numbers get through people. And so I don't get pushback at an individual level. But then the systems that people are operating in are just not designed to do this and to allow people to slow down. So that's some of the work I'm working on now with my team is can we create evidence that actually shows these things are not in tension with each other. You can slow down to speed up, you can do less and get more. You can exchange money for meaning and still be profitable. And demonstrate with this with hard data that might start to move the needle a bit on this.

[Lily James Olds (TED Fellows Program Director)]

I want to get into that more with you, but I think first I Would love to just ask you to reflect on that as a question personally. How do you internally reconcile with this pressure to scale your company? Be a parent, be a partner, be a citizen of the world. What are your practices to do that? To remind yourself to slow down.

[Andrew Bastaurus (Eye Surgeon)]

I'm going to share two things with you, so I'll summarize them as calendars and headphones. So the first thing is I'm fortunate to be able to choose when I start my meetings. And I'd realized for a long time my first meeting of the day would always be at 9 o' clock and I'd be doing the school run in the morning, which meant by the time I dropped the children off, I had five minutes to make a five minute journey home and then straight into that first meeting.

And the consequence of that was if.

I saw somebody I knew or somebody made eye contact with me, I'd have to try and make some kind of gesture that was dismissive to say, you know, I'm in a rush, sorry, I've got to go, I've got a meeting. And I thought, why am I doing. I don't have to ignore these moments and these opportunities to connect. So I just moved my day to start at 9:15, which means that buffer means I can walk the kids to school without rushing, means I've got time to talk to neighbours. And it's often in those on scripted moments that some really beautiful conversations have happened. And just a few months ago, after the school drop off, walking through the park, there was an elderly man there who just looked isolated and I could tell something wasn't right. So I wandered over to him and I just asked if he was okay. And he said, well, his wife died recently and he felt really lost. And we just stood there together for a few minutes talking and mostly listening. And you know, it left with him giving me a hug and I just walked home glowing. I felt connected to another human being. I hadn't alleviated his suffering, but I had at least connected with him and it felt heard. And you know how many of these moments are happening all the time that we, that we don't even recognize? The other I mentioned was headphones. One of the main stage performers at TED in 2025 was Joshua Bell. He did this kind of stunning piece on the violin and he had an orchestra with him. And so I read up about him afterwards and it turned out he was part of a really interesting experiment almost 20 years ago in 2007. So a few days prior to this experiment, he'd been performing in Front of hundreds of people for hundreds of dollars. And people had traveled for it and dressed for it and sat down and they knew they were witnessing something great. And then a few days later, he was performing in the Plaza station at Washington D.C. just before 8. And he played for 43 minutes with about 1,100 people walking past on their way to work, you know, in the open. It was not hidden in a corner. And he was playing on this stunning 300-year-old violin that's worth over $3 million. So it's been like handcrafted and passed down, playing pieces that have lasted 300 years. And he was one of the most talented musicians of all time. And we would assume you have someone like that playing that kind of music in the open, where there's no barrier, anyone can walk up to him, that he would have stopped. But what happened was because people were hurrying, it changed them to tighten up, to narrow, to just to focus on getting to where they were going. People had their earphones in their earbuds and were listening to their own music. And almost no one noticed him. And it wasn't cruelty, it was absence. The fact that only a handful of people stopped at all. He raised only, I think, $30 in 43 minutes. Given that more than a thousand people passed, and I think only literally one person recognized him the whole time and stopped to really pay attention. And this isn't about a super talented musician.

It's a story about us.

It's about what speed does to our souls and how we're constantly, constantly rushing and we miss the kind of obvious, beautiful moments that are happening. We miss one another. And so I suppose the invitation is.

Just take your headphones out and when you come up the.

The travelator, look up, see, notice who's around you. Because we're constantly missing these moments, you know, And I think when we look back on our lives one day we'll realize that our. Our whole life is made of. Of moments that you notice and. And the ones that you don't.

[Lily James Olds (TED Fellows Program Director)]

So as much as I think, think all of us need to figure out, as you're saying, what are these small actions that can make us feel more present in our days and our lives? Whether it's, you know, meditating or taking out the headphones or just adding 15 minutes, as you said before, or between meetings. I think it also is really interesting to think about it from this design problem angle, right, because it's on each of us, but it's also these systems and how they're structured. And I know that your team is currently working on a trial to generate some of this hard scientific evidence that being compassionate to patients actually yields better numbers. And I know the study is still ongoing, but I'm just curious if, in the meantime, you have any updates you could possibly share about how this is going and what you're finding.

[Andrew Bastaurus (Eye Surgeon)]

Yeah, absolutely. So, as you might expect, programs are trying to optimize for throughput because the need is huge. And so they're looking for efficiency. And so when it comes to the screeners and their supervisors, what they're measuring is kind of throughput measures. How many people did you see? How many did you refer? How many turned up? And they're all good measures, but they are optimizing for productivity and not for care. And so our working assumption is that people are inherently compassionate, but there isn't the space to connect deeply enough. And we've seen it when we go and watch people do the screening. I remember in the early days being in Kenya, and this lady who'd been blind for 20 something years at this point, and somebody knocked on the door, did the eye test, found that she was blind, and she refused to go. She said, like one, she didn't believe him that it was possible to be treated. Now, he recorded the screening, recorded the referral, and he could have just walked on to the next house, but instead he asked if someone else was home. There wasn't. But next door was where her son lived. So he went and knocked on his door. Guy called Philip, got chatting to him and explained that his mother had cataracts, was blind, but could get her sight back. And he spent the time really trying to understand why were they scared, why would they not come? And by just sitting and paying attention to them and helping them understand what lay ahead, they decided to take up the surgery. And I always remember this particular lady. So she was kind of known as Mama Philip because she'd been blind for so long. Everyone assumed that she was not only blind, but couldn't walk, and that her memory had gone, that she had severe dementia. But the reality was she hadn't seen anything new in two decades. And then when she had her surgery the following week, when she was brought home on the bus, she got to the edge of her village and where they all got out, she looked across at her house and she recognized it because it hadn't really changed. And her son Philip was stood there looking really anxious as this worked. And she looked at him and didn't recognize him. And so he still thought she couldn't see. And then Suddenly she kind of leaned forward and was like, philip, is that you? And he said, yes, it's me.

And she said, wow, you look so old.

What happened?

[Lily James Olds (TED Fellows Program Director)]

Oh, my God.

[Andrew Bastaurus (Eye Surgeon)]

And then suddenly in that community who were scared to come realize like, wow, look at this. This person was blind. She can see again. How do I get treated?

[Lily James Olds (TED Fellows Program Director)]

Right.

[Andrew Bastaurus (Eye Surgeon)]

That one person just spent a few minutes taking the time to understand their fears and the ripple effect they have had in terms of not just that one person and their son Philip, but all the other people who are now coming, that happened because they slowed down. Whereas if they just done their job, which was hit those numbers, that wouldn't have happened. So the kind of challenge we have, and the question we're asking in peak is how do we design for that? How do we design to create the space for those moments? And we realized if we choose to measure activities rather than the outcome we're after, you will always bias the system for more activity. So here, the outcome that matters to us is that that person turns up and gets treatment that works, as opposed to how many people were tested. And so that's what we're doing now. We're running experiments such as this, such as just giving them more time and changing what their key performance indicators are. So rather than tell me how many you've screened and referred, it's tell me a story about someone you've seen and referred. And that just changes the emphasis. And what we're seeing when we did our kind of pilot work was actually, although they are seeing fewer people per day, more people overall are coming for treatment. And we'll be really excited to see the final data because it's looking like there isn't a trade off. And in fact, when you do slow down, more people get treated. The health workers are happier and not burning out, and so retention is higher and the patients and their carers are much happier and appreciating the service they're getting.

[Lily James Olds (TED Fellows Program Director)]

Well, and it's also such a great example of how trust is so important in this process. And I love that example because it's how you're actually building it again into the design of this system in healthcare, which I just feel like so many people distrust. Right. I'm really excited to see, you know, how those trials continue and if there's ways this can be implemented, obviously with others in healthcare, but also across so many sectors.

[Andrew Bastaurus (Eye Surgeon)]

Yeah. And absolutely. And it is about that, that tension between individuals and the systems they operate in. Because if we have the working assumption that people are good, but the system isn't designed for that. It is a problem. And we don't fail to act because we don't care. We fail because we haven't created the spaces for people to care. And so we end up serving the clock rather than one another. And when you put people under stress, whatever their value set, they're unlikely to live to it. And I think that's a key thing to take away anyone who's in a position of influence in terms of designing an environment, Whether it's your home environment, your work environment. If you put people under stress, you will not create an environment for them to live in alignment with their own values.

[Lily James Olds (TED Fellows Program Director)]

And I guess just building off that. What advice would you give to other leaders who are trying to redesign their own either work or home environments to value compassion? How would you advise them?

[Andrew Bastaurus (Eye Surgeon)]

There's so many things, and I'm conscious that, you know, I absolutely hypocritical in this because I. I certainly don't do all of these things, But I think it can be from small things like not having your phone near you when you're talking to someone else, because it's a sign of distraction, you're ready to have your attention diverted, or if you have to pick up your phone and communicate, or doing whatever it is that you're doing to actually say, hey, I'm just. I'm just responding to so and so, or I'm needing to do this because the assumption for the person on the other half is I'm not worthy of your attention. And I'm super conscious of this, you know, having young children, how. How do we model those kind of behaviors? Because they'll only end up doing the same things we're doing. And then, I think, you know, things within home life.

It's also just, I think, creating the space to, if you're someone that needs.

To be on your own, occasionally finding those spaces, whether it's going out for a walk, whether it's the first thing in the morning, last thing at night, you know, I think most people need some space to themselves and within the work environment. We're trying really hard, and I say really hard because it is hard to do it. You know, there's the usual whirlwind of activity when you're building something new. When things are going badly or things are going well, there's always work to be done. So you have to kind of work hard at creating the space to not be busy. And I think a lot of that comes from providing people not with certainty, because we can't do that. But providing clarity. So clarity comes from doing the deep work. That means everyone really understands where we're going. Why do we do what we're doing? Because so much energy is misspent in the kind of dance around uncertainty. And I don't think we can solve for uncertainty. The future is unknown, but we can provide clarity. But to provide clarity, we have to slow down and do that kind of work. And that can be as practical as having a planning week per quarter, having a day every fortnight where there's no meetings, having an hour and a half every day where you just get to do deep work, having 10 minutes off every hour where you're not in a meeting so you've got space to move between them.

So it can be, it can be.

Really small things, but these add up to giving you the space to keep perspective and maintain clarity.

[Lily James Olds (TED Fellows Program Director)]

Okay, I'm taking notes. I'm feeling grateful that we can check back with each other and see how we are both implementing these into our daily lives. I'm so grateful to you, Andrew, for this conversation and your work. It just always gives me such a sense of depth and hope when I speak with you. I really appreciate it.

[Andrew Bastaurus (Eye Surgeon)]

Oh, thank you, Lillian and all the amazing TED Fellows team.

[Podcast Host/Producer]

That was TED Fellow Andrew Bestaurus. The music you heard in the interview is Joshua Bell and the Chase Chamber Orchestra of America. It's from their 2025 performance and talk on the TED stage. To learn more about the TED Fellows program and watch all the TED Fellows films, go to fellows.ted.com and that's it for today. This episode was produced by Lucy Little, edited by Alejandra Salazar and fact checked by Eva Dasher. The audio you heard at the top comes from the short film made by Divya Gadangi and Owen McLean. Story edited by Corey Hajim and produced by Ian Lowe. Video Production manager is Searing Dolma. Additional support from Lily James Olds, Leone Horster and Allegra Pearl. TED Talks Daily is part of the TED Audio Collective. Our team includes Martha Estefanos, Oliver Friedman, Brian Greene, Lucy Little and Tonsika Songmarnivong. Additional support from Emma Tobner and Daniela Ballarezzo. I'm Elise Hu. I'll be back tomorrow with a fresh idea for your fee. Thanks for listening.

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