When Vision Eye Institute sought a new CEO in 2023, it didn’t need to look far for the ideal candidate. AMANDA CRANAGE traces her remarkable rise from orthoptist to leading Australia’s largest private ophthalmology provider.
The significance of Ms Amanda Cranage becoming CEO of Vision Eye Institute (VEI) is neither lost on her, nor her colleagues. When the network was first conceptualised by a group of Australian ophthalmologists 22 years ago, few would have expected the buck to stop with a trained orthoptist. But times have changed, and when it came to replacing her predecessor, Cranage and the organisation were ready for one another.
“It is something I do reflect on at times, especially when I receive messages of support. In particular, the orthoptists have told me that having a fellow orthoptist as the CEO of Vision Eye Institute is incredibly inspirational and motivating. They do feel more connected to the organisation. Receiving such positive messages has truly validated the journey and made it exceptionally rewarding,” she says.
As for the ophthalmologists – some considered international leaders in their field – they too have expressed support for Cranage. She believes they appreciate having somebody who understands the daily challenges of the clinics and day hospitals at a granular level. At the same time, Cranage has an equal respect for the operational and financial sides of the business and believes finding the right balance is the key to success.
“I’ve known many of our doctors for quite a long time – some since the start of their career when I was in charge of recruiting doctors to VEI,” she says. “A lucky few will even have great memories of me driving them around Melbourne to tour each of our sites. So, they’re comfortable getting on the phone to let me know if there’s an issue or if things are going well. There’s a mutual respect.”
In fact, Cranage was present before VEI’s inception. She started in 1996 as an orthoptist, progressing to orthoptic team leader at Camberwell Eye Clinic – the eventual birthplace of Vision Group and, subsequently, VEI in 2001. Acquired by China’s Jangho Group for AU$200 million in 2015, VEI is now Australia’s largest private ophthalmology provider, with 18 consulting and laser clinics and 11 day hospitals operating under the Vision Hospital Group banner.
“At Camberwell, I was running a 12-strong orthoptic team across a couple of locations and really enjoyed motivating and inspiring everybody. It became a great training ground for learning how to manage teams effectively and make sound decisions. But I felt I needed even more of a challenge – I guess I had reached a crossroads in my career,” she says.
To understand this drive, it’s important to go back to the start where, from the outset, Cranage was never shy of a challenge. Soon after graduating, she worked in regional Queensland where she was frequently confronted with complex ophthalmic and orthoptic cases. The steep learning curve continued at the Royal Children’s Hospital in Brisbane while showing parents how to fit contact lenses in aphakic babies. It was a robust training ground for an orthoptist so early in her career and embedded a mentality that followed her to Camberwell.
“One of VEI’s founding doctors suggested I explore the business side of ophthalmology – and I haven’t looked back,” she says.
“Various team leader and middle manager roles helped hone my leadership skills. Then I discovered profit and loss, and it was so just fascinating – to me at least. I was amazed by how simple efficiency strategies translated into better financial and operational results. We had happier doctors, happier staff and happier patients. It was really rewarding to contribute to the overall financial health of the organisation.”
Since moving from the clinic to operations 15 years ago, Cranage has etched many highlights on her CV. This has included overseeing the Victorian and Brisbane businesses, a stint as national operations manager, leading the 2015 development of Panch Day Surgery Centre in Melbourne, refurbishing a palliative care unit into consulting rooms at RiverCity Private Hospital in Brisbane, and the expansion of VEI’s Footscray consulting facility in Melbourne (now the largest ophthalmic clinic in the state). Interspersed with these major projects was the establishment of several greenfield VEI clinics in Victoria.
“At the same time, I was also leading negotiations with the health fund contracts for our day hospital business. I’m grateful that VEI has always made an effort to keep me engaged with challenging and stimulating projects whenever I put my hand up for more.”
Even with this penchant for hard work and her years of experience, the CEO role represented a whole new realm. While there’s advantages to being part of the organisational fabric for so long, Cranage was acutely aware of the challenges she would face running a large-scale private ophthalmology business in 2023 – and their complexity.
Appointed CEO in June 2023, Cranage credits her predecessor, Mr James Thiedeman, with leading the organisation through a “transformative” five and half years. Now, she will use her long-standing tenure at VEI to consolidate all aspects of the business.
“Seeking somebody that had been in the organisation for a number of years with both clinical and operational expertise is a new and exciting perspective. About the time James was preparing to depart the organisation, we had several conversations about my suitability for the role and I’m thrilled the board and our owners agreed with him,” she says.
Until recently, Cranage was also a director and board chair of Alina Vision – a social enterprise bolstering eye health services in underserved communities in Vietnam. This appointment was at the behest of The Fred Hollows Foundation and saw her play a pivotal role in expanding services in the north of Vietnam. A key project was setting up the ophthalmology department in one of Hanoi’s main hospitals. Despite her best efforts to juggle both commitments, she has recently relinquished Alina Vision to focus solely on leading VEI.
Cognisant of the challenges
Private health insurance funding, cost escalation, doctor recruitment and availability, and sustainability are just some of the big themes requiring Cranage’s short-term attention. She’s also keen to build further momentum around VEI’s research culture through its not-for-profit Future Vision Foundation that’s provided grants to 24 projects since its inception two years ago. Investing in people and career pathways are on her radar too, so VEI can continue its healthy track record of developing and promoting from within.
When she looks at her top priorities, the first of these is addressing the long tail of the post-pandemic era. Ophthalmologists and healthcare workers are still fatigued, exacerbated by long wait lists in the public system and greater pressure on healthcare in general. The ongoing exodus from the industry adds more strain.
“Staff wellbeing and psychological safety are topics our executive leadership team discuss often, as it feeds directly into development and retention. These terms are bandied about a lot, but we do take them very seriously. As CEO, when I’m out and about talking to the staff, I’m not just listening and nodding my head but truly engaging in the conversation. Our people make VEI what it is, and they deserve to feel safe, feel heard and feel valued,” she says.
“Many ophthalmologists across the industry have also had a rethink of their own roster and work-life balance. This has caused limited, or even no, ophthalmic services in some areas. When you combine that with the backlog of cataract wait lists in the public sector, it makes sense to explore partnerships between private ophthalmology and government. After all, we still have a common goal to ensure patients can access the care they need when they need it.”
Naturally, VEI and the broader industry are looking at ways to better utilise the current workforce. Collaborative care models where orthoptists wield greater responsibility are among those being investigated.
“Orthoptists are such crucial members of the eyecare team. They provide specialised care, help expand our services, promote preventative care, contribute to research and advocate for eye health policies. Their expertise now and into the future will be crucial in addressing the challenges eye health organisations such as VEI are facing,” Cranage says.
Geographic atrophy (GA) presents another oncoming challenge or opportunity – depending on how one perceives it. For the better part of a year, VEI has been working internally to map out how it will deal with an influx of these patients once the first therapy is approved by the Therapeutic Goods Administration, which could occur in 2024.
“The entire ophthalmic community needs to figure out how they’re going to deal with new diagnostic and management pathways for GA. We’re looking at how we will be able to cater for the sheer volume of patients that need diagnosis and then access to treatment in facilities that are already well-utilised and very busy,” she says.
“I think AI has a big part to play in diagnosis so we can streamline some of that care. The opportunity with AI is interesting. I would say we are looking at AI informally, but with the understanding that it’s an area of the business that needs a lot of time and attention.”
Sustainability is also an inescapable part of running a business in 2024. The issue is a priority for organisations like RANZCO, which launched new Sustainable Practice Guidelines for cataract surgery and intravitreal injections at its congress in October 2023. Other examples include the European Society of Cataract and Refractive Surgeons and its Mission Zero initiative to have zero waste to landfill and zero net carbon emissions from its congress, while becoming a role model for social responsibility.
“It’s something eye hospitals, in particular, need to address,” Cranage says.
“We look at it in our organisation as both an opportunity and a challenge. How it’s implemented and the financial viability – it’s a balancing act while ensuring our quality and safety isn’t compromised,” she says.
“VEI has a sustainability working group to engage with different areas of our business and get insights from our clinic and hospital teams, which will guide strategies to reduce our carbon footprint.”
While these are major challenges, Cranage prefers to reframe them into opportunities. She’s relishing the role and hopes to leave an indelible mark on VEI.
“Of course, there are tough days, but I had a message just this week from someone letting me know the support and guidance I provided them was the best of their professional career. Comments like that absolutely make the hard days worthwhile,” she says.