Exceptional practice: Lessons from a humanitarian mission

As the name implies, this column typically focuses on the value of standard practice, but this month, I want to share some exceptional practices performed by volunteers with Project Perfect World (PPW), an organization founded by the Association for Healthcare Resource and Materials Management (AHRMM). But while exceptional, the work of PPW once again underscores the value of practices that promote sustainability, continuous learning and standardization.

For me, the story began in 2015, at a dinner where my friends Bob and Linda Simpson were receiving a humanitarian award from Pope Francis in part for work they had done to turn a squalid environment into a life-enhancing community for the victims of Hansen’s (leprosy) disease in Guayaquil, Ecuador. But for Bob, who is retiring as chief executive officer of LeeSar/Cooperative Services of Florida Inc., the mission began nearly 30 years before, when he began providing custom surgical packs for physicians who were performing pro bono maxillofacial surgeries in Ecuador. In 1995, under Bob’s leadership as president of AHRMM, PPW was founded. A separate organization today, PPW conducts two medical mission trips to Ecuador each year.

This year, as chair of AHRMM, I had the pleasure of participating in the Spring trip to a children’s hospital in Guayaquil, where a team, including nine physicians, performed 16 surgeries, including 7 complex spine surgeries, and saw hundreds of other children for surgical evaluations and orthotic and prosthetic fittings. I saw firsthand the impact of a true team effort. Members of the team chip in wherever and whenever there is a need. Where else would you see doctors and nurses sitting on the floor, helping count and organize donated supplies or the lead surgeon (Richard Schwend, MD) mopping the floor to turn an OR more quickly to fit in one more surgery. As Dr. Schwend aptly states: “It is better to have an expert team, than a team of experts.”

PPW creates sustainable and continuous value improvement, not only for the children it serves, but also for the healthcare system in Ecuador and even back in the United States.

The mission begins with a child, but it extends beyond: first to the families. Mark Crawford, the administrative lead for the Spring trip, recalls one patient whose father had to carry her everywhere because she could not walk. Today, the father delights in watching his daughter dance and play.

The PPW team does more than fix problems; it works to prevent the need for surgery in the first place. Pete Allen, administrative lead for the fall trip, recalls that many of the surgeries in the early years were performed to correct club foot, a condition that has nearly disappeared in developed countries thanks to better prenatal care. But even when a child is born with the deformity, it can be corrected in infancy in about six to eight weeks through proper gentle manipulations and plaster casts. In 2003 PPW introduced the Ecuadorian clinicians to what is known as the Ponseti method and then established a professional orthotics lab to support the process. Today, PPW sees very few club foot cases, which has enabled it to expand the types of surgeries performed to other orthopedic procedures, including spine.

According to Dr. Schwend, the learning goes both ways. As chair of the Pediatric Orthopedic Association of North America, he strives to continuously improve the value delivered to patients, which includes reducing the cost of delivering care. On trips to Ecuador and other developing countries, Dr. Schwend was struck by the minimal number of instruments and implants set out for a surgery. That compares to an average of 22 instrument trays for a spine surgery in the U.S., when only about 20 percent of those instruments are typically used in a case. The more trays, the greater the chance of infection, not to mention the time involved to manage them. Working with other surgeons and supply chain professionals at his home institution, Dr. Schwend helped Children’s Mercy Hospital in Kansas City reduce the number of trays from 22 to 6, resulting in an average savings of nearly $3,000 per case. Further, specific spine implants, such as pedicle screws, are measured and selected in advance of the case, thus eliminating many trays of implants on the back table.

Bob Simpson brought home similar learnings, convincing surgeons working at the hospitals served by his organization to reduce the number of items in custom surgical packs by storing less frequently used items in smaller quantities in the operating room for those times when they are needed.

PPW President Douglas Beck says the organization is working on ways to extend the value of its work. PPW has made a lot of improvements over the course of 22 years, not only for patients and their families, but also in both clinical and supply chain processes. It is now forming partnerships with other organizations to help replicate the model, which prioritizes building local capabilities.

PPW depends on the generous donations of organizations and individuals, in the form of financial contributions or donations of medical supplies. If you would like to donate, you can contact Doug Beck directly at 385-319-7104, ext.102 or email [email protected]. PPW will make sure the right products make it to the right place at the right time for the right purpose. After all, that’s the foundational mission of supply chain. But as PPW has proven, supply chain can do much more. It can help change the world. HPN