The big idea: Global health agendas were built around the notion of prevention, not intervention. Yet 5 billion people lack surgical treatment that could heal them. What makes surgery and anesthesia different from other health initiatives? And what makes this a business problem?
The scenario: International aid organizations such as the World Health Organization and USAID have long devoted resources and education to improving public health in developing countries. Through immunization, prenatal/postnatal care, infectious disease prevention and more, populations in need were helped. In global health circles, surgery wasn’t talked about much. It required costly equipment and expertise, and preventative disease treatments were thought to be more cost effective.
Even as it was recognized that creating a functional health-care system required both preventive and active treatment, surgical intervention remained a low priority. And trauma, cancer and complications from child birth continued to go untreated.
The resolution: Leaders at a top medical journal, the Lancet, created a commission on global surgery to examine the realities, problems and potential solutions for delivering surgery to all in need. They called on experts in health care, economics, the public and private sector, and government to gather a broad base of experts involving all stakeholders, across all continents. A group of 25 became “commissioners” of the Lancet Commission on Global Surgery.
Core working groups, in a dozen meetings and interactions with nearly a thousand people in 111 countries, generated primary research that resulted in five findings and dozens of recommendations. Five billion people in the world don’t have access to safe, affordable surgical and anesthesia care. It would require 143 million more surgical procedures annually to meet the need. Of those who received safe surgery, 33 million households were thrown into poverty as a result of direct costs and another 48 billion because of indirect costs. Investing in surgical intervention between now and 2030 would save $21 trillion. Surgery and anesthesia were an “indivisible, indispensable part of health care” necessary for a properly functioning health-care system. The commission created a national surgical plan template to help ministries of health develop systems worldwide that incorporate surgery and anesthesia and suggested six core indicators that every country should collect in concert with the WHO and the World Bank.
The lesson: It turns out that many of the problems the Lancet Commission set out to examine are similar to those in large business organizations. Among those: motivating managers and employees with a sense of urgency, moving workers toward a common goal, managing reorganization to better deploy resources, launching employee and organizational change and creating short-term wins to keep a process going. Executing a complex action plan in any context involves seeing the issues, understanding the situation, asking what elements are missing and anticipating obstacles.
Yemen is a senior researcher at the University of Virginia Darden School of Business, and Meara is a professor of global surgery at Harvard Medical School.