Social innovation in surgery: how new systems are saving lives

by Asha Varghese | GE Foundation
Sunday, 13 May 2018 10:00 GMT

ARCHIVE PHOTO: U.S. Secretary of State John Kerry (C) greets nurses and workers during a visit to the Gandhi Memorial Hospital in Addis Ababa May 1, 2014. REUTERS/Saul Loeb

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In hospitals across Africa, innovation often takes on a different meaning to Silicon Valley’s tech first approach

Augmented reality tools training surgeons. 3D printers creating new body parts and organs. Drones delivering supplies. A Google search for “innovations in surgery” will show you the extraordinary potential of technology to transform surgical care.

But for Amsalu Tiruneh, a non-physician surgeon (otherwise known as an Integrated Emergency Surgical Officer, IESO for short) operating in a rural hospital in Ethiopia, these innovations feel like a world away from his reality.

Amsalu has worked at Dangila Hospital for over two years. He has become used to working with an inconsistent oxygen supply, a limited workforce, and a high rate of post-surgical infections without easy-to-identify causes.

On a daily basis, surgery can be delayed while they wait for an anesthetist to travel across from a neighboring hospital. Amsalu has to overcome electricity outages or an interrupted water supply to perform even the most basic of surgeries. These challenges are unthinkable for surgeons operating in state of the art facilities in New York, London or Berlin.

Rather than groundbreaking tech, Amsalu needs basic infrastructure and more well-trained colleagues to operate safely on his patients. Yet innovation is as integral to providing safe and timely surgical care to the community of Dangla, as it is to the next tech revolution.

In operating theatres in low resource hospitals across Africa, innovation often takes on a different meaning to Silicon Valley’s tech first approach. It means creating processes and sustainable models that improve the quality of surgery within the confines of their resources.

Innovation for Amsalu means finding ways to safely transport critically ill patients to local referral hospitals. It means supporting new training programs that can rapidly train surgical and anesthesia providers, and creating processes that the whole surgical team will follow day in, day out.

Amsalu was part of a Safe Surgery 2020 leadership training program in Ethiopia, a partnership funded by GE Foundation that brings together innovations, global expertise and local experience to make surgical care safe and accessible for all. The leadership program took a new approach by training the whole surgical team together – from the nurse to the anesthetist to the IESO.

Hierarchy in the operating room, with surgeons taking an authoritative role and the rest of the team following unwaveringly, has led to surgical errors all over the world.

By training the team together, new lines of communication are opened up, allowing them to co-create better ways of problem solving and implementing the surgical safety checklist. Each team member is empowered to act as a change agent, ready to speak up and devise and implement solutions to improve patients’ care.

The combination of improved technical knowhow with stronger team cohesion was quickly put to use back in the Dangila Hospital operating room. The surgical team increased the number of surgeries they were completing and saw a reduction in post-operative infections and complications. Patients’ lives were being saved.

By delivering safer procedures, the team has changed the way the local community thinks about surgery.

"The people are now believing in us. They trust that the hospital can deliver safe procedures. Patients are going back to their homes and talking positively about surgery – this makes people less scared to have surgery. I feel very proud. I became a surgeon to help people and now I am able to achieve that," said Amsalu.

Safe Surgery 2020 continues to support the surgical team to grow and problem solve through mentorship from an experienced local surgical team, often from the referral hospital where patients are referred to for more acute treatment.

Innovation means doing things differently, so the mentors help the team to find new solutions that work for their unique challenges while ensuring patient safety is maintained.

Surgical teams in Ethiopia and across sub Saharan Africa are proving that innovation is much more than a buzzword.

By broadening our definition of innovation to encompass new processes and approaches, we will unleash its full potential to transform systems globally.

And nowhere is this more critical than in surgery. With 17 million deaths attributed to surgically preventable deaths every year, surgical teams in resource scarce settings must be supported to innovate in their methods, relationships and systems.  

Asha Varghese is the Director of Global Health at the GE Foundation.