TORG-MAG Vol 1 Issue 2, Dec. 2024, pp. 18-25.
By Precious Ijeoma Ogbogbo (Marketing Strategist, TORG-Mag)
Cite this article: Ogbogbo, P.I. (2024) ‘Innovating For Tomorrow: The Future of Global Surgical Excellence’, TORG-MAG, Vol. 1, Issue 2, pp. 18-25. Available at: https://torgevents.org/innovating-for-tomorrow/

Abstract

Global Surgical Excellence embodies the aspiration for superior standards in surgical care, education, and research internationally. It emphasizes the importance of high-quality, safe surgical outcomes while addressing the critical healthcare disparities that exist globally.
Healthcare professionals strive for excellence, motivated by a desire to serve and achieve recognition within their field. Historically, surgical care has not received the priority it deserves on the global health agenda. Recent advancements, particularly in low- and middle-income countries (LMICs), highlight the need for equitable surgical care characterized by partnerships that prioritize research, education, and training.
The recent development of surgical scale-up models has seen the inclusion of surgery in health planning within the National Surgical, Obstetric, and Anesthesia Plans, generating hope for the global surgery community. Although templates for these National Surgical, Obstetric, and Anesthesia Plans exist, individual countries are expected to adopt and adapt them, and then develop their surgical scale-up blueprints.

To realize Global Surgical Excellence, a multifaceted approach is necessary. This includes:

Evidence-Based Practices: Adhering to established guidelines to ensure high standards of care.
Continuous Learning: Keeping abreast of advancements in surgical techniques and technologies.
Patient-Centered Care: Focusing on the safety, comfort, and satisfaction of patients.
Collaboration and Teamwork: Promoting effective communication among multidisciplinary healthcare teams.
Innovation and Research: Pursuing advancements in surgical techniques that improve patient outcomes.
Quality Improvement: Regularly evaluating and enhancing surgical practices.
Global Partnerships: Facilitating the exchange of knowledge and expertise.
Cultural Competence: Understanding diverse patient needs across different populations.
Surgical Ethics: Upholding high ethical standards in surgical practice.
Patient Advocacy: Prioritizing the well-being of patients in all care decisions.

While technology has advanced with minimally invasive techniques and enhanced imaging, significant disparities in surgical access exist. These disparities hinder optimal outcomes and emphasize the need for systematic approaches to measure and mitigate inequities in care. Structural barriers such as workforce shortages, rising healthcare costs, and ethical dilemmas complicate the landscape. Moreover, regulatory challenges can impede the swift adoption of innovations in surgical techniques.

Achieving global surgical excellence requires establishing equitable access to care, implementing quality improvement initiatives, and enhancing surgical education and training. Collaborative networks and partnerships are imperative for knowledge sharing and resource allocation, while data collection and research facilitate continuous innovation in surgical care. The journey towards Global Surgical Excellence necessitates a commitment to addressing existing disparities while fostering innovation, ethical practices, and collaboration across the healthcare spectrum. The aim is to create a future where exceptional surgical care is universally accessible, ultimately leading to improved patient outcomes and quality of life for all individuals, regardless of their circumstances.

Vision: To achieve universally accessible, high-quality surgical care, reducing disparities and improving patient outcomes worldwide.

Mission: To foster a global community of surgeons, healthcare professionals, and organizations committed to excellence in surgical care.

Introduction

Global Surgical Excellence refers to the achievement of exceptionally high standards in surgical care, education, and research worldwide. It’s a goal that aims to improve surgical care worldwide. It focuses on achieving high-quality and safe surgical outcomes, reducing complications, and ensuring patient satisfaction. The recent development of surgical scale-up models has seen the inclusion of surgery in health planning within the National Surgical, Obstetric, and Anesthesia Plans, generating hope for the global surgery community. Although templates for these National Surgical, Obstetric, and Anesthesia Plans exist, individual countries are expected to adopt and adapt them, and then develop their surgical scale-up blueprints. Surgical care is indispensable to the creation of robust health systems and the achievement of health and well-being for all. The sustainable development goals (SDGs) are a set of 17 goals that countries committed to meeting by 2030. Central to these goals is the achievement of SDG 3: “Ensure healthy lives and promote well-being for all at all ages.” If SDG 3 is the hub that drives the spokes of the other SDGs, surgery is the center of that hub.

Realizing sustainable global surgical systems will contribute to the attainment of most other SDGs through the growth of healthy populations. Unfortunately, as with other efforts to address global health inequalities, surgical disease is excluded from national systems developed to monitor the attainment of SDGs. This exclusion is an important contributor to the slow progress in attaining global health goals. Most professionals, indeed, most human beings, aspire to achieve excellence. Motivated by the desire to best serve others and stimulated by internal or external competitive forces, most of us seek to perfect what we do and enjoy the reward of being recognized as the “best” in our field.

Consequently, rating someone in a particular field is part of our culture. For example, rating athletes and their physical abilities is common and relatively straightforward. When athletes compete with each other, a winner emerges. When someone breaks a record or when someone coaches a team that consistently wins, these individuals are deemed the best in their field. The bar is set to a certain level, and whoever exceeds this point and maintains that level of performance is considered to be the best.

Global surgery is a rapidly growing field aimed at delivering equitable surgical care worldwide. Academic global surgery seeks to address current inequities through partnerships promoting research, education, advocacy, and training, often across academic departments and institutions. The advancement and delivery of surgical and anesthetic care in low– and lower middle–income countries (LICs and LMICs) has been a low priority on the global health stage until recently, with limited representation in global health literature and policy forums.

Surgical care is indispensable to the creation of robust health systems and the achievement of health and well-being for all. The lack of human resources, accessory equipment, geographical accessibility, and means for communication all contribute to disparities in care. Thoughtfully crafted academic collaborations—cognizant of historical power dynamics and abuses within partnerships web between LICs/LMICs and high–income countries (HICs)—are integral in advancing the vision of universal access to high–quality surgical care. Sustainable programming includes capacity–building and training endeavors to support and increase the global surgery workforce, as well as the professional development of clinicians and researchers in low–resource settings.

The recent development of surgical scale-up models has seen the inclusion of surgery in health planning within the National Surgical, Obstetric, and Anesthesia Plans, generating hope for the global surgery community. Although templates for these National Surgical, Obstetric, and Anesthesia Plans exist, individual countries are expected to adopt and adapt them, and then develop their surgical scale-up blueprints.

Achieving Global Surgical Excellence requires a commitment to lifelong learning, collaboration, and innovation, ultimately leading to better patient outcomes and improved healthcare systems worldwide.

It involves:

1. Evidence-based practices: Adherence to best practices and guidelines.
2. Continuous learning: Staying updated with latest techniques and advancements.
3. Patient-centered care: Prioritizing patient safety, comfort, and outcomes.
4. Collaboration and teamwork: Effective communication among healthcare professionals.
5. Innovation and research: Advancing surgical techniques and technologies.
6. Quality improvement: Regular evaluation and enhancement of surgical services.
7. Global partnerships: Sharing knowledge and expertise across borders.
8. Cultural competence: Understanding and respecting diverse patient needs.
9. Surgical ethics: Adhering to ethical principles and standards.
10. Patient advocacy: Prioritizing patient needs and well-being.

Current State of Surgical Care

The author’s root cause analysis of the current state of global surgery finds the Alma Ata Declaration of 1978 guilty of unintentionally suppressing the growth and development of global surgery. As a result of its definition of primary healthcare, the Alma Ata Declaration unwittingly excluded global surgery from any progress. Furthermore, the inaccurate perception that surgical interventions are expensive and only benefit a few individuals may be the reason for the limited interest that the World Health Organization (WHO) places in surgery. Surgical milestones achieved by WHO is noteworthy, including the Emergency and Essential Surgical Care Program, the Surgical Safety Checklist, the Patient Safety Pulse Oximetry Project, the Safe Childbirth Checklist, Guidelines for Essential Trauma Care, Standards for Surveillance of Neuro-trauma, and the Global Surgical Site Infection Prevention Guidelines.

However, besides the world health assembly(WHA) Resolution 68.15 of 2015 “Strengthening Emergency and Essential Surgical Care and Anesthesia as a Component of Universal Health Coverage”-Addressing the Public Health Gaps Arising from Lack of Safe, Affordable and Accessible Surgical and Anesthetic Services. Global surgery has remained a side event at every subsequent WHA meeting, as global surgery stakeholders wait expectantly for it to become a mainstream WHO activity.

The current state of surgical care reflects significant advancements in technology, techniques, and patient outcomes, but it also faces a range of challenges. Here’s an overview:

1. Advancements in Technology

Minimally Invasive Surgeries: Techniques like laparoscopy and robotic-assisted surgery have transformed procedures, leading to reduced recovery times and improved patient outcomes.
Enhanced Imaging: Innovations like 3D imaging and intraoperative navigation systems allow for more precise surgical planning and execution.
Telemedicine: Virtual consultations and remote monitoring have become more prevalent, especially highlighted by the COVID-19 pandemic.

2. Improved Outcomes

Lower Mortality Rates: Advances in anesthetics, perioperative care, and surgical techniques have contributed to lower complication and mortality rates.
Personalized Medicine: Tailoring surgical approaches based on genetic and molecular profiling enhances treatment efficacy.

3. Team-Based Care

Multidisciplinary teams, including surgeons, nurses, anesthesiologists, and other specialists, facilitate comprehensive care, leading to better patient experiences and outcomes. These technologies provide interactive platforms where surgeons can practice complex procedures in risk-free environments. As surgical fields continue to evolve, VR and AR are emerging as essential tools in improving global training standards. Studies suggest that these technologies not only enhance technical skills but also reduce training costs and improve patient safety (Johnston et al., 2020).

4. Accessibility

Increased surgical volumes and facilities, particularly in developing regions, aim to address global surgical needs. Initiatives like the World Health Organization’s Safe Surgery Saves Lives promote global surgical interventions.

Disparity in Surgical Outcome

Health care disparity presents on the greatest challenge in achieving uniformly high-quality surgical care. Research reporting disparities in surgical outcomes are abundant.
The cornerstone of delivering high quality healthcare is ensuring optimal access for all patients. A relative lack of access to surgical services may be a contributing factor to disparities in surgical outcomes. Access is “the timely use of personal health services to achieve the best possible outcomes. Utilization of services, the process of entering and staying in the system, and the actual quality of care received are all involved.

Disparities in access arise when the system disproportionately under-performs for a specific group of patients relative to the historically advantaged population Surgery, because of its time sensitive, often high acuity nature, is greatly dependent on access.
In complex surgical systems, there is no established, methodical way of conceptualizing or measuring disparities in surgical access. Efforts to reduce disparities in surgical access require metrics (standardized measurable indicators), which provide the foundation for focused and tailored interventions, which can be applied broadly.

Challenges In Achieving Quality Surgical Care

The WHO plays a critical role in fostering global health, and because of its leadership position, LMICs, collaborating partners, and funding organizations focus on the WHO’s priorities, as most recently demonstrated in its leadership response to the coronavirus 2019 pandemic. Beginning with the Alma Ata Declaration, through the Millennium Development Goals, the SDGs, and the Universal Health Coverage initiative, surgery has remained largely invisible in all the consequential WHO initiatives.
As observed by several authors, surgery is not a core component of the WHO’s focus,7 even after the WHO director-general noted its important role within primary healthcare. The “neglected stepchild of global health”19 was systematically ignored for 37 years, creating a global surgical burden of profound proportions. Barriers include a deficiency of resources, personnel, equipment, and funding, a lack of communication, and geographical challenges.

1. Workforce Issues

Shortages: There is an ongoing shortage of surgical professionals, including surgeons, anesthesiologists, and nursing staff, exacerbated by burnout and COVID-19 impacts.
Training Gaps: Ensuring adequate training and exposure to modern surgical techniques, especially in lower-resource settings, remains a concern.

2. Cost and Resource Allocation

Healthcare Costs: Surgical care can be prohibitively expensive, particularly with advanced technologies and robotic systems, leading to disparities in access.
Resource Management: Hospitals must balance resource allocation between elective surgeries and urgent care needs, which can strain surgical departments.

3. Quality and Safety

Infection Rates: Surgical site infections (SSIs) continue to be a significant concern, requiring ongoing attention to best practices in sterile techniques and postoperative care.
Error Prevention: Human factors and communication breakdowns can lead to surgical errors; maintaining high standards of patient safety is paramount.

4. Ethical and Equity Consideration

Access Disparities: Socioeconomic and geographic factors create inequities in access to surgical care, particularly in low- and middle-income countries.
Informed Consent and Patient Autonomy: Balancing patient autonomy with recommendations for surgery can pose ethical dilemmas, particularly in patients with complex needs.

5. Regulatory and Policy Challenges

Navigating regulatory requirements for surgical practices and innovations can slow the adoption of new technologies or methods, impacting patient care and outcomes.

Pathway To Surgical Excellence

To achieve global surgical excellence, several key factors need to be considered:

1. Access to surgical and Patient-Centered Care: Prioritizing patient needs, dignity, and well-being is essential for better and holistic management. There is a significant disparity in access to surgical care between developed and developing countries. Ensuring equitable access to surgical services is essential to achieving global surgical excellence. This involves improving infrastructure, training healthcare professionals, and increasing surgical resources in disadvantaged regions.

2. Quality improvement initiatives: Establishing and implementing quality improvement programs can enhance surgical care outcomes. This includes standardizing surgical procedures, adopting evidence-based practices, and conducting regular surgical audits. Quality improvement initiatives should be context-specific and consider the unique challenges faced by different regions. Implementing best practices, reducing complications, and enhancing patient safety.

3. Surgical education and training: Standardized, evidence-based curricula and continuous professional development, Proper education and training of surgeons, Nurses, anesthesiologists, and other surgical team members are crucial for achieving surgical excellence. This involves the development of comprehensive surgical training programs, fostering mentorship, and encouraging continuing professional development. The traits of outstanding surgeons are described, as is the role of mentorship and open communication, which support achieving surgical excellence.

4. Technological advancement and Global Partnerships: Facilitating knowledge sharing, collaboration, and resource exchange, embracing technological advancements can greatly enhance surgical care. Innovations such as minimally invasive surgical techniques, telemedicine, and robotic surgery can improve surgical outcomes, reduce complications, and expand the reach of surgical care to remote areas.

5. Collaborative network and Healthcare Equity: Addressing disparities, increasing access, and promoting inclusivity establishes collaborative networks among surgical centers, healthcare organizations, and governments which can facilitate knowledge exchange, resource sharing, and capacity building. Collaboration promotes best practices and enables lessons learned from one region to be applied to another, fostering global surgical excellence.

6. Data collection and research and innovations: Advancing surgical techniques, technologies, and outcomes through collaborative research, Collecting comprehensive data on surgical outcomes, complications, and patient satisfaction is essential for improving surgical care globally. Research studies can provide insights into effective strategies, identify areas for improvement, and inform evidence-based decision-making.

7. Leadership and Advocacy: Empowering surgeons and other health team members who are efficient in amplifying patient voices and influencing policy and should be promoted. An expression of excellence in this respect is that the best surgeons, as leaders of their team, will take full responsibility for the actions of their team when things go wrong. When things go right, excellence in leadership requires that surgeons identify those who made “the right thing” happen. Never miss an opportunity for public praise.

The best leaders ask for feedback and provide it to the other members of the team. Providing feedback to the individual members of the team can be a difficult task. The best surgeons care about their teams, and they meet individually with the members of the team to debrief. During those periods, feedback is given, emphasizing all the good things that have happened as a consequence of the actions of the team member who is being addressed. Criticism should always follow, not precede, the good comments, and it should be constructed in the form of an opportunity for improvement rather than addressed as a flaw in character.

By prioritizing and implementing these measures, global surgical excellence can be achieved. Improved surgical care worldwide will lead to better patient outcomes, reduced morbidity and mortality rates, and enhanced access to high-quality surgical services for all.

Benefits of Quality Surgical Care

Patient satisfaction is essential for improving surgical care globally. Research studies has provided insights into effective strategies, identify areas for improvement, and inform evidence-based decision-making. They include:

Patient Benefits

1. Improved outcomes and reduced complications

2. Enhanced patient safety

3. Reduced risk of infection and hospital-acquired conditions

4. Minimized scarring and improved cosmetic results

5. Faster recovery times and reduced hospital stays

6. Improved pain management

7. Increased patient satisfaction and confidence.

Global Health Benefits

1. Reduced mortality rates and improved life expectancy.
2. Decreased burden of surgical diseases.
3. Increased access to essential surgical care.
4. Improved health equity and reduced disparities.
5. Enhanced global health security.

Healthcare System Benefits

1. Improved reputation and credibility.
2. Increased patient volume and market share.
3. Better data for quality improvement initiatives.
4. Enhanced resource allocation and efficiency. 5. Increased investment in healthcare infrastructure

Economic Benefits

1. Reduced healthcare costs through reduced complications and readmissions.
2. Increased productivity and economic growth.
3. Enhanced economic development through improved health outcomes.
4. Reduced burden on healthcare systems and payers.
5. Increased investment in healthcare research and development.

Societal Benefits
1. Improved quality of life for patients and families.
2. Increased social cohesion and community well-being.
3. Reduced stigma and discrimination related to surgical conditions.
4. Enhanced education and awareness about surgical health.
5. Increased global collaboration and knowledge sharing.

Global Impact

Achieving United Nations’ Sustainable Development Goals (SDGs)
Strengthening global health systems
Promoting universal health coverage
Enhancing global health security and emergency preparedness
Fostering international collaboration and knowledge sharing.

By prioritizing quality surgical care globally, we can:

Enhance global health equity and security.
Save lives
Improve health outcomes
Reduce healthcare costs
Promote economic growth

Join the Movement

Together, we can create a world where every patient receives exceptional surgical care, regardless of location or circumstance. Embrace the pathway to Global Surgical Excellence and be part of a brighter future for surgical care.

Call to Action

Encourage collaboration and knowledge sharing
Promote adoption of best practices and innovation
Support leadership and advocacy efforts.

Conclusion

The journey towards Global Surgical Excellence necessitates a commitment to addressing existing disparities while fostering innovation, ethical practices, and collaboration across the healthcare spectrum. The aim is to create a future where exceptional surgical care is universally accessible, ultimately leading to improved patient outcomes and quality of life for all individuals, regardless of their circumstances.

Global surgery requires a business model to sustainably meet the surgical needs of the 5 billion people globally. The proposed and implemented strategies must meet rigorous criteria to ensure sustainability, as quick-fix solutions are counterproductive. The development of centers of excellence offers a viable solution to problems that must be addressed successfully. While the landscape of surgical care has seen remarkable advancements that enhance patient safety and outcomes, it is essential to address the ongoing challenges to ensure equitable, accessible, and high-quality surgical treatment for all patients. Balancing innovation with proper training, ethical considerations, and cost management remains crucial for the future of surgical care and excellence.

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TORG-MAG Vol 1 Issue 2, Dec. 2024
(Innovating for Tomorrow: The Future of Global Surgical Excellence)
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