KK Sinha Discovery

Professor Kingshuk Sinha Optimizes Pediatric Cardiac Surgery Operations in Remote Underserved Communities for Nonprofits

Monday, March 4, 2019

Throughout his career as a research professor of supply chain and operations management, Kingshuk Sinha has learned that whenever you have a demand problem, you have to look at the supply chain.

Children’s Heartlink, an international medical nonprofit organization which enables the diagnosis and treatment of children with congenital heart disease, was experiencing a demand problem. When the nonprofit organization sent volunteer medical teams to underserved communities in remote areas of the world to deliver extremely affordable surgical care for congenital heart defects in children, they were surprised by the low number of patients requesting their services.

How is it possible, the organization wondered, that extremely affordable, world-class surgical care would not be in high demand?

That question led to an important research question for Sinha and his coauthors: How can international non-profit organizations enable the long-term delivery of surgical care in underserved communities?

The added complexity of surgical care

While most nonprofit organizations focus their healthcare mission work on providing necessary medications, delivering surgical care adds layers of complexity to providing effective healthcare services.

“Pediatric heart surgery is among the most complex surgical care that you can provide,” Sinha says. “With surgery, you need a facility, you need infrastructure, you need high-end equipment, you need indigenous products. Every piece of the operation must function perfectly.”

Sinha’s team developed a theoretical framework that examined care delivery from start to finish, analyzing data to understand how a nonprofit organization’s efforts related to improving affordability, access and awareness affect sustainable delivery of surgical care.

Thanks to a grant from the Dean’s research fund, co-author Emily Kohnke could embed with the volunteer surgical team at the care delivery site: First Hospital of Lanzhou University in China’s impoverished Gansu province.

The First Hospital of Lanzhou University, which has been a Children’s Heartlink mission site since 1999, was selected in part because of its need for care—infants in Gansu province suffer from congenital heart defects more than six times the average rate in China, and birth defects are the province’s highest cause of infant mortality.

Small sample, large legacy

Dr. Joseph A. Dearani serves both as chair of cardiovascular surgery at the Mayo Clinic in Rochester, Minn., and medical director of Children’s Heartlink.

Each year, when Dearani’s team of world-class volunteer surgeons traveled to remote, underserved communities around the world, they did what they did best—tackle the most difficult, complex cases. The surgical team’s mortality rates were low, but the team wasn’t performing many surgeries, and local surgeons were not following the visiting team’s techniques, let alone performing surgeries.

“He told me, ‘For every kid I take care of, there’s a whole bunch that I leave behind and my heart breaks,’” Sinha says. “Their team wanted to help more children with the same amount of resources. So we decided to look at the systems and processes to figure out how we could do better.”

Sinha’s team was able to uncover a seemingly small adjustment that is now making a large impact in the number of young patients treated in Gansu province—shift the surgical team’s focus from saving the most complex and critical cases to teaching local surgeons to save children who need far less complex surgery.

“We asked, ‘Why don’t you operate on the simpler cases during the 10-15 days you are here?’” Sinha says. “If you conduct simpler surgeries, you will have higher-quality outcomes that take less time and these Chinese surgeons will begin to handle at least some of the demand once you are gone. When you treat simple cases, the Chinese surgical teams see successes, which inspires them to recommend and treat more patients.”

Analyzing a complex, interdependent process

Ultimately, Sinha’s team discovered that rather than offering affordable surgical care in a vacuum, non-profit organizations need to pair provider awareness and physical access with the surgical delivery infrastructure. High provider awareness is essential to improving both the volume of surgeries performed and increasing efforts to improving physical access to care.

How is it possible, that extremely affordable, world-class surgical care would not be in high demand? That question led to an important research question for Professor Kingshuk Sinha and his coauthors: How can international non-profit organizations enable the long-term delivery of surgical care in underserved communities?