Professional Documents
Culture Documents
December 2, 2010
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Founded in 1999 when the co founders broke
away from Operation Smile, now operates in 78
countries
Built on existing infrastructure by partnering with
local surgeons, hospitals and social organizations
Efficient team includes only 43 employees
worldwide
◦ Technology to ensure quality & cost efficiency
Cost effective
◦ “Per cleft surgery cost brought down by 90%”
◦ "100% of your donation goes to program - 0% goes to
overhead."
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Accountable Partnerships Accreditation
$250* per surgery
Training
Patients
5
• 500,000 cases treated
successfully worldwide
• Zero charge to patients
Treatment
• Accessible • Community
treatment clinics “no outreach
Accessibility Awareness
one has to walk programs
more than 100 km • Educational
to get treated” materials, flyers
Singular
focus on
cleft lip and
• Pre surgery care
palate • Augmenting
with nourishment existing skills
Empowerment
• Post surgery care, with state of art
Holistic care of local
give toys, food for training
doctors
poor
Safety &
quality
• Emphasis on safety
and quality of
Source: SmileTrain website;
Interview with MacKinnon Webster treatment
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Acting as a payor and not a direct
provider, unlike other cleft
organizations
Standardized guidelines, or
protocol, for treatment of cleft
Cultural – Business
Mentality
8
Reaching the last cleft patient is costly
•Geographic coverage handicapped by available partners
•Some population beyond reach of media channels
•Have pre and post surgery care teams visit patient’s neighborhood
Providing
•Rehabilitation
ancillary
•Broaden network to primary care providers, orthodontists, and speech
services therapists
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“Aishwarya made goodwill ambassador of Smile Train NGO”, The Economic Times, November 1, 2009.
“BBB Wise Giving Report for Smile Train”. Better Business Bureau. http://www.bbb.org/charity-
reviews/national/human-services/smile-train-in-new-york-ny-644. Retrieved November 22, 2010
"DFS and partners raise US$300,000 for The Smile Train". Moodie Report, August 2, 2009.
http://www.moodiereport.com/document.php?c_id=1178&doc_id=19764. Retrieved November 22, 2010.
"Freakonomics, Bottom-Line Philanthropy, the 'Soccer Boy' effect". New York Times Magazine, Stephen J. Dubner
and Steven D. Levitt, March 9, 2008. http://www.nytimes.com/2008/03/09/magazine/09WWLN-freakonomics-
t.html?ref=magazine. Retrieved November 22, 2010.
“Making kids smile again with software”, by M. Somasekhar, Hindu Business Line, November 10, 2000.
MacKinnon Webster phone interview. Program Officer of Smile Train. Conducted November 23, 2010
The Official Smile Train Website. http://www.smiletrain.org/site/PageServer. Retrieved November 22, 2010.
"Scaling Up Charity: Smile Train’s Brian Mullaney". Harvard Magazine, Nell Porter Brown, Sep-Oct, 2009.
http://harvardmagazine.com/2009/09/smile-trains-brian-mullaney. Retrieved November 22, 2010.
“Smile Pinki wins best short Oscar”, BBC News, Geeta Pandey, February 23, 2009.
Smile Train India Home Page. http://www.smiletrainindia.org/. Retrieved November 22, 2010.
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“Franchise” cleft • Instead of sending traditional mission teams from the U.S. or other developed nations
• SmileTrain India has 180 hospitals and more than 250 surgeons, who have now
operations to
performed 250,000 cleft surgeries in India
partner
• Partner hospitals chosen based on “maximum number of children for the minimum
hospitals amount of money”, pre-existing cleft operations, and “champions” for the cleft cause
Enable and • By providing free equipment, free education, training, and on-going financial support
empower local • Doctors, nurses “learn how to fish” and become self-sufficient cleft surgery operators
health • Doctors, nurses incentivized by SmileTrain’s flexible financial and frequent technical
practitioners support provided by 4 staff members under Regional Director of South East Asia
Achieve much • Due to India’s more established medical infrastructure and hands-off approach
• Cost-per-surgery reduced by 90% from mission team model (e.g. Project Smile)
greater
• 4 SmileTrain staff maintains constant communication and carries out frequent visits to
coverage
each partner hospital to assess patient needs
dollar-for- • Smile Grants cover transportation, education, and other expenses to facilitate care
dollar access and post-surgery integration into community
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Maintain lean management & operating structure but incentivize monetarily
• Globally only 43 staff with 24 based in the U.S.; Satish Kalra overseas all of South Asia
• With G&A ~1% of total expenses and fund raising ~18%, 80% of resources funneled
towards supporting partner hospitals (today, each surgery costs 12,000 rupees, with
flexibility allowed on a case-by-case basis, decided by Mr. Kalra)
• Retain business talent via market-rate salaries
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Tap diverse media channels to raise awareness
• Outreach teams are led by trained social workers that create trust with families of patients
• Psychosocial impact of clefts is brought home in Smile Pinki an Oscar-winning short
documentary film in 2008 about SmileTrain India
• According to co-founder Mullaney, a major motion picture is in the making
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Reimbursement, free equipment
+ & training, Smile Grants to
Indian providers
Investment in medical R Note: positive reinforcement (labeled R) and negative
infrastructure by providers + reinforcement or “balancing” (labeled B); + and –
Positive Returns indicate positive and negative correlation, respectively
from Infrastructure
+ Access to cleft +
Availability of patients No. of cleft surgeries +
physicians and medical performed
staff + R
Physician +
Empowerment Learning across the
+ organization
Investment in Demand for cleft
+ training treatment
Network of Partner
+ R + + +
Providers
+ Learning increases Coverage (Patients
Safety and Quality
safety quality and served / Dollars spent)
coverage +
+
Positive Press and
+
+ Word of Mouth
+ Donations
Ability to monitor safety
Social Appeal R
and quality at low cost
+
+ R Technology
+ promotes Lean
Celebrity
Investment in cutting
Bandwagon
+ edge technology
Engagement of R Awareness among
prominent supporters
+ Ability to tap diverse Outreach + cleft patients
media channels +
Investment in
outreach efforts
- Backlog
No. of cleft surgeries -
performed
B Cost of reaching cleft
+
patients on the margin
Reaching the last
cleft patient is costly +
Access to cleft Ability to monitor safety Attractiveness of providing
population and quality at low cost other services with better
+ R coverage
-
Decline in backlog
creates incentive to shift
- focus
B +
Network of partner Coverage
providers +
Growing network +
+ increases monitoring Shift in focus to services
costs with better coverage
+ B
Donations + Positive Press and
Shift in focus may hurt
Word of Mouth -
Smile Train's brand
Note: positive reinforcement (labeled R) and negative - Transparency of business
reinforcement or “balancing” (labeled B); + and – indicate model and visibility of
positive and negative correlation, respectively results
Resistance from donors and -
other stakeholders who support
singular focus on cleft
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We also have a number of systems in place to monitor and detect potential
fraud. Ideeinc, SmileTrain’s fraud detection software, scans every record that
is uploaded to our patient records database for potential red flags and will
notify our staff if a record matches previous records based on facial
recognition or name and birthday repetition.
Ideeinc also sends a notification if it cannot detect signs of surgery on a
patient record or if a photo appears to have been altered (via Photoshop,
etc.).
We also look for clues like if the before and after picture are taken within a
few minutes of each other. The system is quite sensitive and has managed to
catch photos that were re-uploaded under multiple patient names, even
when each record contained unique metadata or is uploaded at different
hospitals.
If a new surgeon receives an average failing score for their 10 lip records, or if they fail 2 out of 5 palate
surgeries, the identified surgeon is relegated to a second round of record review. In round 2, 10 more lip and 5
more palate records are reviewed. Those surgeons who successfully meet ST criteria are transferred to the
established surgeons group.
If the surgeon fails their 2nd round, then the Chairman of the MAB reviews their records and makes a
recommendation as to whether further training is needed. If needed, a final set of 10 lip and 5 palate records
are reviewed after the training is complete. If the surgeon is still receiving failing scores, then he/she will be
brought to the MAB to determine the next steps to be taken.
During the QI Review, records can be flagged as problematic. A surgeon with a flagged record will receive an
email notification and must explain the issues raised by the reviewer. Generally, the primary surgeon responds
to the queries in an expeditious manner and the record’s questions are resolved without further review. In this
setting the flag is removed when the review is complete. In the event that a record’s issue remains open for
review even after the response of the surgeon, then the record in question is presented to the head of the MAB
for final review and recommendation. (To date 3 cases have taken this path.) SmileTrain reserves the right to
hold payment for further surgeries uploaded by the surgeon in question until all case related issues are resolved
are resolved by the MAB or its emissaries.