title: Scalable, sustainable cost-effective surgical care: a model for safety and quality in the developing world, part II: program development and quality care.
abstract: BACKGROUND
  The Guwahati Comprehensive Cleft Care Center (GCCCC) is committed to free medical and surgical care to patients afflicted with facial deformities in Assam, India. A needs-based approach was utilized to assemble numerous teams, processes of care, and systems aimed at providing world-class care to the most needy of patients, and to assist them with breaking through the barriers that prohibit them from obtaining services.
  
  
  METHODS
  A team of international professionals from various disciplines served in Guwahati full time to implement and oversee patient care and training of local counterparts. Recruitment of local professionals in all disciplines began early in the scheme of the program and led to gradual expansion of all medical teams. Emphasis was placed on achieving optimal outcome for each patient treated, as opposed to treating the maximum number of patients.
  
  
  RESULTS
  The center is open year round to offer full-time services and follow-up care. Along with surgery, GCCCC provides speech therapy, child life counseling, dental care, otolaryngology, orthodontics, and nutrition services for the cleft patients under one roof. Local medical providers participated in a model of graded responsibility commiserate with individualized skill and progress, and gradually assumed all leadership positions and now account for 92% of the workforce. Institutional infrastructure improvements positioned and empowered teams of skilled local providers while implementing systemized perioperative processes.
  
  
  CONCLUSIONS
  This needs-based approach to program development in Guwahati was successful in optimization of quality and safety in all clinical divisions.
authors.affiliation: From the *Operation Smile, Virginia Beach, Virginia; †Penn State Hershey Medical Center, Hershey, Pennsylvania; ‡Cedars Sinai Medical Center, Los Angeles, California; and §Operation Smile India, Guwahati Comprehensive Cleft Care Center, Guwahati, India.
authors.forename: Alex
authors.initials: A
authors.lastname: Campbell
authors.forename: Carolina
authors.initials: C
authors.lastname: Restrepo
authors.forename: Don
authors.initials: D
authors.lastname: Mackay
authors.forename: Randy
authors.initials: R
authors.lastname: Sherman
authors.forename: Ajit
authors.initials: A
authors.lastname: Varma
authors.forename: Ruben
authors.initials: R
authors.lastname: Ayala
authors.forename: Hiteswar
authors.initials: H
authors.lastname: Sarma
authors.forename: Gaurav
authors.initials: G
authors.lastname: Deshpande
authors.forename: William
authors.initials: W
authors.lastname: Magee
mesh_terms: D002648:Child; D002675:Child, Preschool; D003191:Comprehensive Health Care; D003362:Cost-Benefit Analysis; D019465:Craniofacial Abnormalities / Q000191:economics / Q000601:surgery*; D019033:Delivery of Health Care, Integrated; D003906:Developing Countries; D006268:Health Facilities; D006297:Health Services Accessibility; D006801:Humans; D007194:India; D007223:Infant; D044342:Malnutrition / Q000628:therapy; D020380:Needs Assessment; D015596:Nutrition Assessment; D010347:Patient Care Planning; D010348:Patient Care Team; D061214:Patient Safety; D016730:Program Development; D011787:Quality of Health Care / Q000592:standards*; D019651:Plastic Surgery Procedures / Q000191:economics* / Q000592:standards