The Innovative Leader Behind Operation Smile’s Medical Oversight and Safety

When Dr. Gaurav Deshpande first stepped into an Operation Smile program to observe a cleft palate surgery in 2011, he never imagined that one day he would be spearheading the organization’s efforts to improve patients’ care using the most advanced technology available today: an AI tool developed specifically for the organization in partnership with Microsoft. For every patient that Operation Smile works with, the team takes before and after pictures of their faces, in an effort to evaluate the results and learn how to improve care. They capture tens of thousands of images of faces every year. “We are completing more than 15,000 surgeries a year,” explains the associate vice president of medical oversight and safety. “It’s nearly impossible to review all the results of them manually. Now we have an AI tool that can immediately help us access the results and help us know how to improve things in real time. It’s incredible.” 

This work is part of Operation Smile’s commitment to providing quality care and better health outcomes for children all over the world. For the past 42 years, Operation Smile surgeons have operated on more than 400,000 patients in more than 35 countries, expanding access to essential surgeries and health care, starting by providing children with life-saving surgeries and comprehensive care for cleft conditions, free of charge. In Deshpande’s current role, ensuring the quality of this care is his number one priority. “It is our duty to keep all the children that come to our doorsteps not only safe care, but to make sure they receive the highest quality care,” he says.  

We sat down to talk with Dr. Deshpande about his career at Operation Smile and how the drive to constantly improve care has led to remarkable innovations.  

Tell us how you began to work with Operation Smile. 
Dr. Gaurav Deshpande: My story started in 2011 when I just finished my residency. I heard about an Operation Smile surgical program, and I thought well, let me apply and see if I can be an observer. I never had operated on a patient with cleft lip and palate. In fact, I had never seen a patient with cleft lip and palate in my life. I applied and met [Dr.] Alex Campbell. And he said, “Shadow me, and we’ll see where we go.” I started shadowing him and slowly, started assisting him. And then he allowed me to operate. And by the time the program was over, I was able to operate independently under his supervision. I never looked back.  

How does your background as a surgeon help in your current role overseeing medical oversight and safety for the organization? 
GD: When I was a surgeon, I would see the trust that the parents or the caregiver shows in you. They don’t even know you, but they’re here because they know Operation Smile and our programs. They know they can trust us, so it’s very important that we keep that trust intact. In the medical oversight department, we make policies and protocols so that no matter where our volunteers are from or where they are operating, they can work with consistent guidance. 

Why is this kind of guidance important? 
GD: For example, I’m very comfortable operating in my own hospital because I know the nurses, the equipment, the operation room, etc. But our volunteers are working all over the world with people they may be just meeting. Because of the standards that our department makes, it becomes a little easier for them to work together by reducing the variability. Long story short, keeping our children safe and giving them the highest quality care is what Operation Smile is. 

What does the “gold standard care” mean?  
GD: I’ve done over 30 programs as a volunteer before taking on this role, and I’ve always been a big fan of these standards. Because we know that we must exactly follow certain steps, so that we do not make mistakes. It’s like how a pilot has a checklist before they start operating any aircraft. Even though they’ve done that thousands of times, they still go and follow that checklist because humans can forget and can make mistakes. 
 
What are some of the innovative ways that Operation Smile is raising the bar of quality care? 
GD: We’ve always tried to embrace the new technology. It started with very simple things like just going back to the charts and looking at our complication rate. But then things became huge. At the medical Guwahati Center [Operation Smile’s comprehensive cleft care center in northeastern India], we’re doing 3,500 surgeries a year, so we started a program to review the results of all our surgeries. We reviewed the charts and photographs, then we send them to unbiased reviewers, plastic surgeons around the world. It could take six months for us to get the outcome of a surgery reviewed, which is not good.  

So, we started training non-physicians to be able to review them. The inter-rater reliability was over 80%, which is extremely good in terms of research and training. They started giving us the outcomes within a week. But there is still some human bias. We thought like, how can we now use machines where there is no bias at all? Caroline Yao and her team had eight surgeons who actually looked at thousands of pictures so that we could train the model.

And now, we have this AI model where you just give it pictures, and it immediately tells you how successful the surgery was. This is a breakthrough technology that we worked with the Microsoft team to develop.  

Learn more about how Operation Smile is using AI to improve care.  

Are you able to help use AI to help with any other aspects of your role, like in educational work or helping to identify mentors? 
GD: Yes, with the help of this tool, we are able to notice that some surgeons are getting very good outcomes, very consistently. Then we reach out to them to see if they have any background in education and training. We invite them to be an educator and ask them their secret sauce: Can you share what you know with other people and get them to your level? That’s how we are able to get educators to train the people from low and middle-income countries to make care self-sustainable in their own countries. It’s kind of a chain reaction, which is triggered by the that Microsoft helped us develop. 

Looking to the future, what opportunities do you see for Operation Smile to enhance its impact in global health and safety? 
GD: We hope to build a speech assessment tool. After having a valid surgery, we ask what is the impact on the speech of the child? The ultimate aim of any palate surgery is to help the child speak normally. With the help of AI, we can train the aesthetic outcome model to assess speech outcomes. The challenge with that is we work in 37 countries with hundreds and thousands of dialects. So that is a challenge that we are facing. But I think that is going be a very important tool in future. I’m a dreamer.  

How does seeing this progress over the past 13 years make you feel? 
GD: When I see my evolution in the organization from an observer who had never seen a patient with cleft till now that we are building these smart AI tools, I think it’s a full circle. 
I cannot be more proud. And we’ll keep improving; we are better than yesterday, and I’m sure that tomorrow will be better than today.