Leading a Surgical Revolution: The AO Foundation – Social Entrepreneurs in the Treatment of Bone Trauma PDF
Preview Leading a Surgical Revolution: The AO Foundation – Social Entrepreneurs in the Treatment of Bone Trauma
Jean-Pierre Jeannet Leading a Surgical Revolution The AO Foundation – Social Entrepreneurs in the Treatment of Bone Trauma Leading a Surgical Revolution Jean-Pierre Jeannet Leading a Surgical Revolution – The AO Foundation Social Entrepreneurs in the Treatment of Bone Trauma Jean-PierreJeannet ProfessorEmeritusBabsonCollege Wellesley,MA,USA ProfessorEmeritusIMDInstitute Lausanne,Switzerland ISBN978-3-030-01979-2 ISBN978-3-030-01980-8 (eBook) https://doi.org/10.1007/978-3-030-01980-8 LibraryofCongressControlNumber:2018959613 #SpringerNatureSwitzerlandAG2019 Thisworkissubjecttocopyright.AllrightsarereservedbythePublisher,whetherthewholeorpartofthe materialisconcerned,specificallytherightsoftranslation,reprinting,reuseofillustrations,recitation, broadcasting,reproductiononmicrofilmsorinanyotherphysicalway,andtransmissionorinformation storageandretrieval,electronicadaptation,computersoftware,orbysimilarordissimilarmethodology nowknownorhereafterdeveloped. Theuseofgeneraldescriptivenames,registerednames,trademarks,servicemarks,etc.inthispublication doesnotimply,evenintheabsenceofaspecificstatement,thatsuchnamesareexemptfromtherelevant protectivelawsandregulationsandthereforefreeforgeneraluse. The publisher, the authors and the editors are safe to assume that the advice and information in this bookarebelievedtobetrueandaccurateatthedateofpublication.Neitherthepublishernortheauthorsor theeditorsgiveawarranty,expressorimplied,withrespecttothematerialcontainedhereinorforany errorsoromissionsthatmayhavebeenmade.Thepublisherremainsneutralwithregardtojurisdictional claimsinpublishedmapsandinstitutionalaffiliations. ThisSpringerimprintispublishedbytheregisteredcompanySpringerNatureSwitzerlandAG Theregisteredcompanyaddressis:Gewerbestrasse11,6330Cham,Switzerland Foreword Thetitleofthisbookreflects,inafewlines,theessenceoftheAOFoundationand what it stands for. With the invention of a disruptive surgical procedure it revolutionized the world of trauma, reducing pain and disabilities of patients with broken bones and bringing them back into normal social and working life within days,insteadofmonths.Intheprocess,itsavedtheworld’shealthsystembillionsof dollars—a dream of today’s health experts confronting escalating health costs. Practically unnoticed, a worldwide medical device industry developed around this surgicalprocedureanditssurgicalinstrumentsandimplants—alsodevelopedbythe pioneerAOsurgeonstogetherwithasmall-scaleindustry.Thesocialentrepreneur- ship of a nonprofit organization with changing industrial partners leveraged the disseminationgloballyonanunprecedentedscale. The idea to present this extraordinary story came out of a research project of ProfessorJeannet who identifiedexceptional success stories ofsmalland medium- sized Swiss enterprises, among them Synthes and Mathys, only to realize the interconnection and further develop the story into a separate book detailing the roleoftheAOFoundationinthissuccessstory. Intoday’sworld,withhealthcarecostsexploding,asimilarapproachcombining disruptiveinventionsandinnovationswithacost-effectiveorganizationmightoffer ideasforothersuccessfulpartnershipsorprivateinitiativestoremedyillnesses. The AO Foundation continues to extend its successful work into low-income countries where the burden from injuries and disabilities has assumed epidemic proportions and where treatment methods and care are largely comparable to what thepioneeringAOsurgeonswereconfrontedwith60yearsagoinSwitzerland. The60thanniversaryoftheAOFoundationisanappropriatemomenttopresent its history. This book by Professor Jeannet describes the AO history in a compre- hensiveway,withspecialattentiontothebusinessaspects,makingitofinterestalso forabroader,nonmedical,public. AOFoundation,Biel,Switzerland NikolausRenner AOFoundation,Biel,Switzerland RolfJeker v Preface ThisbookprojectcamemywaywhenIwaslookingforsupportforadifferent,but related,projectonSwisssmallandmedium-sizedexportingcompanies(SMEs)with global success in specific niches. I planned to include Mathys, Straumann, and Medartis, all companies with strong connections to the AO Foundation. However, the AO indicated that they would rather welcome a book on the AO itself with a particularemphasisonitsindustrialimpact.WouldIbeinterested?TheAOassured that I would have complete independence as to the approach I would choose. Initially, I hesitated to entertain the idea, since I possess neither a medical nor an engineeringbackground. Mybackgroundasabusinessschoolfacultymember,however,wasofinterestto theAOleaderssincepreviousbookshadbeenwrittenlargelybysurgeonsormedical historians. And so it came that I, with only a cursory acquaintance of the AO, acceptedtotacklethechallengeofwritingabookthatwouldgivespecialemphasis to the AO industrial achievements and impact. My contacts at the AO Foundation board convinced me that my lack of medical training did not disqualify me from writingabouttheAOandits60-yearhistory.Thereadersofthisbookwillhavetobe thefinaljudgesofthisdecision. Iapproachedtheprojectinlinewithmybusinesscaseresearchexperiencegained from writing scores of cases at IMD (Lausanne) and Babson College (Wellesley, MA,USA).ThismeantthatIdidnotimmersemyselfonlyintothearchivesofthe AO, but instead focused on a large number of in-depth interviews with many individuals who had been associated with this enterprise since its inception. While delvingintomemoriesaboutpastevents,itwastobeexpectedthattherewouldbe conflictingperceptionsofthewhatandwhyofevents.Naturally,Imadefulluseof thepublicationswrittenpreviously,someofwhichwerecrucialtocreatingthestory line I wanted to build, and some helped deal with conflicting memories from interviewpartners. AsIgoteverdeeperinvolvedintheAOhistory,IcametorealizethatIshouldnot only write a book covering the period since 2002, the year the last book was published. Instead, I needed to tell the entire history of the AO from its inception using theparticular lenses that came from mybusinessschool facultybackground. Atfirst,thismeantcreatingatimelineofthe60yearsoftheAOandidentifyingthe criticalpointsinitsdevelopment,beitmedical,engineering,orbusiness-related. vii viii Preface Delvingdeeper,Isawthattherewasbothasocialentrepreneurshipstorycentered around the medical aspects of the AO’s achievements, as well as a business entrepreneurshipstorythat focusedontheindustrialachievementstriggeredbythe AO and its purpose. Identifying the two types of entrepreneurial endeavors, social and business, allowed me to approach the AO history from two different angles whileusingtheconceptuallensesfrommybusinessschoolexperienceforlabeling thekeyevents.Thesebusinesslenseswereattheoriginofmanyofthechaptertitles andsubtitles.Manyoftheseconcepts,partofthemodernbusinessvocabulary,did notexistwhentheAOwasstarted.Throughoutthetext,Ihavetakenthelibertyto pointouttheorganizationalandbusinessachievementsfromearlierperiodswithout the access to a technical infrastructure we take for granted in today’s business environment. TheintentistoreachanaudiencebeyondtheAOcommunity.Reflectingonthe potentialreadersofthisbook,Iwascognizantofthefactthatobviouslythistextis not intended or suited as a manual for surgeons interested in the AO approach to traumacare.Andyet,themedicalinformationpresentedhadtofindapprovalofthe surgeons involved in trauma care, a constant challenge that was confronting me throughoutthetwoyearsofworkingonthisproject.Ihopethistextwillbereadbya general audience, including the large number of patients who have benefited from theresultoftheseefforts,aswellasinterestedreadersfromthebusinessandresearch communitywhomightfindinspirationintheAOapproach. Whilethisbookwaswrittenbaseduponextensiveresearch,itwasnotintendedas anacademicexercise.Instead,theaimwastotellthestoryoftheAOFoundationand oftheindividualswhowereinstrumentalincreatingthisenterpriseandtodosoina captivating, interesting, and also personal way. The AO’s tenacity to push ahead with Osteosynthesis for trauma care when confronted with strong opposition from the medical establishment, and to do so with limited resources, could serve as an inspirationforothersuchprojects. ThroughtheresearchontheAO,Ibecameawareoftheenormousimpactofthe organization. Millions of people walk the streets having benefited from the breakthroughs achieved by the AO, and yet few members of the general public haveanyideawhowasorisbehindtheseachievements.Inthatsense,Iamhappyto haveacceptedthechallengetowritethis storyandtorender it, Ihope,ina wayto bringittotheattentionofawideraudience. Belmont,Switzerland Jean-PierreJeannet August2018 Acknowledgements Thisbookwouldnothavebeenwrittenwithoutthegenerousandactivesupportof theAOFoundationanditsGovernance.TheAOFoundationBoard,particularlyits PresidentKlausRenneranditsCEORolfJeker,activelyworkedtoopendoorsand obtainaccesstocountlessdocumentationandofferedhelpwithsecuringinterviews. Asmallsteeringcommitteedealingwith60thanniversaryissueswasalwaysready to provide guidance. Important financial support for this project was provided throughtheBLIInstituteattheUniversityofLucerne,assuringthatthebookproject could also find a reputable publisher. Most important, however, was the hands-off approachoftheAOleadershipallowingtheauthortoexpresshisownopinionwhile givingamplesupportthatalltherelevantfactscouldberenderedcorrectly. The development of this book benefited from very capable authors of earlier worksontheAOFoundation,especiallyfortheperiodsuptoabouttheyear2000.In particular,thepublicationswrittenbyRobertSchneiderandUrsHeimontheearly part of the AO history, Eugen Kuner on the development of the Osteosynthesis approach, Thomas Schlich on the medical history of the AO and its treatments, JosephSchatzker’sbiographyofMauriceMüller,aswellasthehistoryofAOVET editedbyJörgAuerandhiscolleagueswereaconstantguideduringtheresearchand writing of this manuscript. All of these authors are extensively cited throughout thebook. Enormousgratitudeisowedtoabout60individualswhowerewillingtositdown forinterviews,typicallylastingonetotwohours.Theysharedfreelyoftheirexperi- ence, history withtheAO,eventstheywitnessed,and stories theyremembered,and offeredtheirreflectionontheAOorganization,inthepast,today,orthefuture.The summaryoftheseinterviewsallowedmetogainamuchdeeperunderstandingofthe importance and impact of the AO, both in medical and business terms. Where appropriate, I have referenced these conversations in footnotes. A complete listing ofallpersonsinterviewedisprovidedintheListofInterviewees. I am thankful to the surgeons who took the time to explain the intricacies of Osteosynthesis to this not medically trained author, in particular Peter Matter, Reinhold Ganz, and Teddy Slongo who spent extra time with me and reviewed part of the manuscript. The technical issues surrounding the AO Instrumentarium andimplantswerepatientlyexplainedtomebyRobertMathys,Jr.,andRobertFrigg whoalsoreviewedpartofthemanuscriptaswellasOrtrunPohler,whoworkedwith ix x Acknowledgements meonthematerialscienceissues.Andfinally,RolfJekerspentmanymeetingsand phonecallswithmeexplainingtheintricaciesoftheAOgovernance.Withouttheir helpIwouldnothavebeenabletocover,absorb,andorganizetheentireAOhistory inonesinglebook. Iwouldliketoexpressmyappreciationtothemanyinstitutions,individuals,and copyrightholderswhoallowedustoillustrateimportantaspectsoftheAOhistory. The AO Publication team contributed their skills to converting the many exhibits into publishable visuals for the book. Finally, a special thank you goes to Anita Husseywhoeditedaroughmanuscriptintoapublishablestory. Last but not least, I would like to thank my wife, Christine Jeannet, who has patientlylistened over thepast two years to thecountlessstories I unearthedabout theAOFoundation,hasdebatedmanyaspectsofthemanuscriptanditsorganization withme,andthuscontributedimmenselytothestorypresentedinthisbook. Contents 1 Prologue:OrchestratingACastofThousands. . . . . . . . . . . . . . . . 1 Davos,EarlyonaDecemberMorning. . . . . . . . . . . . . . . . . . . . . . . . 1 DavosHospital,onaDecemberMorning. . . . . . . . . . . . . . . . . . . . . . 2 Solothurn,Switzerland,ontheSameDecemberMorning. . . . . . . . . . . 5 WhoOrchestratesThisCastofThousands?. . . . . . . . . . . . . . . . . . . . 6 PartI LaunchingaSurgicalRevolution 2 OsteosynthesisExplained. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Reference. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 3 ABriefOverviewoftheAOOrganization. . . . . . . . . . . . . . . . . . . . 15 WhatDoesAOStandFor?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 AHumbleBeginning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 4 TreatmentofBoneFracturesPriorto1960. . . . . . . . . . . . . . . . . . . 21 Davos,AnotherWinterDay,inthe1950s. . . . . . . . . . . . . . . . . . . . . . 21 HowConservativeTreatmentConqueredtheWorld. . . . . . . . . . . . . . 21 NegativeExperienceswithConservativeMethod. . . . . . . . . . . . . . . . 23 EarlySurgicalApproachestoBoneFractures. . . . . . . . . . . . . . . . . . . 24 ANailingInnovationfromBoston,PickedupinEurope. . . . . . . . . . . 24 NailingRodfromGermanyMadeItAroundtheWorld. . . . . . . . . . . . 24 ExperimentswithCompressionPlatesinBelgiumRemainedaLocal Affair. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 TheSurgeonWhoCoinedtheTermOsteosynthesis. . . . .. . . .. . . . .. 26 TheBelgianSurgeonWhoBroughtOsteosynthesistotheAttentionofa WiderAudience. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 WhyOsteosynthesisInitiallyLostOuttoConservativeTreatmentinthe RaceforGlobalDominationofFractureCare. . . . . . . . . . . . . . . . . . . 29 TheMedicalWorldReactsNegativelytothePracticeof Osteosynthesis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 xi
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