Good Reads: Before and After by Brian F. Mullaney, Co-Founder of Smile Train and WonderWork.
Before and After: Chapter 8
Around the same time, we were putting Smile Train on independent tracks, I reached a milestone in my career. Mike and I came to the end of the period where we still had to run our ad agency on a day-to-day basis. Now that it was sold and we’d completed our commitment, we were free to pursue other ventures. So I set myself a new goal: I wanted to build another business from scratch, this time online. It was late 1999, and dot-coms were taking off like crazy. My big idea was the ultimate website for people who were thinking about getting cosmetic surgery. Over the years working with my surgeon clients on Park Avenue, I learned a lot about cosmetic surgery and I knew that this industry was becoming very big business. Meanwhile, the main barrier facing consumers was that they had a hard time finding accurate information about cosmetic surgery, and there were a lot of misperceptions about what it entailed. Most people thought cosmetic surgery was prohibitively expensive and just for the rich and famous. So I decided to create a website that made it easy for everyday people to find out reliable information about all of the most popular cosmetic surgery procedures, including prices, recovery times, how to find the right surgeon, and information on financing. By far the most innovative feature of the website was our “free preview of the new you.” This allowed anyone to upload their photo, which we would retouch to show them how they would look after surgery. No one had ever done “before” and “after” photos for prospective clients online until now. So I went out, raised the money, launched the website— personalsurgeon.com — and even took out full-page ads in the New York Times.
And whenever I wasn’t working on my new business venture, I was also starting to draft Smile Train’s mission.
The mission as I saw it was organized around three clear goals:
- We were going to focus on a single problem—the problem of clefts. So many charities try to be all things to all people, and we weren’t going to fall into that trap.
- We were going to solve the problem of unrepaired clefts. We had our cure—a simple, inexpensive surgery with a 99 percent success rate—we knew roughly how many children needed surgery, and we had a new strategy to deliver surgeries for one-tenth of what it costs via the mission model. We had all the ingredients to solve the problem; now we just need to execute. Maybe it would take us twenty years, maybe thirty, maybe even more, but that was the audacious mission at the heart of Smile Train. We wanted to work ourselves out of a job. Anything less would be failure.
- We were going to run our charity like a business. I remember the same year we started Smile Train, I came across an article in Forbes magazine that ranked some of the major charities in America according to efficiency and impact—or lack thereof. The worst offenders were spending as little as 15 or 20 percent of the money they’d raised on their stated mission; the rest was going to overhead. I had no intention of joining that hall of shame. We were going to craft a business plan for Smile Train that had a clear road map for what we were going to achieve and strong metrics for measuring our success. We were going to focus on tight management, strategic spending, and concrete goals. We knew that by using technology, we could keep our overhead low while driving our productivity sky high.
The parallels between how I wanted to run my high-tech business start-up and my nonprofit charity weren’t incidental. At Smile Train, we weren’t just going to be good-hearted and well-intentioned; we were going to be like the proverbial startup in a garage, with a tiny, smart, and ambitious staff working like crazy. I believed that if I could apply what I had learned from the business world to the nonprofit world, we were going to see a substantial increase in the number of children we were going to be able to help. And this could only be a good thing.
My strengths were in business and management, but I also knew my weaknesses. I didn’t know much about running a nonprofit program and I had zero medical knowledge. I was incredibly fortunate that one of the first people to come on board at Smile Train was DeLois Greenwood. When I’d first met her, I thought DeLois seemed somewhat quiet and unassuming—until I saw her fight like a bulldog when it came to children who needed her help. Hiring DeLois was one of the best things we did in those early days. By that point, she had almost twenty years of experience in helping children receive life-saving surgeries in developing countries. She was smart, she was passionate, and no one cared more about helping kids than DeLois.
Along with excellent staff members, I knew we needed allies in the medical world, too. One of the first calls I made in the early days of Smile Train was to Dr. Joseph G. McCarthy, director of the Institute of Reconstructive Plastic Surgery at New York University Medical Center. I had gotten to know Joe while I was running the New York City schools program. I knew that he was both a world-renowned plastic and reconstructive surgeon and also the editor of the definitive series of medical books that every plastic surgeon in the United States had to read in order to become board certified. If anyone knew how to train and empower surgeons globally, it was Joe. So we invited him to head up our medical advisory board, and to our enormous relief, he said yes.
Joe recruited a team of world-class medical professionals who would go on to guide our work at every level, from establishing safety protocols and quality controls to overseeing training and educational programs designed to improve surgical outcomes for our partners. Joe believed in Smile Train’s mission to help build self-sufficiency in developing countries, as opposed to working with the old model of flying surgeons in developing countries. He called our program “the right idea at the right time.”
With Joe’s guidance, we began to figure out what we could and couldn’t offer to the doctors in our programs. In the United States, it takes a minimum of eight years of undergraduate and medical school before a doctor can even begin a residency in plastic surgery, so we knew it wasn’t going to be possible to train surgeons from start to finish. Instead, Joe suggested working with doctors who were already qualified to perform cleft surgeries. In other words, we would be working with plastic surgeons or oral and maxillofacial surgeons (doctors who operate on the head, neck, face, and mouth). Once we had found these qualified surgeons, we would offer them a range of educational opportunities. We would give them scholarships to attend international cleft conferences, workshops, and symposia. We would offer the group and individual training, and help them network with their peers globally. We began making plans to create 3D animated training videos that could be shared with our partners easily and inexpensively.
The next step was to find allies overseas. The Chinese government requires that every charity working there partner with some form of Chinese organization. In the spring of 1999, DeLois and I flew back to Beijing, this time to meet with the China Charities Federation (CCF). The CCF is the nation’s biggest charitable organization, and, as it turned out, they were already running a small cleft program, working with local doctors and hospitals. Our meeting with the CCF was a resounding success. Through the CCF, we were introduced to our very first Smile Train partner surgeon, Professor Liu Jiang Tai.
Dr. Liu was an oral and maxillofacial surgeon working out of a hospital in one of the most remote and impoverished provinces in China: Qinghai, on the northeastern edge of the Tibetan Plateau. It’s a community consisting mostly of subsistence farmers, scraping together a very basic livelihood from the mountainous terrain. If we could make our model work there, we knew we could make it work anywhere in the world.
DeLois flew from Beijing to Xining to meet with Dr. Liu at the Qinghai Medical College Hospital. Later that day, she scrubbed up and went into the OR to observe him performing cleft surgery. The room was spotless and the anesthesia was well administered. Dr. Liu worked quickly and effectively. After the surgery was completed, DeLois stayed to observe the quality of the postoperative care. Again, everything looked good.
Dr. Liu told DeLois, “If I had the funding, I could do three hundred surgeries a month.”
DeLois returned to New York excited and inspired.
“I think this can work,” she told me. “In terms of testing our strategy, Dr. Liu and his team seem like the perfect candidates. Even though their facilities are modest, they have their safety protocols in place, they have the experience, and there’s a massive need for surgeries.”
Despite this glowing report, I could tell DeLois was nervous. We had never done anything like this before. Were we ready? It was one thing to talk a big game, but it was another to actually begin implementation.
But where DeLois is thoughtful and cautious, I’m impatient and bullish. I didn’t want to wait. At some point we were going to have to put our model to the test. Here were children who needed surgeries and a doctor ready and qualified to perform them!
That spring, we decided to take a leap of faith and begin working with Dr. Liu. In return for the grant we gave him, Dr. Liu would provide us with a patient chart for each surgery performed, along with a “before” and “after” photograph of every patient. Our medical advisory board would assess the charts and photographs to make sure they adhered to our standards of quality.
We waited. It was a nervous-making time. There were nights when I woke up wondering if any of this was going to work. DeLois was also losing sleep. What if the whole idea was too ambitious? What if something went wrong in Qinghai, and all our donors and supporters turned their backs on us?
If our experiment with Dr. Liu failed, that could be the end of our train before it even pulled out of the station. On the other hand, if we were successful in Qinghai, we would be able to say that our model was viable.
Collectively, we held our breath.
After a few weeks, Dr. Liu’s patient charts began arriving at our offices in New York, stacks of them in large manila envelopes. With every week that passed, there were more deliveries, more envelopes, and more charts. I remember looking at those stacks and thinking to myself, “Each of those charts represents a child who’s been helped.”
Dr. Liu and his team went to perform 2,000 surgeries in just six months. That was a staggering number, more than a traditional mission organization would be able to complete in ten years. We really got excited when we saw this. Maybe Smile Train really was the right idea at the right time. We met with our new partner, CCF, and reviewed the tremendous results of our test project. They were just as excited as we were, responding that they had many more surgeons lined up and wanting to participate in our program.
Now that we had our model of funding and empowering local doctors—and our Chinese surgeons were proving to us that the model could work—it was time to scale up. It wasn’t enough to stop with 2,000 patients children each year; millions were waiting for surgery. We had great intentions, a working model, and a tremendous amount of passion. But we kept hitting roadblocks. The biggest problem was that we couldn’t find the right executive director. I was busy with my start-up, so I couldn’t take on a full-time job with the charity; Charles Wang had a global business to oversee; and DeLois was clear that her strengths lay in running programs, not managing the entire organization.
The first executive director we hired came from a Peace Corps background. He was a really smart, well-intentioned guy who had spent ten years building wells in Africa. On paper he seemed to have all the credentials, including a degree from Duke. But in practice, he seemed to spend all his time flying around the world, talking, convening, analyzing, and giving speeches.
“When are we going to start doing more surgeries?” I kept asking him. “We have millions of dollars in the bank but nothing’s happening. When are we going to start scaling up our surgeries?”
“Brian,” he told me, shaking his head. “You have to slow down. It’s going to be years before we do large numbers of surgeries. We need to learn more about what’s happening out in the field, how we can best structure our programs and establish relationships with thought leaders before we even begin to think about surgeries.”
This sounded like bureaucratic doublespeak to me. I was a businessman and I wanted to see results. I couldn’t understand why everything was moving so slowly. We had a long list of prospective partner hospitals waiting for our support. We had millions of children in need of surgeries. We had a proven business model. And we had $50 million in the bank. What were we waiting for?
After another year of dragging heels, we parted ways with our first executive director and went back to the drawing board. We found a new director, someone who was older and had more experience in the for-profit world. We felt confident that he would pick up the pace.
While Smile Train was barely pulling out of the station, my plastic surgery website—personalsurgery.com—had hit a serious impasse. In April 2000, the dot-com bubble burst. Suddenly anything with a .com in its name was doomed; funding for my start-up completely dried up and I had to close down the site. For the next few months, I was in career limbo, licking my wounds. I had lost money and wasn’t sure what I was going to do next. I began thinking that my best option was to return to what I knew best: advertising. I had built one agency; I knew I could build another one and make it a success. Maybe that should be my next step.
Thankfully, I had something else to look forward to that year. Cricket was pregnant with our first child.
When we found out we were having a girl, my wife came to me with an idea for a name.
“I think we should name her Maura, for your sister,” she said.
I loved this idea, but it also made me nervous. Ever since Maura’s death, it had been an unwritten rule in my parents’ house that no one spoke my sister’s name. My mom still struggled with depression, and no one wanted to remind her of all the pain and suffering associated with Maura’s loss.
Then, one night over dinner with my folks, soon after we announced Cricket was pregnant and we were having a girl, my wife got up the courage to ask for permission: “We’re thinking of naming our baby Maura. We wanted to ask you if that would be okay.”
There was a long silence. My parents looked at each other. They both got a little teary-eyed. I held my breath.
My mother got up, went over to Cricket, and hugged her.
“We would love that,” she said.
After that, it was as if Cricket had broken a spell. My parents, my brothers—all of us had a new and hopeful reason to speak our sister’s name again.
When baby Maura was born in September 2000, and the nurses handed her to me for the first time, I was floored. She was so tiny and beautiful, I started singing “Somewhere over the Rainbow” to her, cradling her in my arms. In that moment, it was as if the world stopped turning. When it started spinning again, I was sure it revolved only around her.
INSERT PHOTO: BrianBabyMaura
Once I became a father, the need to make sure Smile Train was a success came with even higher stakes. I finally understood the pure love and intense need to protect your child that every parent feels. I couldn’t imagine the horror of my daughter having a medical problem and me not being able to get her the help she needed. And yet this was what parents were going through every day, in every corner of the planet.
Although we’d had high hopes for our second executive director, as it turned out, he moved even slower than the first guy. He was very nice and had good intentions, but he wasn’t driven, and he didn’t have any sense of urgency about the work. After a year of watching him fly around the world taking a lot of meetings— but making little progress in scaling up surgeries—we fired him, too.
At this point, it wasn’t even clear if Smile Train would be able to continue. We had wasted two years trying to find the right executive director. We had tens of millions of dollars sitting in the bank gathering dust. It was pretty embarrassing. Here I was going around telling everyone that we were going to run this nonprofit like a business, but in the meantime, it looked a lot like we were running a nonprofit that was going out of business.
The evening after we fired Smile Train’s second Executive Director, I went home and told Cricket about what had happened.
“Oh Brian, I’m so sorry,” she said. “What are you going to do now?”
“I really don’t know. At this rate, I may have to step in and run the charity myself!” I joked.
“Well, I think that’s a great idea,” she said, without skipping a beat.
“Wait. You do?” I asked, a little stunned.
“Yes, I do,” she said. “You should do it! You keep saying you’re going to start another ad agency, but do you really need to do that again? It’s time to be honest with yourself and think about what you really want to be doing with your life.”
Cricket knew how much I cared about Smile Train. Maura was sitting on her lap as we spoke. Our daughter was seven months old now, gurgling and smiling up at me.
“What would Maura want you to do?” Cricket asked. “Just think about it. You don’t have to run Smile Train forever! Why not do it for a year and see if you like it? Then someday you can tell your daughter all about this great thing you helped to get off the ground. Think how proud she’ll be.”
I was still hesitant. What if running a charity was more difficult than I thought? What if I failed? Even so, in my heart, I knew Cricket was right.
The following week, I told my cofounder I was willing to step in as interim president for one year, just to get Smile Train on the right track. In that time, I could stabilize the organization, develop a business plan, and hire the right staff to make it successful. Then I’d hand it off to the next person and get back to building my for-profit career. I loved Smile Train, loved the mission, and was completely committed to making it work, but even so, I still had my work as a businessman to think about. My identity was wrapped up in being an entrepreneur. Running a nonprofit was something I could only do on a temporary basis.
He agreed.
Good Reads: Before and After by Brian F. Mullaney, Co-Founder of Smile Train and WonderWork.
