January/ February 2019 O&P Visionary

Jack Richmond, CPOA

President and chief executive officer of the Amputee Coalition offers his vision of a perfect day in the O&P profession

     When I was asked to write about my vision for the perfect day for O&P, I began to think of my own perfect days in O&P. All my perfect days in O&P have had a patient at the center. The first of those days was 31 years ago, when I was that patient at the center.

Just six weeks after an accident at work that resulted in the loss of my leg at the transtibial level, I was standing and taking a few steps while holding back tears. Standing on two feet again was a miracle moment for me, my family, and friends at work who were waiting for my return. Compared to what modern prosthetic care provides today, my first prosthesis wasn’t much in the way of technology. It was, however, exactly what I needed for the first steps back to the life I knew.

Over the past 28 years I have worked with patients as a care provider, manufacturer, and advocate. I have been blessed to see my miracle moment repeated by others many times. Memories of a child standing for his first time with the help of an orthosis, and of delivering a prosthesis on Christmas Eve to someone who couldn’t pay for it—these are perfect days that have surpassed my own. On days like these, smiles, hugs, tears, and renewed hope are all the evidence we need to justify what we do.

So how do we make more of these perfect days possible? In my opinion, the answer is not as complicated as it might seem. It comes down to a commitment of putting patients first, helping to empower them with knowledge and a focus on evidence-based practice. Our health-care system is changing; a willingness and ability to adapt to those changes are critical for you and your patients.

There has been much written about patient-centric care. If putting patients at the center of every decision makes sense, why doesn’t it happen every time with every patient? There are lots of reasons: Not enough time, unrealistic expectations, and reimbursement issues are just a few issues that pull focus away from your patients.

Patient-centered care, like excellence, is a journey—not a destination. My vision of the journey has a few stops along the way.

Understanding and Being Understood

There is no replacement for good communication. Listening takes time and patience, but it is the only way to learn how your patients will define a successful outcome. Ask questions to direct the conversation, and then share your knowledge and experience with your patients.

Adherence (compliance) by the patient to the plan of care is key to successful outcomes, and the keys to adherence are understanding and motivation. Develop the plan together, explain the goals, and make them responsible—with you—for the results.

When we talk about patients, it is important to understand that caregivers are often the decision makers. Caregivers need to be as much a part of the plan as patients are.

Support and Education for Patients

As the president of the Amputee Coalition and an amputee advocate, my goal is to make sure all amputees have, as I did, the help and support they need to live well with limb loss.

Through the National Limb Loss Resource Center, the Amputee Coalition provides educational materials, events, one-on-one peer support, and support groups. We also have a comprehensive website full of incredibly useful resources for amputees and those who care for them.

The most disappointing moment in my job is when someone says, “I wish I had known about the Amputee Coalition when I lost my limb.” Please, do your patients, and yourself, a favor by connecting them with the Amputee Coalition and everything we have to offer.

Care, Not Components

In my vision of a perfect day, the management of a patient’s orthotic or prosthetic care is at the center—not the delivery of a prosthetic arm or leg or a brace. With expertise and experience, you advance a plan of care for the patient, and the focus is delivering care that includes a device as a component of that care.

Technology is part of the plan of care, but the best technology will never replace a human touch with your skill and knowledge. The key to technology is assessing the need, considering the options, explaining the options to the patient, then selecting the best option for the patient with their input.

Managing the expectations of technology is critical; a wise practitioner once told me, “The best device I’ll ever make is just a tool a patient must learn how to use to get on with their life.” Expectations must be realistic, including expectations of technology for patient satisfaction to become reality. Technology may be key to success, but patient-centric, not device-centric, care is critical for successful outcomes and patient satisfaction.

Measure Success and Failure

When I go in for a checkup, my doctor has a page full of test results that we review together. When something is out of the normal range, he explains why it is a problem and describes the options to correct the problem. This usually comes down to fewer cheeseburgers and more exercise, or an alternative plan of care involving medication and bypass surgery. For motivation, he clearly explains studies that show the consequences of not correcting the problem. Unfortunately, we are not yet there in O&P; we still need more evidence to support our recommendations.

In my vision of that perfect day, we’ll measure outcomes for every patient and share the data for the benefit of all, especially the patient. Collecting data, sharing data, and studying the data will produce knowledge and lead to best practice recommendations. These recommendations can then be shared with patients and payors as a basis for why a certain plan of care is the best option.

Collecting outcome data gives us the opportunity to measure results and review the care provided. We can then fix what didn’t work and improve on what did. Continuous quality improvement is what some call it; I think it’s just a dedication to pursue that perfect day in O&P.

Partner With Payors

Yes, I said partner. Help the insurance companies and other pay sources you work with understand that we are
all on the same team, with a patient at the center.

Education, justification, and communication are essential ingredients in teaming with payors. Get your patients involved when appropriate; after all—they are paying the premiums and are described as the “beneficiaries” of the plan.

The Amputee Coalition can help you advocate for your patients and help them advocate for themselves. The Amputee Coalition has created the “Amplify Yourself” website for just that purpose: www.amputee-coalition.org/amplifyyourself/. Patients can look there to find advocacy resources and even write a letter to the presidents and medical directors of their insurance companies.

Living in the Moment

As you imagine the future and that perfect day, don’t lose sight of today. Celebrate all of the perfect days along the way to the goal of perfection. Take time to celebrate with your patients on their perfect days, and remember they are at the center of all we do and why we do it.

I’ll close with a modified version of something I wrote in 2017 for AOPA’s 100th anniversary:


Press deep the seed of hope,
that its roots may reach the soul.

Restoring the life that is lost,
when misfortune takes its toll.

Their hope is your hope,
with every step you take.

Your ability, their new ability,
in everything you make.

With hands and feet, their new
tomorrows—tomorrows you create.

With gentle force, limbs once bent, now made straight. 

Working together there’s
no telling how far we’ll go,

Evidence? Lives rebuilt are
there for you to show!

You’ve helped so many hopes
and dreams come true.

Experience, dedication, and vision,
a perfect future waits for you!

Here’s hoping for that perfect day and wishing you all many perfect days along the way.

Jack Richmond, CPOA, is president and chief executive officer of the Amputee Coalition.