To the Editor We commend Ginwalla and Rickard on their recent publication “Surgical Missions: The View From the Other Side”1 in JAMA Surgery. At Operation Smile, we wholeheartedly support and agree with the comments put forward by the authors regarding the duty of mission-based organizations to implement programs that are not only effective but also conducted responsibly. The 2 vital components of implementing the mission model responsibly are integrating practices within the local health system, as highlighted by Ginwalla and Rickard,1 and emphasizing quality. Although elements of safety and effectiveness have been addressed extensively in the literature, patient centeredness has been notably absent in the global surgery discourse.2,3