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The changing paradigm in surgery is system integration: How do we respond?

Published:December 07, 2017DOI:https://doi.org/10.1016/j.amjsurg.2017.11.031

      Highlights

      • With hospitals integrating into health care systems, there are no processes in place to absorb surgical practices.
      • We created a community surgical division for an academic health care system, as it integrated 3 community hospitals.
      • Physician leadership, infrastructure and resources create a culture which led to recruitment of community surgeons.
      • The appointment of a faculty leader embedded into the community was key to its success.

      Abstract

      With expansion of health care systems across the country, close relationships need to be developed between academic medical centers and their affiliated community hospitals. This creates opportunity to integrate surgical programs across different hospitals. Herein we describe a model of surgical integration at the system level of five large hospitals. We discuss utilizing advantages that both the academic and community hospital bring to the model. A close relationship between an interdisciplinary team, which includes the academic surgical chair, a regional director liaison who was embedded in the community, individual hospital leadership, and practice plan leaders was created. Three pillars as a foundation to success were physician leadership, the use of system infrastructure and development of new processes. This resulted in development of trust, leading to successful recruitments, models of employment and expansion into novel areas of patient safety. Once created, new opportunities for programming for surgical safety across the health care were identified.
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