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

Published:December 07, 2017DOI:


      • 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.


      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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        • Charles A.G.
        • Ortiz-Pujols S.
        • Ricketts T.
        • et al.
        The employed surgeon: a changing professional paradigm.
        JAMA Surg. 2013 Apr; 148 (PubMed PMID: 23715861): 323-328
        • Napolitano L.M.
        Surgeons as hospital employees. Good, bad, or indifferent?.
        JAMA Surg. 2013 Apr; 148 (PubMed PMID: 23715881): 329-330
        • Scoggins C.R.
        • Crockett T.
        • Wafford L.
        • Cannon R.M.
        • McMasters K.M.
        Improving clinical productivity in an academic surgical practice through transparency.
        J Am Coll Surg. 2013 Jul; 217 (discussion 51-5 PubMed PMID: 2362822): 46-51
        • Koch T.G.
        • Wendling B.W.
        • Wilson N.E.
        How vertical integration affects the quantity. and cost of care for Medicare beneficiaries.
        J Health Econ. 2017 Jan 17; 52 ([Epub ahead of print] PubMed PMID: 28182998): 19-32
      1. A Profession in Transition. New York Times, April 22, 2011
        • Ishii L.
        • Pronovost P.J.
        • Demski R.
        • Wylie G.
        • Zenilman M.
        • Ambulatory Surgery Coordinating Council
        A model for integrating ambulatory surgery centers into an academic health system using a novel ambulatory surgery coordinating council.
        Acad Med. 2016 Jun; 91 (PubMed PMID: 26934690): 803-806
        • Grant M.C.
        • Yang D.
        • Wu C.L.
        • Makary M.A.
        • Wick E.C.
        Impact of enhanced recovery after surgery and fast track surgery pathways on healthcare-associated infections: results from a systematic review and meta-analysis.
        Ann Surg. 2017 Jan; 265: 68-79
        • Teter J.
        • Zenilman M.E.
        • Wachter P.
        • Johns Hopkins Medicine Cleaning, Disinfection and Sterilization Clinical Community
        Assessment of endoscope reprocessing using. Peer-to-Peer assessment through a clinical community.
        Joint Comm J Qual Patient Saf. 2016 Jun; 42 (PubMed PMID: 27184242): 265-270