The impact of professionalism on safe surgical care

Abstract

For the past 7 years, I have served as the chief medical officer (CMO) and senior vice president for clinical affairs at the Brigham and Women’s Hospital in Boston. The hospital provides 750 beds, and each year discharges 56,000 patients, including 9,000 new little souls, and performs 31,000 surgical procedures. There are 13,000 employees, including 3100 nurses and 5500 members of the medical staff. Among the physician component, there are 2200 active attendings, 1500 trainees (850 in 36 accredited Accreditation Council for Graduate Medical Education [ACGME] programs), and 1600 investigators engaged in primary research endeavors with $400 million from federal and sponsored sources. The quality “bottom bottom” line is our 1.7% hospital mortality, which benchmarks against the University Healthcare Consortium’s observed-toexpected ratio at 0.74. It is an extraordinary privilege to help facilitate the mission of the institution and the objectives of its department chairs and their dedicated staff. However extraordinary, this privilege is fraught with equally extraordinary challenges, prime among them the assurance of sustainable, safe, and yet cost-effective patient care in the context of increasing volume and acuity. Craig Donaldson, our president, friend, and colleague for three decades, asked me to deliver a provocative lecture drawing on this experience. I’ll try not to disappoint. Much has been made of patient safety of late, not that we haven’t been promoting safe care for the entirety of our professional lives. After all, the American Board of Surgery, charged with certifying “the education, training and knowledge of surgeons,” was created in 1937 through the efforts of the American Surgical Association. President Archibald’s address in 1935 underscored that “Fellowship in the American College of Surgeons did not assure sufficient mastery of both the art and science of surgery.” His address prompted subsequent deliberations within a committee chaired by Evarts Graham, who in his own presidential address, declared to the membership “. . . steps were