with those rank-and-file troops who have “boots on
I would opine that a truly successful surgical group
must be bottom-up with active engagement of our
surgeons in the field. Several decades ago, the Board
of Regents had a reputation for rigidity—whether
deserved or not. I can assure all ACS Fellows that the
current members of the Board of Regents and ACS
Officers are actively engaged and fully committed to
serving our patients and our Fellows in a flexible and
timely manner. However, a top-down organizational
structure from Chicago or Washington, DC, will never
allow us to be the organization we desire to be.
The Advanced Trauma Life Support® program is
one of the most successful programs in ACS history,
and its reach is worldwide. However, establishing this
program wasn’t a dream of a Regent sitting in Chicago,
but rather it was a mission generated by surgeons in
Nebraska who saw a need and acted on it. Similarly,
our current initiatives in rural surgery were instigated
by the women and men in rural areas who developed
an Advisory Council for Rural Surgery and the online
Rural Surgery Community, and these individuals continue to advocate for change in this important area.
Countless other efforts have similarly arisen, and the
ACS leadership has responded accordingly. For young
Fellows, local involvement may be an ideal starting
point. Many ACS chapters are floundering and need the
energy and creativity young Fellows can bring to the
table. When local issues are identified, become involved
and use the chapters, Members Services staff, or specialty society Governors as a conduit to ACS leadership.
Good actions—those that are patient-centric rather
than surgeon-centric—often are successful.
Quality: The founding pillar
Improvement in the quality of surgical care was the
core principle behind the founding of the College, and
quality improvement remains one of the ACS’ pri-
mary missions today. Surgeons undoubtedly want to
provide high-quality patient care, but the majority of
these health care professionals are unlikely to directly
participate in quality efforts in their practices or at their
hospitals. I would submit simply working in a hospital
that has a surgical quality officer, chief medical officer
overseeing quality efforts, a “quality” nurse, or the like
will not suffice.
Quality, which will be increasingly data- and out-
comes-driven, is the benchmark by which future
surgeons will be judged. Surgeons must own quality.
Its measurement must be local, personal, accurate,
and risk-adjusted. If surgeons don’t become involved
in quality improvement and take ownership of this
space, someone else will. The ACS has invested millions
of dollars in the development of quality programs, but
surgeons and their institutions must put them to use
to have a meaningful impact on patient care.
We have recently seen Internet rating services that
rank the quality of care that surgeons provide. Some of
these rankings use administrative data as a source for
these evaluations. Surgeons must take a leadership role
in providing the transparency of our quality improve-
ment effort as well.
The College has the ACS National Surgical Qual-
ity Improvement Program (ACS NSQIP®) and “QIPs”
for trauma, cancer, and other areas of surgery. If your
hospital can’t afford to participate in ACS NSQIP, find
a partner, build a consortium or cooperative, or create
your own quality improvement measurement tool.
Specialty societies have registries that you can tap.
Tomorrow’s surgeons will need a record of all cases
and outcomes and a means to critically evaluate their
work. Undoubtedly, the tools will change, but the core
value of quality care for our patients must not. My
admonition is that you “own” quality, or the system
may own you.
Education is our foundation—not a pillar
Since the first Clinical Congress more than 100 years
ago, education has been at the heart of all College
efforts. The ACS now engages in myriad educational
activities at all levels, from “boot camps” for incoming
residents to residency teaching tools. However, our
primary focus has been primarily on post-residency
Quality, which will be increasingly data- and outcomes-driven, is the benchmark by which future surgeons
will be judged. Surgeons must own quality.
DEC 2015 BULLETIN American College of Surgeons