Defining vision – Over the past year, surgeons across the province have prioritized world-class excellence in patient care, education, research, and advocacy. These discussions have informed the development unifying vision and mission statements.
Developing a value based agenda – The UBC Division of General Surgery has adopted the integrated practice unit (IPU) model (Porter, Harvard Business Review 2014), in which general surgery is deconstructed into small, patient-centered units, to pursue value based agendas, as a strategy to increase surgeon engagement and agility in solving clinical and academic challenges. These IPUs function like small start up companies, united by an unrelenting focus surgical quality and cost or, in other words, the value of surgical care. Optimization of value is best accomplished when integrated, multidisciplinary IPUs, capable of mapping and measuring their processes, outcomes, and costs, are built around the needs of patients, rather then being organized by subspecialty siloes. These units can scale across geographies. UBC General Surgery has adopted a value based agenda and the IPU concept as a unifying strategy.
Creating facilitated networks – Clayton Christensen (who coined the term disruptive innovation), defines 3 stages of business transformation, which roughly correspond to health care transformation (The Innovator’s Prescription). First, solution shops are cottage industries (surgical clinics) of high expertise that care for patients individually and comprehensively, but also variably and inefficiently. Second, value adding processes realize economies of scale to make health care highly standardized and more efficient. This is where surgical care stands today – standardized, but still not patient centered, precise, multidisciplinary, or appropriately complex and comprehensive. The next transformation, which general surgery in BC is about to undergo, is the creation of facilitated networks, that use digital technologies to promote the rapid exchange of ideas and skills, to tailor therapies of appropriate complexity in highly integrated and multidisciplinary systems of surgical care, and to continuously measure and optimize performance.
This proposal restructures UBC General Surgery into 16 patient-centered integrated practice units, each engineered with detailed educational curricula and each with capacity to measure and optimize performance. The feasibility of this work has been tested at the Vancouver General Hospital. The IPU categories will then be scaled across the province, to include surgeons and their multidisciplinary partners, based on clinical interests and practice patterns, using custom built (Reticulum Website) and off the shelf (Slack) digital technologies. The provincial IPUs will be used to promote the Division’s key opportunities (exchange of knowledge and skills, quality improvement, and career development). Web based technologies will facilitate educational exchanges and promote collaboration, to support a more integrated, cutting edge, patient-focused surgical culture in BC.
The Strategic Investment Fund Award will be a once in a generation opportunity to:
- Complete work on unifying vision and value statements for UBC General Surgery
- Fully define business plans for all 16 integrated practice units
- Create real hub and spoke networks of expert and practicing surgeons for each IPU, across the province, and closely align these IPUs with key partners (BC Cancer Agency, Trauma Services of BC, Surgical Quality Action Network etc.)
- Develop and use web-based technologies to enhance dissemination of ideas and educational and quality exchanges within these networks (the Reticulum Website)
In truth, the elements of transformation (clinical excellence, provincial resources, technology) already exist. The facilitated network will engage surgeons to take collective action to improve their expertise, their systems, and the health of their populations