Departmental Retreat: The Big Four and Integration

Fall is here, excitement is in the air, and we in the Department of Surgery have begun the journey towards clinical integration with our partners at Abington and Aria. On Saturday, September 24, 2016, nearly 100 attendees joined us in the Hamilton Building for our second Department of Surgery retreat in the last 18 months. This retreat differed from our first as we focused on two topics: The Big Four and Jefferson Health System Integration. The morning commenced with a reminder of our vision and mission statements, a review of the fiscal exigencies which prompted a need for change, and the charge to the participants. Dean David Nash then spoke on “Population Health: Is it the Secret Sauce?” and Dr. Anne Docimo, CMO, followed on the topic of “The Search for Value in the Healthcare Marketplace.” Next, Jasmine Arfaa, PhD, MHSA, and Terry Lynch (Press Ganey Associates) spoke on “The Patient Experience at Jefferson.” Finally, Mr. Neil Lubarsky, SVP for Finance, expertly discussed “Healthcare Cost Consciousness.” Following these four thought provoking talks, breakout sessions were held to encourage brainstorming and the prioritizing of our action plans. Following lunch, Hugh Lavery, SVP for Government Affairs, spoke on “Federal and State Landscapes.” President Steven Klasko, MD, MBA, speaking on his 3rd Anniversary at Jefferson (applause!) reviewed the numerous governance alterations that have taken place creating a more nimble and expansive Jefferson Health System. The half day retreat ended with a summary and action plan by each of the group facilitators. It was wonderful to sit in the same room with our colleagues from Jefferson, Methodist, Abington, Aria, and the Main Line. The interactions were robust, introductions were made, shared threats and opportunities were discussed, and…now the work begins! Soon, Jefferson’s Integration Management Office (JIMO) will nucleate surgical integration teams to help develop and implement changes to support our Jefferson Integration 2.0 goal. We will need timelines, milestones, and deliverables. Various project managers will be assigned. There is excitement in the air and hard work to do. We in the Department of Surgery have the opportunity to help lead this integration process. Recordings of the morning presentations are available at: jdc.Jefferson.edu/surgeryretrea

The Many Roles of an Academic Surgeon

One of our most important responsibilities is training the next generation of fellows, residents, medical students, and undergraduate students aspiring to a career in medicine. Last summer Sidney Kimmel Medical College launched our new educational curriculum, termed JeffMD (Jefferson.edu/JeffMD). There is great excitement as we have welcomed 270 new medical students, who will be engaged in an entirely new and improved curriculum focused on problem-based learning, small group sessions, lifetime learning, longitudinal threads and experiences. The Department has helped develop the new curriculum, and also hopes to bring to fruition a surgically-focused curriculum, for those medical students who differentiate early into a surgical field. Stay tuned for more, as this materializes under the direction of Drs. Gerald Isenberg and Harrison Pitcher. We also educate our learners by publishing books and journals focused on surgery. Congratulations to the many members of our Department who have led the way and brought to fruition the following major endeavors: • Cataldo Doria, MD, PhD, MBA, FACS, published Contemporary Liver Transplantation (book) • Alec Beekley, MD, FACS, published the 2nd edition of Front Line Surgery (book) • Gerald Isenberg, MD, FACS, released the first issue of the ACS online publication: Case Reviews in Surgery (journal) • Nicholas Cavarocchi, MD, FACS, FCCP, published Critical Care Clinics, Extracorporeal Membrane Oxygenation (e-book) • Francesco Palazzo, MD, FACS, and Michael Pucci, MD, FACS, are working on a new book The Fundamentals of General Surgery with many chapters already submitted. • Just two years ago Adam Berger, MD, FACS, edited a monograph on Melanoma, and David Tichansky, MD, MBA, FACS, edited The SAGES Manual of Quality, Outcomes, and Patient Safety • My personal project, the 8th Edition of Shackelford’s Surgery of the Alimentary Tract just celebrated the submission of the last of the 184 chapters that will make up this 2 volume set. Lastly, having just concluded my summer faculty chats with all 61 of our Jefferson-based faculty members, it is impressive to reflect on their accomplishments and achievements to date. It is certainly clear to me that our Department makes critical contributions to Thomas Jefferson University Hospital being named to the U.S.News & World Report Honor Roll, as the 16th best hospital in America. Please enjoy the various articles which compose this issue and keep up with our news on Facebook.com/JeffersonSurgery and Twitter@JEFFsurgery in between issues

The Spring of 2017…Change and Hope

There is excitement in the air at Jefferson this spring. We had a superb “Match” on March 17, and will be welcoming 6 terrific categorical general surgery residents come July. The Philadelphia Phillies just completed spring training well above .500, and there are high hopes for an improved year. In late April, the American Surgical Association − co-founded by our very own Dr. Samuel D. Gross (Chair of Surgery, 1856-1882) − hosted their 137th Annual Meeting here in Philadelphia. As part of the social program, attendees toured Lubert Plaza in the heart of our Center City campus, which includes the magnificent Samuel Gross Monument by Alexander Calder. Jefferson Health continues to sustain momentum towards further expansion, with the planned addition of Kennedy Health in New Jersey and Philadelphia University to our Jefferson family soon. Some work is already underway with Philadelphia University (see the Enterprise Integration column), taking advantage of their expertise in creative design, innovation, and space planning. Add to this the work being done at our Center City, Abington and Aria campuses by our 7 surgical 2.0 Integration teams focusing on patient-centered, highest quality care… much is happening. April 1 marked the launch of our Wave 2 EPIC implementation (inpatient EPIC) at our Jefferson Hospitals in Center City and on our Methodist campus. The power of this electronic health record (EHR) is quite amazing. Patients are being encouraged to sign up online for the “MyChart” patient portal, we are linked to other organizations via the Care Everywhere platform, and we now have one unified EHR for our outpatient and inpatient environments. As you might imagine, the surgical residents have embraced this new technology with great enthusiasm, while at least some of us (attending surgeons) are finding we have to work a bit harder to become facile. We look forward to further optimization of these systems, so that we can truly see the power of this far reaching, multi-layered EHR. Please enjoy the various articles which compose this issue and keep up with our news on Facebook.com/JeffersonSurgery and Twitter@JEFFsurgery in between issues

“Writers Workshop – How to Write a Paper for Publication”

43 minute presentation on how to write a paper for publication

Concluding Remarks

Shira Goodman is the Executive Director of CeaseFirePA, a statewide organization to take a stand against gun violence. She has extensive experience in the nonprofit world and joined the organization following ten years as a public policy advocate working for better courts in Pennsylvania and a career in labor law. She is involved in the Philadelphia, Pennsylvania and American Bar Associations, and serves on the board of the Legal Intelligencer and several community nonprofits. Thomas Farley is Commissioner of Health for the City of Philadelphia. From 2009 to 2014, Dr. Farley was Commissioner of the New York City Department of Health and Mental Hygiene. As Health Commissioner, Dr. Farley advocated for innovative public health policies, including making the city’s parks and beaches smoke-free, prohibiting price discounting of cigarettes, raising the legal sales age of tobacco to 21, capping the portion size of sugary drinks sold in restaurants at 16 ounces, and restricting the burning of air-polluting dirty fuels to heat buildings. He is coauthor of Prescription for a Healthy Nation (Beacon Press) with RAND Senior Scientist Deborah Cohen, and author of Saving Gotham: A billionaire mayor, activist doctors, and the fight for 8 million lives (W.W. Norton)

Mini-Incision Versus Laparoscopic Cholecystectomy

Background: We report a prospective randomised comparison between laparoscopic and small-incision cholecystectomy in 200 patients which was designed to eliminate bias for or against either technique

A Brief Overview of the Life and Work of Lyon Henry Appleby, M.D. (1895-1970).

The life and work of Dr. Lyon Henry Appleby, M.D., portrays the essence of a devoted clinician committed to scholarly excellence. Born in Deseronto, Ontario, in 1895 and passing in 1970, Dr. Appleby influenced all areas of general surgery, most notably popularizing a procedure that bears his name today. After a tour in World War I, he quickly proved himself to be a dedicated clinician with roots in academia, which translated into excellence within the Department of Surgery at St. Paul\u27s Hospital in Vancouver, Canada. He served in various leadership roles including Chair of the Department of Surgery, President of the International College of Surgeons, and Fellow of the Royal College of Physicians and Surgeons. The Appleby procedure, or en bloc removal of the celiac axis, at the time of gastrectomy, is the technical focus of this paper, although reference is made to Appleby\u27s extensive contributions to historical medicine