American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Surgeons should take the lead in healing health care

OCTOBER 25, 2017
Clinical Congress Daily Highlights, Wednesday First Edition

Surgeons and other health care professionals need to take the lead in addressing problems in our health system, or patients and citizens will be the poorer.

That was the key message Wednesday of Clare Marx, CBE, DL, FRCS, Ipswich Hospital, UK, and a past president of the Royal College of Surgeons.

Although the United Kingdom has a public health system, many of the challenges it faces are similar to those in other countries, including the U.S. They include rising costs, constrained resources, increasing patient demands, aging population, disparities in health, and inconsistent care, she said.

Funding for the National Health System (NHS), which is run “incredibly efficiently,” has suffered as tax revenues have never fully recovered from the recession nearly a decade ago, Dr. Marx said. The NHS budget, which at £120 billion now accounts for 8.6 percent of GDP, will drop to 7 percent of GDP by 2020. Episodes of care have increased from 7.9 million in 1994 to 18.1 million in 2014, an increase of 129 percent. The aging population and poor education are major drivers of increased demand for health services, including urgent care, she said. For instance, in Suffolk, England, men who are highly educated live an average of 7.2 years longer than those who have a low level of education.

“As leading health care professionals, we need to ensure our policymakers understand this relationship between the quality of education and the quality of health,” she said.

Surgeons have an especially important role in improving health care quality and reducing variation. The Get It Right the First Time (GIRFT) initiative in England discovered and is addressing huge variations in practice and outcomes in terms of device and procedure selection, clinical costs, infection rates, readmission rates, and litigation rates, she said. GIRFT is now addressing these variations in breast cancer, gallbladder disease, urology, diabetes, and chronic respiratory disease.

But surgeons themselves can do more to address variation in care, starting by intervening with colleagues who are not performing well, leading to poor outcomes for patients.

“There has been a conspiracy of silence about low-performing colleagues,” she said.

Dr. Marx urged her colleagues to have difficult conversations with their poorly performing peers. In many cases, improving performance may simply involve coaching or additional education, she said.

Surgeons also need to better understand and use the flood of patient data that has become available. This may involve using “big data” analytics, looking at public data on surgeon performance from national transparency efforts, or understanding how to tap into the rise in genomic data from large populations and other efforts. Ultimately, data can be used to support quality improvement.

Additional Information:
The Named Lecture, Right for the Patient, Right for the Citizen – Professionally Led changes in Healthcare, was held October 25, at the 2017 Clinical Congress of the American College of Surgeons in San Diego, CA. Program, webcast and audio information is available online at

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