Surgeons Harness AI, Resilience, and Teamwork to Transform Quality

The 2026 ACS Quality, Safety & Cancer Conference (QSCC), July 30–August 2 in Orlando, Florida, combined the ACS’s former Quality & Safety Conference and the Cancer Conference for the first time, providing attendees with actionable insights and expert perspectives.

Approximately 1,400 surgeons, nurses, oncologists, and data registrars attended the event, which carried the theme of “QI Powered by AI.” The potential of artificial intelligence (AI) and other advances in technology and technique were woven through the conference’s 10 plenary General Sessions, several of which are summarized in this article. The ACS Quality Programs were well represented in these and the more than 50 Breakout Sessions that focused on discipline-specific content.

The event began with a welcome address by Clifford Ko, MD, MS, MSHS, FACS, Senior Vice President of the ACS Division of Research and Optimal Patient Care, who highlighted the importance of collective expertise and the role of attendees in achieving high-quality care.

Referencing the magical framing of the conference, Dr. Ko suggested that while quality professionals may dream of a magic spell to meet their goals, achieving healthcare quality and patient safety takes real effort.

“In our view, the individuals who uphold quality are those people who roll up their sleeves and do it. The people who persevere are those who really uplift and uphold quality, and achieve better quality and safety going forward,” Dr. Ko said.

Joining Dr. Ko on the stage was Ronald J. Weigel, MD, PhD, MBA, FACS, Medical Director of ACS Cancer Programs, who discussed the importance of quality improvement (QI) in cancer. He also humorously observed that there are parallels between quality expertise and magic.

“For both of them, you’re not born with that knowledge. It takes years of disciplined practice to develop the skills and knowledge needed, which is why it requires continuous improvement. And that’s how you achieve quality, in practice, precision, evidence, and teamwork,” Dr. Weigel said. Both Drs. Ko and Weigel noted that there was no “waving a magic wand” in QI, and the time, effort, and dedication are what achieve results.

Potential and Pitfalls for AI in Quality

A robust discussion on the current state of AI as a clinical and administrative aid, including its potential and pitfalls in QI, kicked off the conference.

Surgeons and QI professionals can lean into the current strengths of AI as a tool for QI data aggregation and collation, according to Bruce Lee Hall, MD, PhD, MBA, FACS, from UC Davis Health in California.

Current AI models can effectively be used to review literature, assist in designing a QI study, generate a process and materials list, and significantly improve efficiency in these tasks.

“If you take 10 minutes of time to develop a strong QI project prompt for AI to interpret, wait for the results, and then spend an additional 30 minutes or an hour fine-tuning what it provides, you can potentially save hours of time and real dollars to get to a very usable project,” Dr. Hall said.

As the frontline health professionals often most closely involved in QI implementation, nurses play an invaluable role in determining the success of AI in quality projects.

Kristen Fessele, PhD, RN, of Memorial Sloan Kettering Cancer Center in New York City, said AI could help improve quality metrics by streamlining data collection, identifying trends, and standardizing workflows, but emphasized that human oversight remains essential for identifying and analyzing unexpected discrepancies in patient outcomes or processes.

“An AI disagreement with expected results should not just disappear into the workflow. It should become a reviewable quality event,” Dr. Fessele said.

Nikhil Thaker, MD, MHA, MBA, FABS, a radiologist at Capital Health in Pennington, New Jersey, further discussed the current risks of using AI in medicine. Current questions include: What data can the tools access? What happens if something goes wrong?

“The failure modes are relatively consistent, including the problem of missing source data, poor generalizability, and hallucinations where the answers or outcomes seem good, but they can be completely made up,” Dr. Thaker said. “And if those small errors get propagated at scale, we’re looking at compounding errors that could risk patients.”

Humans Remain Essential as AI Transforms Medicine

The AI focus continued in the conference’s first Keynote Address by Jonathan H. Chen, MD, PhD, director for medical education in artificial intelligence at the Stanford Center for Biomedical Informatics Research in California.

Dr. Chen, a magician himself, showed some convincing illusions on the stage to reinforce a point about AI.

“It’s getting difficult to tell what is real and what is not in the world of AI,” he said.

Recent advancements in AI technology have radically changed perceptions of the technology within healthcare. For example, when ChatGPT debuted and every professional started to wonder how it would impact their own field, researchers found that the early models were unable to pass a medical licensing exam.

But AI accuracy has grown exponentially with the release of each model of ChatGPT, and now “multiple AIs have emerged that can handily pass a medical exam,” Dr. Chen said.

A key distinction between early AI and human clinical experts was the clinicians’ ability to reason through complex, open-ended questions, distinguish relevant from irrelevant information, summarize a case, and develop a differential diagnosis. But in the past 2 years, AI models have advanced to such a degree that they can now provide answers to complex scenarios.

Dr. Chen cited recent studies comparing ChatGPT-4 (already outdated in 2026) with physicians in diagnostic reasoning cases. The results were surprising, as ChatGPT-4 alone arrived at more correct answers than physicians using either traditional internet sources or an AI model.

“This flies in the face of our understanding of technological advancement, that humans were always needed as a guide. Now, it appears that humans are slowing the computer down,” Dr. Chen said.

However, in case management reasoning, physicians who had access to ChatGPT-4 and were trained to use it effectively achieved the best results.

He said that clinicians play an invaluable role in implementing AI into healthcare in its current state, because while the technology has information, “you need human judgment to discern what is credible when evaluating the output of an AI model.”

Dr. Chen provided a look at several other recent developments in AI, including the deployment of AI “agents,” which can not only provide information but also act on their own volition, which could have implications for medication prescribing and even autonomous surgery far in the future.

While AI may end up having a permanent, transformative impact on healthcare, human clinicians and surgeons will be needed to “manufacture trust” from patients that will allow the technology to thrive. But clinicians must also be ready to adapt to the changing times.

“Any doctor who could be replaced by a computer should be,” Dr. Chen said. “While AI is not going to replace anybody, those who learn how to use it will replace those who cannot.”

Embracing Failure Can Improve Quality

Improvements in healthcare aren’t always linear, as long-term successes are frequently born from short-term failures. In fact, recovering from failure and “getting it wrong” can be a gift that imparts actionable lessons for future success.

Failures in both clinical and QI contexts can have a formative impact on a surgeon, according to Stephanie A. Savage, MD, MS, FACS, from the University of Wisconsin School of Medicine and Public Health in Madison.

Dr. Savage recalled her experience as medical director of a Level 1 trauma center when she tried to understand and change some of the processes at her new institution.

She wanted to bring the various groups involved in trauma care together, “but when I didn’t understand who needed to be there, people started to think the meetings were a secret, where we were trying to hide things, and that started to undermine trust.” While she was able to create an effective team, she said the failure to connect in those early days may have prevented the care teams from meeting their full potential, and she learned to “slow down, because good ideas stand up to testing.”

Fully embracing failure as not just an unfortunate byproduct of healthcare or QI, but as fertile ground for continuing innovation, can provide ongoing growth, according to Ashley Arehart, MSN, RN, NPD-BC, from Oregon Health & Science University in Portland.

She described her attempt to launch a pediatric critical care transition process program that began with promise but came apart within about a year, and from that experience, she started the “Fail Club,” a group that comes together regularly to share their failures and learn from them. It is a safe space for learning, listening, telling a story, and taking a lesson. And if QI professionals implement a fail club at their institutions, they may see real change take place.

“The goal is not that failure disappears; it’s that we get to try again,” Arehart said. “It may not be better, but it will be different, and that is where improvement happens.”

Perseverance Fuels Olympic Success and Cancer Care Teams

Responding to challenging circumstances in clinical care and in QI projects is often a test of perseverance, an attribute that Chaunté Lowe, a four-time Olympian, a bronze medalist, and a breast cancer survivor, has exemplified in her athletic career and cancer treatment.

She shared her story, and the deep commitment of her care team, in the conference’s inspiring second Keynote Address.

Lowe began by discussing a life-changing event from when she was 4 years old and saw Florence “FloJo” Joyner dominate in track at the Olympics, which set her on a path of athletic accomplishment from a young age.

Lowe said she took inspiration from her grandmother, who never gave up on a dream to be a singer, and her persistence eventually led her to sing at a small event, where presidential candidate Ronald Reagan asked her to sing at his inauguration if he was elected. When he eventually won, Juanita Booker did indeed sing the National Anthem at his inauguration in 1981.

“You have absolutely no idea how a small thing can have a ripple effect that will impact people for years to come. It might be a patient conversation, it might be filling out a form a certain way, it might just be listening and taking the extra step,” Lowe said.

Lowe’s early attempts, including participating in the qualifying rounds in the 2004 Olympics, did not meet immediate success, but she took what she learned, refined her processes, and tried again. Even in the face of finishing college while pregnant with her first child and resuming training with all those physical changes, she returned to the track and started to succeed. She eventually participated in several Olympics, winning the bronze in the women’s high jump in 2008.

But Lowe’s biggest challenge would come after athletics, when she found a small painless lump in her breast during a self-exam. She was diagnosed with triple-negative breast cancer, and she underwent a double mastectomy and chemotherapy. In the course of her treatment, she said she was able to remain positive and hopeful because of the attitude, professionalism, and quality of her care team.

“I was able to smile because of you all. I had a team that humanized me. Reminded me that I was a person. I was still the athlete, still the mom, and the rest of my story was still being written,” she said.

Now, 6 years cancer-free, Lowe has learned that the same mindset of perseverance and teamwork that brought her success in athletics can bring success to healthcare teams.

“The champion’s mindset isn’t avoiding challenges. It’s meeting them with integrity and confidence, and it’s built in little moments where you see the person,” she said. “When each person does their part so the collective moves together, resilience becomes sustainable, and culture stays strong.”

Education Can Improve Care and QI

Effective education doesn’t just focus on learner outcomes; instead, education in healthcare should be centered on the patient, according to Kyla P. Terhune, MD, MBA, FACS, ACS Senior Vice President of Education and moderator for the education-focused General Session.

Dr. Terhune suggested that education serves as a form of implementation science, translating the work of educators into practice, and while there are many ways to measure how well medical education is proceeding—board pass rates, ABSITE scores, and so on—the true measure of quality in education is more direct.

“Education outcomes shouldn’t be dependent on the learner. They should be dependent on the patient. The more we can connect quality to education, the better,” Dr. Terhune said.

In keeping with the theme of the conference, Kevin W. Sexton, MD, from Vanderbilt Health in Nashville, Tennessee, explored the practical use of AI in education, emphasizing the importance of human oversight and the potential for AI to augment learning.

Dr. Sexton highlighted an area of great potential, but also peril, that was brought up a number of times at the conference: the idea that the use of AI may lead to “deskilling.”

“Every tool you’re using is either teaching you something or it could be quietly deskilling you,” Dr. Sexton said.

Using polyp detection during colonoscopy as an example, he noted that AI has helped increase gastroenterologists’ polyp detection rates, but cautioned that if the technology becomes unavailable, clinicians’ detection skills may atrophy. With that in mind, AI tools must be used thoughtfully to enhance learning, and humans must remain in the loop.

To ensure that the tenets of QI remain embedded in medical training, experiential learning practices and deliberate practice must be emphasized, according to Tyler J. Loftus, MD, PhD, FACS, from the University of Florida College of Medicine. 

Dr. Loftus emphasized that effective QI education is necessarily experiential and that educators must encourage learners to reflect on their projects. He illustrated this point with a QI project focused on improving patient handoffs.

“Here’s a high-quality handoff, here’s a low-quality handoff, here is one where it was going sideways, something was missing, but the team recovered and had a good and effective handoff,” Dr. Loftus said. “What allowed them to be resilient? What can we teach based on what we observed in that recovery? That reflection is a really good basis for creating change.”

Rural Cancer Care, AI Policy, and Sustainability

The final session provided a high-level view of three QI topics.

Ingrid Lizarraga, MBBS, FACS, from the University of Iowa Health Care Clinical Cancer Center in Iowa City, began by addressing the challenges of providing high-quality care in rural areas, highlighting disparities in cancer mortality between rural and urban patients—differences she attributed to factors such as limited access to high-quality care, financial constraints, and staff shortages.

All the same, hospitals want to provide cancer care, and patients will prioritize being close to home.

“Patients are already receiving care in rural communities, whether they are receiving care from the most capable centers or not, so it behooves us to improve the care available to them,” she said, as she went on to discuss the impetus and early success of the recently launched ACS Commission on Cancer Rural Cancer Program Accreditation.

The conference made clear that medicine in the US is evolving at a rapid pace, sometimes in response to a volatile political environment in Washington, DC, according to Christian Shalgian, ACS Senior Vice President of Advocacy and Health Policy. Much of his discussion focused on AI policy, which remains largely undeveloped.

“There’s a rush to use AI, but what is the policy? Who’s in charge of AI? It’s kind of the Wild West at the moment. But at the ACS, we know there needs to be appropriate surgical input into AI policy in order to protect our members and their patients,” Shalgian said.

Who owns the data AI companies use? Which federal department regulates AI? Who owns the liability? He said that these questions, among others, are being addressed in AI policy grand rounds that the ACS has started hosting with subject matter experts.

Benjamin Miller, MD, FACS, from Cleveland Clinic in Ohio, concluded by discussing the responsibility that surgeons and health systems have to understand and address the environmental impact of surgical care. Importantly, he noted that QI and sustainability work hand in hand.

“When you drive down complications, you’re going to reduce the resources you need to take care of those complications to enhance sustainability. Quality also focuses on decreasing the variability of surgical care through standardized care paths, decreasing hospital length of stay, and decreasing unnecessary testing and imaging, which all improve sustainability,” Dr. Miller said.

The ACS has recently delved into this area with last year’s launch of the Surgical Sustainability Team for Action and Innovation (SUSTAIN) Collaborative.

This year saw the launch of the Preference Card Optimization Campaign, which provides education and resources for individual surgeons to formulate their bespoke surgical tool and supply lists. This level of customization will reduce wasted single-use tools that go unused during procedures, Dr. Miller said.

Save the Date

The 2027 QSCC will take place July 29–August 1 in Seattle, Washington.

Matthew Fox is the Digital Managing Editor in the ACS Division of Integrated Communications in Chicago, IL.