Approximately 10 years ago, the American College of Surgeons (ACS) embarked on a program to help train surgeons in health care policy and advocacy. The goal was to create a critical mass of surgical leaders with expertise in those areas who, at some point in the future, would help to promote the mission of the College. One component of that initiative was to offer a course on health care policy that Fellows of the ACS could attend to learn the details of how laws and regulations are developed at the national level.
Since its inception, the program has centered on a week-long, intensive course taught by experts in health policy and other specialty areas necessary to ensure that physicians can be successful in advocating on behalf of the profession and surgical patients. Over the years, the College has partnered with other surgical organizations to design the course and award scholarships to surgeons who are ACS Fellows and members in good standing of those specialty groups. (See Table 1 for a listing of organizations that cosponsor the program.)
Table 1. Sponsoring organizations
- American Academy of Otolaryngology–Head and Neck Surgery
- American Association of Neurological Surgeons
- American Association for the Surgery of Trauma
- American College of Surgeons
- American Pediatric Surgical Association
- American Society of Breast Surgeons
- American Society of Colon and Rectal Surgeons
- American Society of Plastic Surgeons
- American Surgical Association
- American Urogynecologic Society
- American Urological Society
- Eastern Association for the Surgery of Trauma Foundation
- New England Surgical Society
- Society for Surgery of the Alimentary Tract
- Society for Vascular Surgery
- The Society of Thoracic Surgeons
The initial course took place at Harvard University, Boston, MA, but for the last eight years, it has been presented at Brandeis University’s Heller School for Social Policy and Management. It is now known as the Heller Executive Leadership Program in Health Policy and Management and is located in Waltham, MA. Jon Chilingerian, PhD, has served as the program director at Brandeis. An example of one year’s curriculum is depicted in Table 2. In addition to health care policy development, a wide range of topics related to fostering advocacy skills are covered in the course, including leadership, change management, basic accounting, and conflict resolution.
Table 2. Course syllabus
- The evolution of health care in America
- Comparative effectiveness research as part of the Affordable Care Act
- High-performance health care
- Health care economics
- Strategic thinking in health care: Individual and group decision making
- U.S. health policy: Paying providers for health care services
- Managing clinics and the health care process: Hospital physics
- Roles for physician leaders
- Learning from outliers: New approaches to measuring and managing health organizational performance
- Effective clinical leadership styles: Building a commitment to goals
- Leading change in complex systems
- Conflict negotiation
- Everything you always wanted to know about financial statements but were afraid to ask
- Cost behavior and effective tools for making accounting decisions within the organization
- The utility of process performance measurement for Medicare value-based purchasing
Measuring the program’s effectiveness
Recently, the College and the other sponsoring societies sought to measure the effectiveness of the program. To that end, we surveyed all of the ACS Fellows who had received scholarships from 2003 to 2012. Questions centered on demographic information, such as gender and age, as well as the year the Fellow attended the Heller Executive Leadership Program. The survey asked respondents to self-assess their level of involvement in health care policy development before and after they had attended the Heller program, and to describe the levels (institutional, local, regional, state, or national) at which they had participated. The survey asked responents for examples of personal involvement in health care policy development and for comments on the impact the programs had on them. (See Table 3 for a comprehensive list of survey questions.)
Table 3. Survey questions
- What is your gender?
- What is your current age?
- Prior to attending the Heller Executive Leadership Program in Health Policy and Management, how would you rate your involvement in health care policy development?
- What year did you attend the Heller Executive Leadership Program in Health Policy and Management?
- Have you attended any other similar health care policy or leadership courses?
- After attending the Heller Executive Leadership Program in Health Policy and Management, how would you rate your involvement in health care policy development?
- How many times have you attended the ACS Leadership and Advocacy Summit?
Please give examples of what you consider to be the three most important health care policy areas in which you have been personally involved.
- Please add any other comments concerning your involvement in health care policy development and the impact the Heller Executive Leadership Program in Health Policy and Management has had on you.
We sent the survey to 93 surgeons, and 53 responded for a response rate of 57 percent. A total of 48 respondents (91 percent) were male, which reflects the gender ratio of the overall group, and 98 percent were between the ages of 35 and 64, with one younger and one older than that range. Figure 1 depicts the number of attendees by year.
Overview of results
Of the respondents, 62 percent indicated that they had attended other health care policy or leadership courses, including those that the ACS sponsors. For example, 72 percent reported that they had attended the ACS Leadership & Advocacy Summit, with 55 percent of those individuals indicating that they had attended the annual meeting more than once.
Figure 2 and Figure 3 demonstrate the attendees’ perceptions of their health care policy involvement at their institutional, state, and national levels before and after participating in these programs. In all instances, the shift clearly is toward more involvement. That same trend was noted when respondents were asked about their involvement in health policy matters at the community and regional levels. Table 4 lists examples of health policy areas and activities in which the graduates of the Heller Executive Leadership Program have become involved. The list has been edited to remove duplicate references to activities. As an example, we received 120 individual responses to survey question number eight, requesting that respondents give examples of what they consider to be the three most important health care policy areas in which they have been personally involved.
Unquestionably, the College’s collaboration with other surgical societies and the resulting investment in the health policy scholars program is paying dividends. By taking a group of interested and committed surgeons and giving them specialized education, the ACS has created a skilled cadre of physicians who are willing and able to assist the College with health policy and advocacy activities.
Recently, the ACS has moved the management of the health policy scholar alumni from the Division of Members Services to the Division of Advocacy and Health Policy. This shift should ensure more continuous interaction between the scholars and the College’s advocacy staff. As a result, the ACS anticipates that the scholars’ impact on health policy and advocacy matters important to surgeons will continue to increase.
Table 4.Examples of self-reported health policy activities
- Accountable care organization development
- Use of resources at the hospital level
- Cost containment
- Development of coordinated care organizations
- Promotion of greater provider input
- Quality and patient safety
- Medicare readmissions
- Optimization of health care for children
- Leadership in change of Ohio’s trauma system
- Assist in defining quality for state of Oregon
- Maryland hospital-acquired conditions
- Advocacy for funding care for underserved populations
- Regionalization of complex care
- Assistance in developing a behavioral health infrastructure
- State reimbursement of long-term cancer follow-up
- Trauma care legislation
- Assistance in monitoring and developing an adequate health provider workforce
- Use of state tobacco money for smoking-related disease
- Communication of advocacy efforts to surgeons throughout the state of Maine
- Help in starting Oregon’s ACS National Surgical Quality Improvement Program collaborative
- Pre-hospital trauma care—statewide policy changes
- Work with state legislators to develop a breast cancer reconstruction bill
- American Medical Association (AMA) Relative Value Scale Update Committee
- Government Relations Committee of American Urogynecelogic Society
- Elected to National Quality Forum
- Physician reimbursement/sustainable growth rate
- Member of ACS Health Policy Committee
- Medical liability reform
- Surgical workforce issues
- Government Affairs Committee of the American Society of Plastic Surgery
- ACS Board of Governors’ Socieconomic Issues Committee
- AMA Current Procedural Terminology Committee
- Chair, Legislative Affairs Committee, American Urologic Association
- Co-Chair of national policy workgroup for specialty organization
- Optimum resources for pediatric surgical care
- Founding member of the Surgical Quality Alliance
- Chair, Health Policy Committee of the American Urogynecologic Society
- Health Information Technology for Economic and Clinical Health Act
- Value-Based Purchasing
- Delegate to the American Medical Association House of Delegates
- Payment policy reform for the American Academy Otolaryngology–Head and Neck Surgery
- Vice-Chair, Urology Political Action Committee
- Member of Health Policy Committee for the Society of Vascular Surgery
- Graduate medical education funding