As we emerge from the coronavirus 2019 pandemic and focus on the many issues that emerged during this time, and on the eve of my departure as Executive Director of the American College of Surgeons (ACS), I’d like to leave you with a few final thoughts and introduce you to a new initiative that we launched at Clinical Congress 2021.
Our values define us
Every organization is ultimately defined by its values. The ACS for more than a century has gone much further than that. Our values, our highest ideals, and most sacred commitments have been made manifest through action. Our forefathers had a vision and established the ACS as a professional oasis where surgeons could convene and collaborate to determine and reach consensus on how to best serve the surgical patient.
Then, as now, our patients have counted on their surgeons to provide safe, quality care when in need. Our commitment is maintained—it is earned—by maintaining the highest standards of surgery, by continuously improving quality, by embracing collaboration, and by prioritizing knowledge. Our commitment is ongoing. Our commitment is active.
Our forebears’ vision “to serve all with skill and fidelity” is very well-conceived, but today, more than ever, we need to practice it with grace. With that ethos as our foundation, now is the time for Fellows of the ACS to recommit to our values in a manner that both bolsters and illuminates our unique combination of participation, education, collaboration, and innovation—all with the singular goal of providing care to the surgical patient.
To serve all with skill and fidelity is a philosophic statement, which still is aspirational more than a century later, but we are getting closer. Furthermore, we have new challenges that we must address with the same drive and integrity that Franklin H. Martin, MD, FACS, and his cofounders of the organization showed in issuing standards for hospitals and graduate medical education programs. Today, it is our responsibility to lead in the areas of cost reduction and ensuring the elimination of disparities in access to quality surgical care. I truly believe this is an achievable goal.
Meaning of our motto
“With skill” defines our professional responsibility to learn, to teach, and to personally commit to being the best we can be using knowledge, evidence, consensus, and teams or systems to provide the best surgical care possible. Our array of more than 50 educational programs fulfills that part of the vision.
We have traditionally defined “fidelity,” from the Latin fidelus, as faithfulness and loyalty, which sometimes causes confusion. However, the primary definition is trust. In a 2014 Bulletin article, Frederick Weber, MD, FACS, then President of the New Jersey Chapter of the ACS, noted, “The College has traditionally translated fidem as ‘fidelity,’ but, in my opinion, this translation conveys only a partial meaning of the word. The primary definition is ‘trust,’ and I prefer to translate the word as such. Patients put their trust and lives in our hands. We are entrusted with the surgical care of our patients. As surgeons, we carry the burden of the outcome of our procedures.”*
In other words, fidelity is given, whereas trust is earned. Trust captures the ethos of our work and our relationships with our patients and our colleagues. By creating standards of care, committing to their appropriate delivery, constantly benchmarking our performance, and opening ourselves and our institutions to transparent peer review and verification, we make it possible for patients to judge our ability for themselves and, in turn, trust us to deliver. It is not a mere semantic distinction. It is a recommitment to the idea that our motto should be reflective of our perpetual and collective effort to align our expertise with our accessibility and our authenticity, and our values with our actions.
Our values—professionalism, excellence, introspection, inclusion, and innovation—define the work of the College. The ACS is a little like a garden in that we use our values to seed, harvest, and cultivate programs that add to our vision. We use committees; Officers, Regents, and Governors; advocacy; finances; technology; and human resources to achieve our goals. With Optimal Resources for Quality and Patient Safety (also known as the Red Book), Optimal Resources for Surgical Education and Training (the recently released Gold Book), and THRIVE (Transforming Health care Resources to Increase Value and Efficiency), we have tilled fertile ground for the future of the organization.
To Heal All with Skill and Trust
The ethos of our efforts going forward should reflect our commitment to the patients whom we serve. With this thought in mind, the College unveiled a new campaign at Clinical Congress 2021 to remind our patients and our communities of the unique role surgeons play in society and, just as importantly, to remind ourselves of our core values and ethos: To Heal All with Skill and Trust. (See Figure 1, and watch the video at tohealall.org.) This effort reflects the core values in which we all believe, inspires our continued dedication and purpose, and centers our own shared commitment to our active role in serving our patients and communities.
Far and away, the most important resource we provide to our patients is us. The essence of what we provide is all about the operating room and the fidelity or trust placed in a surgeon when a patient is in need.
“To heal all with skill and trust” is more than a statement of our core values or intentions. It is a promise—not only to provide the best care possible, but also to stand by our patients, to advocate for them, and to give them the opportunity to return to the activities and lives they knew before they became so ill they needed surgical care.
We also have developed a new logo, not to replace the time-honored seal, but rather to complement it with modernity (see Figure 2). This logo highlights the core values in which we all believe, salutes and reaffirms our dedication and purpose, and continues to highlight our active role in serving our patients and communities.
FIGURE 2. NEW ACS LOGO
Tell your story
Surgeons advocate fearlessly to improve the lives of surgical patients. Surgeons, like any other group of people, are subject to economic, political, technological, and social change, but we are generally very adaptable. Surgeons are driven from the start. We choose personal sacrifice, empathy, and total dedication to patients over short-term gratification.
Nonetheless, surgeons, again, like any other group, are vulnerable, and our success in developing and providing patient-centered surgical services could be taken for granted or passed over as simply operational as big financial, technological, and social changes sweep through our nation. We cannot take the uniqueness of surgeons and what we represent for granted. We need to tell their stories.
Surgeons are driven from the start. They choose personal sacrifice, empathy for others, and total dedication to their patients. Their personal stories show you what really drives them. Surgeons get you back to life. They have one goal, whether a patient is having elective or emergency surgery—to bring the patient back to the life they recognize or closer to the life they remember or imagine.
Surgeons pay a high price in well-being because of the sacrifices they make. Surgeons are involved in patient care well before the day of surgery, taking precautions, conducting research, and planning for the unexpected. Often much is at stake as the surgeon takes responsibility to do whatever it takes to care for the patient. Surgeons often pay a high price in their own well-being because of the sacrifices they make in their personal lives. This personal toll often does not get the attention it deserves.
Throughout their training and careers, they constantly pursue “better,” continually adapting and changing to apply new technology to provide better care for their patients. They are hard-wired to always search for a better way to care for their patients.
We need to elevate these aspects of surgery and to promote our new campaign to celebrate these ideals and to renew our commitment to our profession and our patients. We are poised to go to the next level as we recommit to our vision following our values and strategic road maps, defining our needed resources, maintaining our role as the convener of the House of Surgery, focusing on our responsibility to be diverse and inclusive, and achieving our goal of healing all with skill and trust.
Our future is earned by the promises we keep. I challenge you to recommit to our patients—all of our patients—with the greatest of skill and trust. It’s been a privilege to serve as your Executive Director for 12 years. I look forward to seeing you soon.
*Weber FK. The ACS motto: What does it really mean? Bull Am Coll Surg. 2015;100(3):32-34. Available at: https://bulletin.facs.org/2015/03/the-acs-motto-what-does-it-really-mean/. Accessed November 1, 2021.