Academic Careers in Quality Improvement

Codman introduced the modern concept of quality improvement (QI) in surgery in the late nineteenth century. The assessment of surgical outcomes helped pave the way for provider and hospital comparisons on complications and mortality after various procedures. Later, mortality and morbidity were risk adjusted based on patient factors, which allowed for comparisons across different populations and environments. The science behind risk adjustment was the pillar of academic career development for surgeons in the twentieth century. The field later incorporated patient safety, patient satisfaction, quality of life after surgery, long-term functional outcome, access to care, disparities and cost. As such, the field evolved from risk adjusted mortality and morbidity to the broader field of surgical outcomes. Adding infrastructure, processes, coordination of care, staff education and culture transformed the field into the broader arena of health services. Surgeons interested in any of these areas can endeavor into scholarly activities and have a lasting impact. Over the last two decades, the health services research and practice derived from nurturing young surgeons and supporting them through their career development has resulted in improved systems, provider performance and patient care. The founders of surgical QI would be proud of the field’s rapid and far-reaching expansion and the enthusiasm of academic surgeons of all ages to pursue new related ventures. With the availability of health services research fellowships and the multitude of institutional, regional, national and international programs serving the surgical patient, careers dedicated to quality improvement present many opportunities for growth and future leadership in surgical care.