Center for Surgery and Public Health

1. Center for Surgery and Public Health Joint initiative of Brigham and Women’s Hospital Harvard School of Public Health Harvard Medical School

2. Mission To advance the science of surgical care delivery by studying effectiveness, equity, and value at the health system and population levels, to inform policy, and to provide support for faculty and trainees committed to excellence in surgical health services research (HSR). To bridge HSR to the global health arena to address the challenges of surgical delivery in resource-poor settings. To support research in education as it applies to simulation-based training and coaching. PURPOSE: HSR and Faculty Development!

3. What We Do CSPH was established by Dr. Michael Zinner in 2005 as a joint initiative of Harvard Medical School and the Harvard School of Public Health to: • EXPAND KNOWLEDGE • study population databases • TRANSFORM PRACTICE • new ways to deliver care • INFLUENCE PUBLIC POLICY • engage Washington: financing and care restructuring under healthcare reform law • TRAIN FUTURE LEADERS WHO surgical safety End-of-life Decision quality

4. Unique Strength: Our Portfolio of Programs HSR Overlap = Our Sweet Spot • Clinical Outcomes • Patient-Centered Outcomes • Comparative Effectiveness • Advanced Care Planning • Appropriateness of Care • Decision/Cost-Effectiveness • Disparities/Access • System Innovation • Quality • Safety • Outcomes • Workforce • Simulation • Curriculum Development Global Health Education

5. Unique Strength: Dynamic Multidisciplinary Collaborations Facilitate Unparalleled National and Global Impact • Ariadne Labs • Carrying large-scale trials of innovations to improve surgical outcomes in seven countries • STRATUS Center for Medical Simulation • Examining surgical team performance/coaching strategies for surgeons to improve non-technical skills and enhance safe practice in the operating room. • Also global application - develop a novel tool for assessment and feedback to develop non-technical skills among surgeons and surgical trainees in Rwanda • Department of Anesthesia/Weiner Center for Preoperative Evaluation • Appropriateness of Care • American College of Surgeons • Payment models for specialty care • Uniformed Services University of the Health Sciences • Analyzing healthcare data in the DoD’s TriCare system to determine whether Provider Induced Demand (PID) is a determinant of variation in healthcare spending and utilization in the Military Health Systems (MHS)

6. Programs in HSR Programmatic Development

7. Programs in HSR, continued Funded • Comparative Effectiveness and Provider-Induced Demand Collaborative-DOD(Nguyen) • CRICO Surgical Safety Team Training- CRICO (Smink) • Surgeons and PCPs under ACO model- ACS (Weissman) • Medicare Physician Payment Value-Based Update (VBU) ACS (Weissman/Zinner) • Coaching interventions for Surgeons and Surgical teams - William F. Milton Fund (Yule) • Geriatric Trauma (End-of-Life Care) – NIA R03 (Cooper) • Funding for Trainees – 2 Federal (T32), 1 Foundation (The Commonwealth Fund), 1 Institutional (Dartmouth)

8. CSPH Global Health in Surgery Programs • Global Health Equity Residency in Surgery • 1-2 residents per year over 7-year training period to become leaders in the field • New programs in cost-effectiveness • Cleft lip (worldwide); Cardiac surgery (Rwanda); Laparoscopy in trauma (Tanzania); • Quality Metrics/Care Delivery (Mozambique) • Simulated Feedback/Evaluation Tool (Rwanda) • Process Innovation and Mobile Health (Haiti) • Outcomes of Surgical Safety Checklist Implementation (Rwanda) • Human Resources for Health (Rwanda) • 7 year USAID-funded project to strengthen Rwanda’s residency programs

9. Accelerate Faculty Success in HSR and Surgical Outcomes • Faculty support • Faculty mentorship • Academic career development in HSR • Early program development and program sustainability • Development of HSR protocols, funding proposals: federal, foundation, philanthropic • Mentor skills development • Access to HSR/mentor network • Data base inventory - Paula and Team in RM • Strategic programmatic development • Faculty One-on-One Meetings designed to develop and refine project and research financing ideas as well as opportunities for collaboration. Sessions informal and interactive • Monthly Conference/Didactic Series • Surgical Decision Science Interest Group • Global Surgery Research Meetings • HSR Forum • Ongoing WIPs

10. Faculty Program Development and Support Executive Director, Mike Zinner CSPH Director, Zara Cooper CSO/DD, Joel Weissman, Leadership Council Infrastructure: • Analytical Core: Biostatistical programming, PhD and Master’s trained • Grant Development Process • Top-to-bottom grant prep team with expertise in issues/opportunities unique to HSR • Leveraging DOS RA pre and post functions. • Administrative support • Budget development/management • Research visibility/communications/public affairs • Funding radar/proposals: federal, foundation, philanthropic • Program development • Onboarding of HSR fellows, trainees, POI(s), Collaborators and Contractors • IRB/data Project Management with HSR expertise • Work space/think tank with faculty/fellows/support staff • Affiliate/Alumni and Communication Networks Admin Director, Tammy Ballard Biostats, Programming Support Training and Career Development Research Development and Admin Support

11. Train the Next Generation of HSR Leaders Nationally recognized fellowship programs for surgical residents: • Arthur Tracy Cabot Fellowship: $40K over two years for work in innovative health research/outcomes – salary support supplemented by external funding, training grants • 10 current (internal and external) • Global-Health Equity in Surgery: Funding based on need, trains surgeons in the science and practice of surgical care delivery in resource poor settings • 3 current (internal only) • CSPH Fellows: Funded through mentor or external sources to train in the CSPH • 5 current • POI Collaborators and Research Trainees: • Opportunities for funded international fellows