HYBRID EVENT: You can participate in person at Madrid, Spain or Virtually from your home or work.

5th Edition of Global Conference on Surgery and Anaesthesia

September 05-07, 2024 | Hybrid Event

September 05 -07, 2024 | Madrid, Spain
GCSA 2023

The process manifesto: Improving healthcare in a complex environment

Douglas P Slakey, Speaker at Surgery Conferences
University of Illinois Chicago, United States
Title : The process manifesto: Improving healthcare in a complex environment


Patient care during surgery and anaesthesia occurs in a complex environment or system.  Within any system process flow describes the efficiency and reliability by which events occur and the fundamental process functions.  Too often health systems have attempted to reduce surgical process to a linear, highly predictable, and structured construct.  This reductionist approach does not fully appreciate the complexity of providing care to individual patients.  Further, the inevitable unpredictability and variation of surgical care and patient need cannot be accommodated safely when anaesthesia and surgical teams are overly restricted and unable to adapt to circumstances that arise during patient care.

Our research has demonstrated that applying complex system theory and empowering the frontline care givers to respond effectively to individual patient care needs can dramatically improve quality, safety, and reliability.  In one example in which we resolved process flow disruptions related to post operative respiratory failure, significantly improved patient outcomes and increased value in care delivery.   By identifying process flow disruptions and resolving them, we reduced the incidence of adverse events by 59% and achieved a total cost savings of $447,200 (USD) in six months in a 900-bed tertiary care hospital. 

Appreciating and understanding process in a complex environment is essential if healthcare systems are going to function with the highest reliability.   Complex systems consist of multiple separate but interdependent components.  Anaesthesia and surgery are examples of this.  Although they are independent units within the healthcare system with different budgets and typically different leadership, there is no question that they are completely interdependent where patient care is concerned.   In fact, to optimize process flow during surgical care, all professional units that provide patient care must be tightly coupled.   Overly rigid, linear process management can prevent or inhibit the ability of professionals to respond to process flow disruptions and the point of patient care.   We spend large amounts of money and time training professionals (anaesthesiologists and surgeons for example) to be expert and able to respond to unexpected situations and to prevent or intercede to reduce the potential for process flow disruptions to result in adverse events.

Ultimately, to improve reliability of patient care and ensure greater safety and value in care delivery, health system leadership must acknowledge that patient care occurs within a complex environment that cannot be reduced to an overly rigid linear system model.  The health care system must manage complexity in a way to allows the professionals within it to have the training, information, and resources necessary to respond appropriately when needed to optimize process flow.

Audience Take Away Notes:

  • The audience will understand the difference between linear, complicated, and complex systems.
  • The learner will be able to discuss how process flow can be assessed and disruptions in flow recognized and corrected within a complex environment.
  • By understanding process flow and improvement within the complex patient care environment, the leaner will be able to identify research and quality improvement projects that can result in improved patient outcomes and greater value in healthcare delivery.


Dr. Douglas Slakey is an internationally recognized transplant surgeon and healthcare professional and administrator with 30 years of comprehensive success and rapid career growth in Clinical and Business Leadership. He is enthusiastic about driving change, constantly searching for ways to improve processes, and leading teams to optimize patient treatment. Doug strives for the best outcome and has led strategically major transformation initiatives that have propelled organizations to peak patient care and high reliability while ensuring that the return on investment and bottom-line impact are on target. He is highly committed to a philosophy of “patient-centric” medical care. He is enthusiastic about discovering methods of collaborative healthcare ecosystems whereby patient data and analysis enable various functions to communicate and conduct proactive treatment and care. Doug has utilized his training and position as a respected surgeon to introduce novel management ideas, leading to highly successful treatment practices. Doug is currently the President of DPSURGICAL, LLC, a healthcare consultancy focused on enhancing and optimizing operations and process flow, emphasizing complex system management strategies. His work incorporates advanced analytics to individualize patient care and effectively align resources with patient needs during their personal healthcare journey. Doug designs education and simulation training to empower “teams of teams” that create value and top-of-license performance at the point-of-care delivery. During his 5 years at Advocate Aurora Health, Doug served as Chief of Surgical Services, providing direction and strategic guidance in defining a vision for surgical services across 27 hospitals and articulating the potential for growth in patient services and clinical training. In addition to his clinical responsibilities, He focused on identifying and eliminating inefficiencies and incorporating ways to better adopt technology (e.g., advanced data analytics, artificial intelligence, and machine learning) to become more patient-centric and efficient, incorporating “design-thinking” principles to optimize the patient experience.  As part of his ambitious growth plan, Doug launched a unique program closely aligned with what medical professionals and patients indicated they needed. Doug procured funding sources to work with external stakeholders, such as innovative technology providers.  He also developed and implemented a new surgery residency program, leveraging critical learnings from similar programs built in other locations, incorporating education, simulation, and research. Before this, Doug spent 21 years of his career at Tulane University, cumulating in his role as Professor and Chair of Surgery.  To build the most effective organizational support structure, he adopted a multi-disciplinary approach to create “teams of teams”, including medical and administrative disciplines.  He established collaborative relationships internally and externally to improve healthcare throughout the Gulf South, including reducing disparities in access to care.  He built a team of highly reliable experts, including leaders from other industries, such as aviation, and led innovative efforts to demonstrate improvements in healthcare value globally.   After Hurricane Katrina, Doug led efforts to rebuild healthcare across the region.  Amidst fragmented structures and processes, he was able to secure funding and support (on average, $2M/year) through donors and other stakeholders. Doug is a strategic, astute, and empathetic leader with a solid commitment to inspiring connection and delivering value. He is an enthusiastic executive proponent of employee mentoring and training to instill company culture, translate values into action, and apply best practices for effective change management. He is focused on empowering others to succeed and providing education and training to enhance effectiveness, efficiency, and collaboration. Doug sits on the editorial boards of major medical journals, has nearly 40 referenced abstracts, and has authored more than 150 peer-reviewed articles. He received his Bachelor of Arts and Master of Public Health degrees at UC Berkeley and his Medical Degree at the Medical College of Wisconsin. Residency and fellowship training was at Medical College of Wisconsin, University of Oxford, and Johns Hopkins