Disruptive Innovation(1) improves a product or service in ways that the market does not expect. It has shaped various industries (including the motor, airline and entertainment industries) to bring quality, accessibility and affordability to the forefront of consumer demand. Such ‘disruptive’ economic and market forces will also drive change in the healthcare industry to bring about increasing value.
The current value proposition (Value = Outcomes / Cost) in healthcare is suboptimal—with developed countries spending >10% of their national gross domestic product (GDP) on healthcare and yet 20-30% of this expenditure is wasted (Figure 1)(2). Perioperative factors that contribute to such ‘waste’ include inadequate preoperative optimization of patients, unnecessary laboratory testing, and preventable postoperative complications—with between one fifth and one quarter of patients suffering postoperative events (Figure 2)(3).
Postoperative complications are costly (Table 1)(4), reduce patients’ long-term survival (Figure 3)(5), and in turn reduce the global access to surgery. The annual economic welfare loss through lost workforce productivity secondary to surgical disease (with >95% attributed to trauma and cancer) is estimated at ~17% of the GDP(6). Ensuring access to essential surgery and a rapid uncomplicated recovery from surgery is a global priority and would have a significant impact on economic welfare.
A disruptive innovation to improve this value proposition is a coordinated and integrated surgical care model with significant anaesthesia leadership. This model moves away from traditional modular and reactive processes toward a more proactive, coordinated team-based approach. A simple analogy is prehabilitation versus rehabilitation.
This need for a integrated team-based approach provides the impetus for the Perioperative Surgical Home (PSH; Figure 4) — providing patient-centered, coordinated surgical care throughout the preoperative, intraoperative and postoperative phases to reduce cost and improve clinical outcomes, thereby ensuring that each patient receives the right care, at the right place, and at the right time. The Royal College of Anaesthetists (UK) calls this the ‘Perioperative Team’ and the American Society of Anesthesiologists calls this the ‘Surgical Home’.
A recent editorial in British Journal of Anaesthesia emphasized that despite the different names of such initiatives globally, as anaesthetists we have the same goals and need to recognize and “embrace our expanded role as perioperative physicians as our main value proposition”(7). Over the last few decades anaesthetists have expanded their role, moving beyond the operating room to pre-anaesthesia clinics (PAC), post-anaesthesia care units (PACU), pain services, high-dependency and intensive care units (HDU / ICU), and the wards. Expanding this role is crucial, especially as the global population ages, with an increasing prevalence of comorbid disease states, poly-pharmacy, and frailty. As such, with this changing landscape Anaesthetists are best suited to lead the way in a patient-centered, multidisciplinary team-based innovative healthcare model. In doing so, this provides a strong impetus for anaesthetic departments to change their name to incorporate their role in perioperative medicine(8).
To facilitate this, we invite you to a series of workshops that develop the concept of a Perioperative Surgical Home and focus on various facets of the perioperative journey to equip clinicians and allied healthcare workers with the knowledge and tools to deliver high quality care and potentially reducing cost.
 Christensen CM, Grossman JH, Hwang J: The Innovator’s Prescription: A Disruptive Solution for Health Care. New York, McGraw-Hill Books, 2009.
 Berwick DM, Hackbarth AD. Eliminating waste in US health care. JAMA 2012; 307:1513-1516
 Ghaferi AA, Birkmeyer JD, Dimick JB. Variation in hospital mortality with inpatient surgery. N Engl J Med 2009; 361:1368-1375.
 Boltz MM, Hollenbeak CS, Ortenzi G, Dillon PW. Am J Med Qual. 2012; 27:383-390.
 Khuri SF, Henderson WG, DePalma RG, Healey NA, Kumbhani DJ. Ann Surg 2005; 242:326-341.
 Alkire BC, Shrime MG, Dare AJ, Vincent JR, Meara JG. Global economic consequences of selected surgical diseases: a modelling study. The Lancet Global Health 2015; 3(S2):S21–27.
 Cannesson M, Ani F, Mythen MM, Kain ZN: Anaesthesiology and perioperative medicine around the world: Different names same goals. Br J Anaesth 2015; 11:8-9.
 Kain ZN, Fitch JCK, Kirsch JR, Mets B, Pearl RG. Future of Anesthesiology is Perioperative Medicine: A Call for Action. Anesthesiology 2015; 122:1192-1195.
PSH Australia Program Directors
Professor Bernhard Riedel
MBChB FCA FANZCA FASE MMed MBA PhD
Director of Anaesthetics at Peter MacCallum Cancer Centre
Professor Bernhard Riedel is an academic anaesthesiologist with a special interest in oncologic and cardiothoracic anaesthesia. Bernhard currently serves as Head of Department, Department of Anaesthesia, Perioperative and Pain Medicine, at Peter MacCallum Cancer Centre and holds an academic appointment with the University of Melbourne.
Professor David A Story
MBBS, MD, BMedSci, FANZCA
Chair of Anaesthesia, The University of Melbourne
Professor David Story is foundation Chair of Anaesthesia at the University of Melbourne; and Head of the Anaesthesia, Perioperative and Pain Medicine Unit within the Melbourne Medical School. He promotes research and teaching at the 14 hospitals affiliated with the University of Melbourne, and engages the broader community on perioperative care. His main research interest is reducing perioperative complications. His clinical work involves perioperative care for all surgical specialties including liver transplantation.
Dr Debra Leung
Debra is a staff specialist anaesthetist at the Peter MacCallum Cancer Centre. Her academic and clinical interest lies in Shared Decision Making (SDM) for high-risk surgical patients. From this, she has established a SDM pathway for high risk surgical patients at the Peter MacCallum Cancer Centre.
She has also headed up a project, working in conjunction with the Australian and New Zealand College of Anaesthetists (ANZCA) Perioperative Medicine SIG and the Royal College of Anaesthetists (RCOA) in the UK, to produce the first short animated film to increase patient understanding and engagement about perioperative shared decision making. This film will be officially launched at the Perioperative Medicine SIG meeting in November 2019.
Dr Laurence Weinberg
Laurence Weinberg is a director of Anaesthesia at Austin Hospital. He is an A/Professor in both the Department of Surgery, and the Anaesthesia Perioperative Pain Medicine Unit, at the University of Melbourne. His clinical and academic interests include anaesthesia for cardiac and hepatobiliary surgery, including liver transplantation. He is actively involved in fluid research for major hepatobiliary-pancreatic surgery, liver transplantation and cardiac surgery.