Interview with our President - International Association for Ambulatory Surgery

You have recently assumed the presidency of the International Association for Ambulatory Surgery (IAAS). Can you tell us a bit about your professional journey leading up to this role?

I began my career in Anesthesia and Perioperative Management 27 years ago, with a specific focus on Ambulatory Surgery early on. After completing my medical degree and Anesthesia Residency, I pursued further specialization in Pediatric Anesthesiology.

Early on in my career, I also became the medical director of an Ambulatory Surgery center which introduce me to the world of Perioperative Management and Leadership. My passion for these fields grew as I realized the significant impact that Ambulatory Surgery could have on patient outcomes, healthcare efficiency, and cost-effectiveness.

Over the years, I have had the privilege of working in various capacities, including as a clinician, president of several societies and a consultant. I have been actively involved in numerous initiatives aimed at expanding access to Ambulatory Surgery, improving safety standards, and promoting best practices globally. My journey with the IAAS began several years ago when I started as a representative of the US-based Ambulatory Surgery Center Association to IAAS’ General Assembly. I also participated in its conferences. I am humbled and honoured to serve in this capacity and I am excited to continue working towards the global expansion and improvement of Ambulatory Surgery during my term.

What are the main objectives and goals you have for IAAS during your term?
During my term as president of the IAAS, my primary objectives will center around four key areas:

A. Global Expansion and Accessibility: I aim to increase the global reach of Ambulatory Surgery by promoting its benefits and supporting the establishment of Ambulatory Surgery centers in regions where they are not yet prevalent. This includes working closely with our member associations and their local healthcare providers, governments, and organizations to develop tailored strategies that address specific regional needs and challenges. For countries that already have established Ambulatory Surgery practices, aim to help them fine-tune their practices and prepare for the continued expansion of ambulatory surgery as guided by evidence-based results;
B. Safety and Quality Improvement: Ensuring the highest standards of safety and quality in Ambulatory Surgery is a top priority. I plan to focus on enhancing our existing guidelines and developing new protocols that can be adapted to different healthcare settings as represented by our member associations. We will also continue to provide education and training opportunities to healthcare professionals to maintain and improve these standards through benchmarking relevant patient outcomes;
C. Technological Integration and Innovation: Embracing and integrating new technologies is essential for the continued advancement of Ambulatory Surgery. My goal is to facilitate the adoption of better communication venues among our members wherever possible as well as digital health tools. By doing so, we can improve patient outcomes and increase efficiency;
D. Reinforcing the Infrastructure of the Association: These objectives will help guide our members’ efforts as we work to make Ambulatory Surgery more accessible, safer and more effective for patients globally.

How does IAAS plan to promote and expand Ambulatory Surgery in different regions of the world?

The IAAS will promote and expand Ambulatory Surgery through educational outreach and training programs, collaboration with local healthcare systems, advocacy and awareness campaigns, resource sharing and knowledge exchange among the members, supporting infrastructure development, and tailored regional conferences and events.

How does this association promote safety and quality in Ambulatory Surgery?

IAAS promotes safety and quality in Ambualtory Surgery by having tailored strategies for regional needs assessment and customization. IAAS recognizes that each region has unique healthcare needs, cultural factors and regulatory environments. Therefore, capacity building and training programs are a must. Educational training will expand our educational offerings to include more region-specific training programs. Partnering with local stakeholders and having collaborative efforts will forge partnerships with local governments, healthcare institutions and professional associations to advocate for the inclusion of ambulatory surgery within national healthcare frameworks. Educating local governments on the safety and advantages of ambulatory surgery is an absolute must.

I would like to create a quality committee within the association to promote best practices and quality standards. The IAAS promotes global standards for safety, quality and efficiency in Ambulatory Surgery. We will share best practices from regions with advanced ambulatory surgery systems and help implement these practices in emerging markets. This will ensure that as ambulatory surgery expands, it does so with a focus on patient safety and high-quality care. Monitoring and evaluating continuous improvement is an essential component of any patient quality initiative, and I would aim to have the association help set those benchmarks.

Is IAAS planning to collaborate with other international health organizations?
Yes, the IAAS is actively planning to collaborate with other international health organizations. We recognize that partnership and collaboration are essential for advancing the field of Ambulatory Surgery on a global scale. It will be key to have joint initiative and projects through collaborative programs that will advance Ambulatory Surgery at a local level and one efficient way to do that is to partner with local associations, as well as region specific organizations. It is also key to emphasize harmonization of standards and guidelines in order to help global consistency and ways to measure it. Through education and training, collaborating with the international health organizations will allow us to extend our reach and provide training and capacity-building programs. One recent example of such is our efforts to help regulations in Peru.

What are the biggest challenges that Ambulatory Surgery faces?

This is a broad topic that we could spend hours discussing. Ambulatory Surgery has made significant strides over the years, but it also faces several challenges that need to be addressed to ensure its continued growth and success. Top issues include patient selection and safety since the complexity of cases has grown tremendously over time.

Also, infrastructure and resources can be limited in many regions and there is a lack of dedicated Ambulatory Surgery centers equipped with the necessary infrastructure to perform a wide range of procedures safely. Building and maintaining these facilities requires significant investment, and this can be a barrier to the expansion of ambulatory surgery, particularly in low resource settings.

Regulatory and policy barriers are also a significant hurdle in developing and expanding Ambulatory Surgery. The regulatory environment for ambulatory surgery can vary widely from one region to another. In some areas, there are restrictive regulations that limit the types of procedures that can be performed in an ambulatory setting, or there may be a lack of clear guidelines altogether. Navigating these regulatory challenges is crucial for the growth of ambulatory surgery.

Financial and insurance challenges can also be a major hurdle for the advancement of Ambulatory Surgery. Insurance coverage and reimbursement policies can be inconsistent and create financial challenges for both providers and patients In some cases, ambulatory surgery may not be adequately covered by insurance, leading to higher out of pocket costs for patients and financial losses for providers.

Finally, cultural and perception barriers can lead to hurdles for patients and provider acceptance. In some regions, there is a cultural preference for inpatient care, with both patients and healthcare providers being hesitant to embrace Ambulatory Surgery.

Which technological innovations do you believe will have the greatest impact in this field in the coming years?

Technological innovations are set to significantly shape the future of Ambulatory Surgery, enhancing both safety and efficiency of procedures while improving patient outcomes. Minimally invasive surgical techniques and advances in laparoscopy, endoscopy and robotic-assisted surgery will be at the forefront all surgical domains. Enhanced anesthesia and pain management with long acting analgesics and pain-control devices will also play a crucial role. Telemedicine and remote monitoring are fast evolving fields which will, for sure, change the degree to which patients having ambulatory surgery will be assessed preoperatively and monitored after discharge. Last but not least, Artificial Intelligence and Machine Learning will have a crucial role in improving diagnostics, patient selection and surgical planning.

In your opinion, what public health policies could favor growth in this context?

To foster the growth of ambulatory surgery globally, public health policies need to support the development of infrastructure, ensure equitable access to care and promote best practices in safety and quality. Some of the key public health policies that could favor the expansion of ambulatory surgery include:

A. Promotion of Ambulatory Surgery as a Cost-Effective Healthcare Option: Reimbursement and Funding Policies:

Governments and health insurers should implement reimbursement models that incentivize the use of Ambulatory Surgery. By providing adequate funding for outpatient procedures, these policies can encourage healthcare providers to offer more surgeries in ambulatory settings, which are generally more cost-effective than inpatient surgeries;
- Development Grants and Loans: Public health policies should include financial incentives, such as grants and low-interest loans, for the construction and modernization of Ambulatory Surgery centers. This investment in infrastructure is essential to expanding access to these services, especially in underserved regions;
- Technology Integration: Policymakers should support the integration of advanced surgical technologies wherever possible. By funding technology upgrades, governments can help ensure that these centers are equipped to provide high-quality, efficient care.Cost Savings and Efficiency: Policymakers should recognize and promote the cost savings associated with Ambulatory Surgery, including reduced hospital stays and faster patient recovery. This can lead to broader support and investment in Ambulatory Care facilities.

B. Investment in Ambulatory Surgery Infrastructure:

Development Grants and Loans: Public health policies should include financial incentives, such as grants and low-interest loans, for the construction and modernization of Ambulatory Surgery centers. This investment in infrastructure is essential to expanding access to these services, especially in underserved regions;
Technology Integration: Policymakers should support the integration of advanced surgical technologies wherever possible. By funding technology upgrades, governments can help ensure that these centers are equipped to provide high-quality, efficient care.

C. Standardization and Regulation of Safety and Quality:

Establishment of Global Guidelines: Public health policies should promote the adoption of international safety and quality standards for Ambulatory Surgery. By standardizing best practices, countries can ensure that patients receive consistent, high-quality care regardless of where they undergo surgery;
Regulatory Oversight: Governments should establish clear regulatory frameworks that govern the operation of Ambulatory Surgery centers. These frameworks should focus on patient safety, infection control and the credentialing of healthcare providers.

D. Access to Training and Education for Healthcare Providers

Continuous Professional Development: Public health policies should support ongoing training and education for surgeons, anesthesiologists, nurses, and other healthcare providers involved in Ambulatory Surgery. This can be achieved through government-sponsored programs, partnerships with professional associations and the inclusion of Ambulatory Surgery in medical curriculum;
Telemedicine and E-Learning Platforms: Policies should encourage the use of telemedicine and online learning platforms wherever possible to provide training and education, especially in regions where access to in-person training may be limited.

E. Public Awareness and Education Campaigns:

Promoting Patient Understanding: Public health campaigns should educate patients and the general public about the benefits and safety of Ambulatory Surgery. Increased awareness can lead to greater acceptance and demand for these services, driving growth in the sector;
Patient Empowerment: Policies should focus on empowering patients to make informed decisions about their surgical care. This includes providing clear information about the options available and the expected outcomes of Ambulatory Surgery.

F. Strengthening Health Systems and Referral Networks:

Integrated Care Models: Policies should encourage the integration of Ambulatory Surgery centers into broader healthcare systems, ensuring that they are part of a well-coordinated continuum of care. This includes establishing strong referral networks between primary care providers, specialists and ambulatory surgery centers;
Postoperative Care and Follow-Up: Public health policies should ensure that there are robust systems in place for postoperative care and follow-up. This includes support for home care services and telehealth options that allow patients to recover safely at home while remaining in contact with their healthcare providers.

G. Addressing Equity and Access:

Reducing Barriers to Care: Public health policies should focus on reducing financial, geographic and cultural barriers to accessing Ambulatory Surgery. This could include subsidizing transportation costs for patients in remote areas, offering financial assistance to low-income patients, and ensuring that Ambulatory Surgery centers are accessible to all populations;
Inclusive Policy Making: Policymakers should involve a diverse range of stakeholders, including patients, healthcare providers and community leaders in the development of policies related to Ambulatory Surgery. This ensures that policies are inclusive and address the needs of all communities.

H. Support for Research and Data Collection:

Investing in Research: Governments should fund research initiatives that explore the outcomes, benefits and challenges of Ambulatory Surgery. This data is crucial for understanding the impact of Ambulatory Surgery and for developing policies that support its growth;
Data-Driven Policy Making: Public health policies should be based on robust data and evidence. By collecting and analyzing data on Ambulatory Surgery outcomes, utilization and patient satisfaction, policymakers can make informed decisions that promote the growth and improvement of this sector.

How do you see the future of Ambulatory Surgery?

Ambulatory Surgery has a very bright future. We have proven equal or better outcomes as compared to inpatient surgery, financial advantages and great patient satisfaction. It would be very hard to argue against the success that ambulatory surgery has had for decades.

Can you share an example of a country or region that has successfully implemented an Ambulatory Surgery model? What can we learn from this example?

One notable example of a country that has successfully implemented an Ambulatory Surgery model is the United States, particularly through the proliferation of Ambulatory Surgical Centers (ASCs). These facilities have become a significant part of the U.S. healthcare landscape, offering a range of procedures that can be performed on an outpatient basis.

Key Examples and Lessons:

Cost Efficiency: ASCs in the U.S. often demonstrate lower costs compared to traditional hospital settings. This is due to streamlined operations, reduced overhead costs, and focused care environments. The emphasis on efficiency in these centers has led to cost savings for both patients and the healthcare system;
Patient Convenience and Satisfaction: Patients benefit from shorter wait times and quicker procedures. The patient experience is typically enhanced through more personalized care and less bureaucratic red tape compared to larger hospitals. The focus on outpatient care allows for faster recovery and less disruption to daily life;
Quality and Safety: Many ASCs have maintained high standards of care with robust protocols for infection control and patient safety. By specializing in certain procedures, ASCs often have staff with extensive experience in specific types of surgeries, which can lead to better outcomes;
Regulatory and Accreditation Models: The success of ASCs is partly due to rigorous regulatory standards and accreditation processes. Organizations like the Accreditation Association for Ambulatory Health Care (AAAHC) and The Joint Commission have established standards that ensure quality and safety in these facilities;

Innovation and Flexibility: ASCs often have more flexibility to adopt new technologies and procedures compared to larger hospitals. This adaptability can lead to innovative approaches in surgical care and patient management.

Lessons Learned:

Focus on Specialization: Specializing in certain types of procedures helps ASCs achieve high efficiency and expertise, contributing to better patient outcomes and streamlined operations;
Patient-Centered Care: Prioritizing patient experience and convenience is crucial. ASCs often provide a more personalized and efficient experience compared to traditional hospital settings;
Cost Management: Effective cost management practices in ASCs can serve as a model for other healthcare settings. Streamlined processes and reduced overhead can lead to significant savings without compromising care quality;
Accreditation and Standards: Implementing strong accreditation and quality standards is essential for maintaining high levels of care and safety. This model can be adapted by other regions and countries aiming to establish or improve their ambulatory surgery capabilities;
Adaptability and Innovation: Encouraging flexibility and innovation in healthcare delivery can lead to improvements in efficiency and patient outcomes. ASCs often exemplify how adaptability in practice can benefit the healthcare system as a whole.

Overall, the success of the Ambulatory surgery model in the U.S. provides valuable insights into improving healthcare delivery through efficiency, specialization, and a focus on patient experience. These principles can be adapted and applied in other regions and countries seeking to enhance their outpatient surgical care systems.

What advice would you give to young professionals who wish to pursue a career in this field?

The advice that I would have for a young professional wishing to pursue a career in Ambulatory Surgery would be to, first, focus on education and training and hands on experience. Seek opportunities for internships, residencies, or job placements in Ambulatory Surgery centers or outpatient clinics. It is also important to develop a patient-centered approach focusing heavily on patient care and satisfaction. A deep understanding of infection control protocols and patient safety measures is critical. It is also important to gain knowledge of healthcare management, business acumen and regulatory knowledge. Understanding the business of healthcare, including cost-management, billing and insurance processes can be very advantageous. Also be aware of the regulatory landscape including accreditation standards and compliance requirements for surgery centers. It would be great to find a mentor to connect with an experienced professional in the field who can provide guidance, support and valuable insights.

Besides the health sector, is there any project you are involved in that you would like to highlight?

I am involved in mentoring young latino students interested in business management. I have always had an interest in business and, after completing an MBA, I now feel I can help mentor young individuals looking for direction in this area.