A message from the Secretary
It is a daunting task taking over as secretary from someone as committed and efficient as Deirdre Watson who has done so much to improve the organisational machinery of the Society over the last few years. Despite this our Society is still perceived by many as an "old boys club" of dubious merit and little or no distinction. This has to change. Cardiothoracic surgery is in the media limelight, partly for the wrong reasons and partly because of the government's commitment to the specialty through the National Service Framework for Coronary Heart Disease. Both provide a unique opportunity for the Society to develop and mature both professionally and politically.
The Executive Committee has undertaken to review the structure of the Society, the communication strategy and our short and medium term goals. As a start the Executive will be reviewing the membership, terms of reference and reporting structures of all the committees and this will be reported on CTSNet and in the next issue of the Bulletin. The aim will be to streamline the committee structure whilst at the same time increasing inclusiveness by involving more members in the distillation of ideas and the Societys decision making process.
But the most pressing issue still remains communication between the committees and the membership in both directions. As a trainee I was never quite sure how the Society worked or what it did, let alone who did it. Then Jules Dussek introduced the "Bulletin" which has gone a considerable way to improving our communication. But the future lies in supplementary electronic interaction through the Internet for two reasons. Firstly, with more members going on-line it provides an immediacy of communication which print publications can't offer. Secondly, it is an inexpensive medium which the Society can afford. CTSNet (www.ctsnet.org) links a huge number of cardiothoracic organisations from around the world, allocates a homepage on the net to every member of the Society, offers the three major journals in our specialty on-line and provides an infrastructure for communication which is now the preferred mode for Society and committee business. To help this run effectively please update your homepage by visiting the "surgeons" section of CTSNet. The surgeon homepages will soon be linked to automatic e-mailing facilities based on the e-mail address entered on the homepage and this should enable rapid communiques from a variety of sources within the Society. In turn, should you wish to communicate with any committee or committee member visit the committee web pages and on the public committee homepage you will find an option: "e-mail committee members". This will allow you to e-mail selected or all members of the relevant committee with ideas, comments or criticisms. For example, to e-mail Executive Committee members, click here
This year we used CTSNet as the sole means of abstract submission for the annual meeting. This was a great successs and all abstracts remain published on the Society's website. In the future we will continue with this and the submission deadline will be midnight on November 5th each year. A unique advantage of using the CTSNet software is that most other cardiothoracic societies who are members of CTSNet will use the same software for abstract submission in the future.
But communication among ourselves is not enough. To really influence the evolution of the specialty the Society must collaborate with the Department of Health. So what can we do to cement this relationship? The advent of the National Service Framework for Coronary Heart Disease in England provides us with a unique opportunity to enhance our influence and to work in concert with central government to improve the delivery of cardiac surgery nationally. The first step is to understand how many operations are done where. We collect different data to the DoH so we have started discussions to try to improve and share our data collection so that surgeons, healthcare planners and politicians are working off the same figures. But we need to collaborate in other areas as well. To this end the Society has recently established a "Government Liaison Committee" and Alan Milburn has suggested that in the first instance we work closely with Roger Boyle, Peter Doyle and Tom Quinn at the DoH to facilitate and co-ordinate delivery of the NSF. But the NSF applies only to England and Wales. The Society must also address how best to support colleagues in Scotland and Ireland in their political negotiations.
Improved communication represents one aspect in an inexorable trend towards a more professional Society but any successful professional or commercial organisation must understand its "raison d'etre" and the service or product it purveys. In our case this requires an understanding of contemporary practice along with an appreciation of quality indicators. With the UK Cardiac Surgical Register we have led the surgical specialties in the UK in understanding our surgical workload. The National Adult Cardiac Surgical Database will help develop this knowledge base further and will complement the Quality Accreditation Programme, developed by Sam Nashef, and designed to address broader quality issues. Although these initiatives will enable us to maintain our lead in this area I remain concerned that there is a growing perception outside the specialty that low mortality equals good quality. This is clearly not always the case and we must shift the agenda one step forwards to prevent this perception being cast in stone. This message will require propagation through a variety of channels including the media and patient interest groups. We must ensure that the very patients with the most to gain are not denied surgery in order to develop or preserve a superficial image of good quality. This may become a very real issue as the NSF develops and more patients with heart failure are referred for consideration for revascularisation.
We need to point out that risk stratification is far from perfect and that other related measures of outcome such as "near misses", proposed by Geoff Berg and Mark deLeval, and long term outcomes may be far more meaningful measures of quality.
The Society must be increasingly receptive to the views and fears of trainees who will become the next generation of independent surgeons and leaders in the specialty. We must develop strategies which ensure that the forensic scrutiny which we feel upon us does not compromise the quality of surgical training nor breed a future environment in which adventurous surgery and innovation are stifled.
We have a tough agenda over the next few years, but understanding our specialty by rigorous data collection and innovative quality initiatives supplemented by sophisticated external communication of our endeavours will go a considerable way towards improving our temporarily, tarnished profile.
