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UNIVERSITY OF T ORONTO THE surgical spotlight ON A L U M N I , F A C U L T Y , R E S I D ENT S & F RIEN ds OF THE DEPARTMENT O F S U R G E R Y F A L L 2 0 0 6 Welcome New Surgical Residents! i n s i d e A new cadre of residents joined our depart- Chair’s COLUMN 3 ment in July 2006. After years of diminish- ing numbers of surgeons in practice and ON THE SHOULDERS OF GIANTS 5 training, the government ascertained that we now need more surgeons! We have a larger DIMITRI ANASTAKIS - cohort of new recruits than in many previ- NEW CHAIR OF PLASTIC SURGERY 7 ous years and there will be jobs galore for them at the end of their training. They will PETER NELIGAN COMPLETES be the best taught residents ever. SUCCESSFUL 10-YEAR TERM AS Thirty-five new residents have entered CHAIR OF PLASTIC SURGERY 8 the department – 27 men and 8 women. Twenty-nine come to us from Canadian pro- SURGERY LEADERSHIP DAY 9 John Bohnen grams, 3 through the Ontario International Medical Graduate stream (finished med school outside Canada, will practice HIGH IMPACT PUBLICATIONS: in Ontario), and 3 are visa trainees, who will return to their home countries IMPROVING REPAIR WITH following training. This diverse group of bright young minds from 3 conti- BONE MARROW 10 nents is a gift that will enrich our department. IN MEMORY - John Bohnen ROBERT DOUGLAS JEFFS 11 Professor and Vice Chair, Education ANNOUNCEMENTS 12 NEW STAFF 14 EDITor’s COLUMN 17 HONOURS / AWARDS / AccOMPLISHMENTS 18 GRANTS / FELLOWSHIPS 19 Khaled Al-Garni – C/S Nicholas Yardley – O/S Aamir Al-Kudmani – P/S continued on page 2 S U R G I C A L S P O T L I G H T F A L L 2 0 0 6 Welcome New Residents Dawi Amariyen – O/S Michael Blankstein – O/S Maryse Bouchard – O/S David Cadotte – N/S Khaled Elgadi – G/S Dean Elterman – U/S Ali Farno – O/S Elisa Greco – G/S Barbara Haas – G/S Farzad Hariri – G/S Suneil Kalia – N/S Shayne Keetbaas – O/S Daniel Lodge – C/S Mary-Helen Mahoney – P/S Sergio Muraca – G/S Olanrewaju Okusanya – O/S continued on page 4 S U R G I C A L S P O T L I G H T 2 F A L L 2 0 0 6 chair’s column but corporate culture, the all-pervading spirit of an organiza- The Merging of Cultures tion that is a unique blend of myth, procedure and collective personality, is a real issue in hospital amalgamations. A hospital The merger and de-merger of Sunnybrook and Women’s culture is like an interwoven organic system of beliefs, values, should give us reason to pause and reflect. The restructur- rituals, personalities and mythology that creates meaning for ing commission, which initiated the changes that result- people at work.”3 Cultures are comprised of the socially inher- ed in the merger, consisted of a group of well-intentioned ited characteristics of a defined group. How many thousands and knowledgeable individuals. of hours were wasted in endless committee meetings trying to The province established the combine the immiscible? How many fights, both public and Health Services Restructuring private, were fought in the name of progress. How much great Commission (HSCR) in 1996. talent was lost to Toronto, as individuals who have better ways The HSCR was mindful of many to spend their time decided to leave, rather than get embroiled redundancies in our system and in a battle they perceived would be endless. And how much faced with finding solutions to money was spent on the unpredictable and intangible costs of tough fiscal realities. There were shuffling the deck in the name of progress. also many competing political Our experience in Toronto is not unique. In other agendas and compromises that words, we have not really learned from others’ mistakes. Richard Reznick had to be made. It was given Perhaps most famous in this regard is the UCSF- Stanford sweeping powers to rearrange Ontario’s hospital system. fiasco. After the de-merger of these two organizations, In March 1997, the commission released its plan for commentators opined that the venture’s biggest downfall Toronto, calling for the closure of 11 of 42 hospitals in may have been that it never managed to bind the two insti- the city, and amalgamation of others. A total of $123 tutions together with a common culture. In a similar com- million dollars a year in savings was projected. Three mentary, a principal in the Geisinger- Penn State merger years later, the HSRC was disbanded, and health care and de-merger commented that cost cutting and efforts to professionals were left to make sense of a new reality. eliminate redundancy failed to deal with the inevitable fact One of the major recommendations was the creation of that in mergers there are winners and losers. Sunnybrook and Women’s College Health Sciences Centre, I believe the experience in Toronto, especially for those an amalgamation of Sunnybrook, Orthopaedic and Arthritic who lived through it in an intense manner, should be a Hospital and Women’s College Hospital. This may have constant reminder that mergers have costs and benefits, and looked good on paper and indeed, some good things have that in that balance sheet we clearly must pay more atten- happened in the last decade. However, as is now evident to tion to the challenges of merging disparate cultures, and pay all, the merger, by all dimensions has not achieved its goals. As as much attention to the social costs of amalgamation as we recently announced, a separation has occurred and the New do the anticipated financial benefits of economies of scale. Women’s College Hospital has been formally established. There are many reasons for failed mergers. They include Richard K. Reznick inappropriate estimates of financial savings, turmoil in the R.S. McLaughlin Professor and Chair ranks of management and workers, lack of appropriate com- munication strategies, and lack of clear governance structures. 1. Markham, B. and Lomas, J. Review of the Multi-Hospital Arrangements Literature: Benefits, Disadvantages and Lessons for And there are other negative byproducts of turbulent merg- Implementation. Healthcare Management Forum, 8(3): 24-35: 1995 ers, such as lack of easy access to certain services, insecurity of 2.. The Merger Decade, What have we learned from Canadian health human resources, loss of managerial and organizational iden- care mergers in the 1990s?A Report on the Conference on Health tity, and disruption of routines at the clinical and organizational Care Mergers in Canada. Organized by the Ottawa Hospital and 1 level. However, I would propose that a fundamental flaw of the Association of Canadian Teaching Hospitals. Canadian Health this merger was a miscalculation, or more pointedly a disregard, Services Research Document . http://www.chsrf.ca/final_research/com- for the social and political costs of trying to merge two cultures. missioned_research/programs/pdf/mergerdec_e.pdf As suggested in a report on a recent conference on hospital 3. Deal T, Kennedy A. The New Corporate Culture. New York: mergers in Canada2, “It can’t be seen or touched or measured, Perseuf Books, 1999 S U R G I C A L S P O T L I G H T 3 F A L L 2 0 0 6 Welcome New Residents Vanessa Palter – G/S Lakhbir Sandhu – G/S Carlo Santaguida – N/S Eran Schlomovitz – G/S Anna Shawyer – G/S Saquib Siddque – G/S Jory Simpson – G/S Syndie Singer – O/S Paul Toren – U/S Varun Kapila – G/S Elias Wehbi – U/S James Wong – U/S Missing from photos: Faizal Bhojani – G/S Karen Wong – P/S Simon Yang – G/S Victor Yang – N/S S U R G I C A L S P O T L I G H T 4 F A L L 2 0 0 6 “ON THE SHOULDERS OF GIANTS” “On the Shoulders of Giants” by Dam de Nogales Sculptors The new Giants of Biomedical Science Hall in the Research, and Jim Friesen, former Chair of the Banting Terrence Donnelly Centre for Cellular and Biomolecular and Best Department of Medical Research, conceived Research celebrates the work of ten research giants at the and provided suggestions for the construction of the University of Toronto. Three of them are surgeons: Centre, which is an example of how a truly great sci- Frederick Banting, Wilfred Bigelow and Robert Salter. A ence facility should be put together. The building won bronze sculpture in the lobby of the Centre depicts each the prestigious Royal Institute of British Architects of these ten who set the standard for the University of International Award. Toronto in biological sciences. In his acceptance speech at an unveiling ceremony and Robert Salter (left) and Richard Reznick Terrence Donnelly (left) and Lee Errett The sculpture entitled “On the Shoulders of Giants” reception on June 27, 2006, Bob Salter spoke movingly was created by the husband and wife team of Veronica of his inspiration for fifty years of basic research, derived de Nogales Leprevost and Edwin Timothy Dam, who from the philosophy of St. Luke the Physician: Unto bring diverse backgrounds (from Spain and Canada) and whomsoever much has been given, of that person shall much a shared artistic vision of the relationship of humanity be required. Salter explained that “all of us in Medicine and nature. Dam and de Nogales also created the “Spirit here today have been given much for which we deserve of Discovery” a spectacular sculpture located in front of no credit -- good genes, loving parents, and a good educa- the Donnelly Centre on College Street.