title: Orthopaedic surgeon-hospital alignment at Geisinger Health System.
abstract: BACKGROUND
  There is broad recognition that the healthcare crisis in the United States is going to require a response and change in clinical practice. The management structure of Geisinger Health System is unique, and this has the potential to change the dynamics of surgeon-administration alignment.
  
  
  OBJECTIVE
  Our goal is to summarize and clarify the relationship between orthopaedic surgeons and the healthcare system at Geisinger, evaluate the positive and negative aspects, and consider which components may be reproducible.
  
  
  METHODS
  This overview arises from a review of management publications, discussions with orthopaedic attendings and administrators, and personal observations and comparison with my previous 15-year university-based practice.
  
  
  RESULTS
  The Geisinger Health System has always been physician-run. The overall efficiency and pragmatic approach found at Geisinger relies heavily on changing surgeon behavior to match what is optimal for the system rather than the individual. This approach appears to bring greater stability and more consistent outcomes, but only by removing what some see as the art of medicine and at the loss of perceived provider autonomy. Despite the rigid demands placed on the surgeon, the system remains adaptable to change and appears to retain faculty at a high rate.
  
  
  CONCLUSIONS
  The Geisinger System is unique in its ability to control an insurance plan, multiple hospitals, and a large physician group. Through clear protocols and behavioral pressure, it demands surgeon alignment with the system as a whole and in return provides a stable work environment. It is not ideal for all surgeons and it is unclear whether it can be reproduced in a less structured setting.
authors.affiliation: Geisinger Health System, 100 N Academy Road, Danville, PA 17822, USA. dshorwitz@geisinger.edu
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Horwitz
mesh_terms: D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D017598:Efficiency, Organizational; D006739:Hospital Administration; D006801:Humans; D015279:Organizational Culture; D009936:Organizational Innovation; D009985:Orthopedics / Q000458:organization & administration*; D010414:Pennsylvania