title: Orthopaedic Surgery Under National Health Reform: An Analysis of Power, Process, Adaptation, and Leadership: AOA Critical Issues.
abstract: Morrison argued that demography, economy, and technology drive the evolution of industries from a formative first-generation state ("First Curve") to a radically different way of doing things ("Second Curve") that is marked by new skills, strategies, and partners. The current health-reform movement in the United States reflects these three key evolutionary trends: surging medical needs of an aging population, dramatic expansion of Medicare spending, and care delivery systems optimized through powerful information technology. Successful transition from a formative first-generation state (First Curve) to a radically different way of doing things (Second Curve) will require new skills, strategies, and partners. In a new world that is value-driven, community-centric (versus hospital-centric), and prevention-focused, orthopaedic surgeons and health-care administrators must form new alliances to reduce the cost of care and improve durable outcomes for musculoskeletal problems. The greatest barrier to success in the Second Curve stems not from lack of empirical support for integrated models of care, but rather from resistance by those who would execute them. Porter's five forces of competitive strategy and the behavioral analysis of change provide insights into the predictable forms of resistance that undermine clinical and economic success in the new environment of care. This paper analyzes the components that will differentiate orthopaedic care provision for the Second Curve. It also provides recommendations for future-focused orthopaedic surgery and health-care administrative leaders to consider as they design newly adaptive, mutually reinforcing, and economically viable musculoskeletal care processes that drive the level of orthopaedic care that our nation deserves-at a cost that it can afford.
authors.affiliation: Memorial Health System, 701 North 1st Street, Springfield, IL 62781. E-mail address: callahan.chuck@mhsil.com.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Callahan
authors.affiliation: Orthopaedic Group at Springfield Clinic, LLC, 800 North 1st Street, 1st Floor, Springfield, IL 62702.
authors.forename: Daniel
authors.initials: D
authors.lastname: Adair
authors.affiliation: Department of Orthopaedic Surgery, UCSF School of Medicine, 500 Parnassus Avenue, MU, San Francisco, CA 94143.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Bozic
authors.affiliation: Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62794.
authors.forename: Blaine T
authors.initials: BT
authors.lastname: Manning
authors.affiliation: Department of Orthopaedic Surgery, UCSF School of Medicine, 500 Parnassus Avenue, MU, San Francisco, CA 94143.
authors.forename: Jamal K
authors.initials: JK
authors.lastname: Saleh
authors.affiliation: Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62794.
authors.forename: Khaled J
authors.initials: KJ
authors.lastname: Saleh
mesh_terms: D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000639:trends; D004465:Economic Competition; D018166:Health Care Reform; D006801:Humans; D007857:Leadership; D009936:Organizational Innovation; D009985:Orthopedics / Q000191:economics / Q000639:trends; D011787:Quality of Health Care; D012955:Societies, Medical; D014481:United States