Introduction

In October of 2010, the Board of Directors of the Society for Surgery of the Alimentary Tract (SSAT) went through a strategic retreat process. The result of this strategic planning provided the direction the SSAT has followed for the last decade 1. As Chair, Dr. Stan Ashley shepherded the board through a second strategic planning process held in December of 2018 with the goals of dealing with significant issues, such as the determination of goals and objectives, and addressing several important factors that have hampered the SSAT since its inception.

The History and the Challenge

From the beginning, the SSAT had difficulty defining its space among surgical societies. The SSAT was founded in 1960 by Dr. Robert Turrell, Dr. Warren Cole, and Dr. John Waugh at a time when gastrointestinal surgery was rather stagnant. Cardiothoracic surgery was a budding, exotic field that was full of excitement and energy. Gastrointestinal surgery and the surgeons who performed it were felt to be pedestrian and non-academic. Dr. Turrell’s dream was to start a new organization that would focus on surgery of the gastrointestinal (GI) tract and to create a foundation to fund education and research directed towards GI surgery 2. Therefore, the three incorporated the society in 1960 as the Association for Colon Surgery. However, it was quickly recognized that a society focused purely on surgery of the colon was not the vision and in 1962, Dr. Cole proposed changing the name to the Society for Surgery of the Alimentary Tract. With this change came new clarity.

In his Presidential address to the society at the 4th annual meeting, Dr. Robert Zollinger examined the need for a surgical society focused solely on surgery of the alimentary tract 2. He wondered aloud if such a society was needed as there were at least 10 other societies that considered themselves to be in the “general surgery” realm. Using data, he clearly demonstrated that no single society brought together surgeons interested in gastrointestinal surgery. He showed that while others had GI surgery papers and some interest, none covered the entire GI tract. He feared this siloed approach to GI surgery would lead to failure to take into account an impact of one disease and its treatment on another portion of the GI tract. He was particularly distressed by the high complication rates in GI surgery and the lack of active research to improve the care of the GI surgical patient. He was also distressed that many of the societies at the time were quite exclusive with limited numbers of members. With these facts in hand, he argued that an inclusive society bringing surgeons of all disciplines together with a focus on clinical treatment and research of GI surgical disease was necessary. He closed his address with the following: “If we have encouraged and brought into focus, at national level, the clinical and experimental solutions to the many problems of the alimentary tract, we will have justified our existence” 2.

At the 38th annual meeting in 1997, President Dr. Tom DeMeester again discussed the role of the SSAT and the importance of change 3. He succinctly described the evolution of the SSAT over the years and its major trials and tribulations. He particularly highlighted two major events in the history of the society that impact us greatly today—the integration of the annual meeting into the Digestive Diseases Week (DDW) and the development of our journal. SSAT aligned its annual meeting with the American Gastroenterological Association (AGA) in 1973 and DDW was formally established in 1974. According to Dr. Robert Zeppa (President 1977–1978) through integration into DDW, the SSAT realized many benefits including an increased opportunity for dialogue with our medical colleagues. The second major change that has positively influenced our society is the development of the Journal of Gastrointestinal Surgery (JoGS). Prior to this, the papers of the SSAT were published in the American Journal of Surgery but there was no single journal that housed papers focused only on disease of the alimentary tract. The story of the development of our journal is one of competition and painful deliberation. However, it ended in 1995 when the board accepted the recommendation of Dr. Keith Kelly to establish the journal that would be owned and copyrighted by the SSAT. This development allowed the society to play a larger role by providing leadership and cohesion through its publication.

In his 2018 presidential address, Dr. Stanley Ashley brought up several relevant points for our organization 4. He clearly articulated the success of the SSAT over the years and highlighted all that the SSAT has done for GI surgery. However, he also laid out some of the main challenges in our current environment, highlighting the importance of a strategic retreat. He pointed out that a society such as ours serving multiple stakeholders ultimately dilutes the impact it can make. He stated, “jack of all trades, master of none approach has prevented us from articulating a vision based on the uniqueness and added value of the SSAT” 4. He also rightly pointed out that we are not the only society suffering from an identity crisis and that many broad based societies are feeling the same stress. Ultimately, he charged the executive council to move through a process of strategic planning that was more aspirational. He challenged us to think where we want our society to be in the future and what really distinguishes the SSAT from others. The hope was that we could then work backwards and develop a set of strategies that will help us get to that ultimate goal.4 What follows is the output of this aspirational work and the goals that we believe will help us achieve our long-term objectives.

Mission and Vision

As we discussed our role in surgery, it was clear that we had to revisit our mission and vision statements to ensure they would serve us in the future. It was felt that the statements developed at the last retreat held in 2010 were strong but could be improved slightly to reflect some changes in direction.

Mission: To lead in advancing the science and practice of gastrointestinal surgery.

Vision: A global community of gastrointestinal surgeons advancing research, innovation, education, and advocacy to benefit interdisciplinary care.

Structure and Charge

Work started months prior to the retreat itself. A strategic firm was engaged and a SWOT analysis undertaken (Fig. 1). The results of this analysis and other surveys helped frame the discussion and direct us to potential topics.

Fig. 1
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Prior to the strategic retreat, all members of the board of directors participated in a SWOT analysis. The results of this survey are presented here

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The board of directors (BOD) ultimately felt the structure of the organization serves the membership well. Therefore, no effort was spent to restructure the committees. However, all in attendance agreed that significant effort needed to be expended to move our society forward through the next decade. We all agreed on certain basic facts:

  1. 1.

    The Journal of Gastrointestinal Surgery will remain critically important in our future.

  2. 2.

    The relationship we have with DDW will remain critically important and we are not leveraging this relationship to the fullest extent.

  3. 3.

    Great opportunity exists for us to lead GI surgery expansion globally. There is a significant need for our involvement and leadership in Central and South America.

  4. 4.

    Our membership is robust, but we are not serving them to the fullest. We have many members practicing in private or academic hybrid environment who are underserved by our society.

  5. 5.

    As we reach out to community surgeons who practice GI surgery, we should not forget the fact the SSAT is one of the most scientific of the GI surgical societies and can continue to provide important academic career development.

  6. 6.

    SSAT membership includes many of the most important leaders in academic surgery; we are not taking advantage of this opportunity to its fullest.

With these facts in mind, the leaders of the SSAT spent the days debating transformational goals. The board ultimately came up with three stand-alone goals and one initiative that would be advanced by the board. The summary of the discussion follows.

Goal 1: Increase Member Value and Engagement

In keeping with our mission, we have to demonstrate leadership in the advancement of the science and practice of surgery. In so doing, we have to ensure that our members find value in being a part of this society. Therefore, the first goal is to increase awareness to the value in membership and to ensure that we are providing our members with opportunities they cannot get elsewhere. The goal can be divided into three primary aims and several secondary aims.

Aim 1.1: Support and Engage Young Professionals

Subaim 1.1.1: Support

We have failed to clearly communicate our mission and vision. In addition, we have failed to communicate the value in membership. The younger surgeons needed to sustain a society will be attracted by opportunities not currently offered by the SSAT. They will be less likely to travel to meetings and will be looking for opportunities in the comfort of their own homes. This challenges us to step out of our traditional comfort zone and to consider how we might leverage various online venues to provide support to these younger surgeons. In addition, younger surgeons are looking for activities outside of the annual meeting.

Subaim 1.1.2: Engage

It is evident that our society has an engagement issue. Our meeting attendance continues to decline year after year. With a perceived lack of purpose and focus, members are less likely to be fully engaged. A clear purpose will enable us to engage members on our mission and vision and get people to rally around tasks related to our purpose.

Outcome Measures

Perhaps the best measurement of engagement will be attendance at annual meetings as well as attendance to the various offerings. These numbers will be tracked carefully ad reported to the leadership and committees. We will also look at interest in committee involvement as a potential outcome measure for engagement.

Aim 1.2: Develop a Mentorship Program that Serves All Levels of Members and Interests of Our Members

Subaim 1.2.1: Define Mentorship

Mentorship can be broadly defined. This can include the type of relationship a resident develops with her primary faculty mentor that is forged over the course of her residency. It also might be the type of relationship a mid-career faculty develops over time with a more senior leader resulting in career advice and opportunity. While this can be a very formal process, there is also a degree of informality that is required for successful mentorship.

Subaim 1.2.2: Define Sponsorship and Develop Networking Events

Sponsorship is clearly different from mentorship. This involves respected leaders providing opportunities for younger members who they may not know well but know of their potential. To facilitate these types of relationship, we will have to develop new content to provide members’ access to the senior leaders in the society.

Subaim 1.2.3: Include All Levels of Members

The resident, fellow, and junior faculty members are generally well targeted. The mid-career and more senior members are often forgotten. It will be the key to determine what the older members need from the SSAT that is currently not offered. In addition, it will be important to understand how the society can best serve these individuals.

Subaim 1.2.4: Programmatic Growth to Fill These Holes in SSAT Programming

We will first need to take an inventory of all current programs to ensure we do not try to duplicate effort. Once we fully understand the current offerings, we can move forward with proposing new programs. One potential new program will be an “Ask Your SSAT Colleague” which would be available for all members.

Outcome Measures

Here, we will look for the committees to take ownership and to develop new offerings. We will have to hold the committees accountable for the outcomes and ask them to give regular reports.

Aim 1.3: Leverage Social Media for Networking, Awareness, and Engagement

Subaim 1.3.1: Clearly Define the Role of the Different Social Media Platforms

The main platform for surgical content tends to be Twitter. However, the use of only one platform will limit the scope as well as the reach of posts. We will have to develop the other platforms more fully to reach different groups of individuals.

Outcome Measures

In order to track the success of the social media campaign, we will have to track the metrics including impressions, likes, and shares. We will also look at the number of followers of the different platforms as well as frequency of posts.

Goal 2: Organizational Development for Growth and Sustainability

A major concern that was brought up time and again during the strategic retreat was the society’s ability to differentiate itself from others. We talked at length about the strength of having a diverse society. This includes being able to work across disciplines and bridging gaps between these disciplines. We also talked about how our diversity allows us to serve as a convener of sorts as we bring groups together around complex issues. In order to capitalize on this convener role, we have put forth the following aims.

Aim 2.1: Increase Intersociety Collaboration

Subaim 2.1.1: Define the Target Societies

It is a natural fit for the SSAT to try to increase collaboration with the other members of the DDW. What a collaboration with these gastroenterology groups looks like outside of the meeting is unclear. However, in addition to these groups, we have developed collaborations with other surgical societies. These collaborations have included resident and faculty grants, scholarships to leadership courses, and development of CME courses. We have the contacts and leadership positions within other societies that enable us to develop these relationships. This aim will focus on using these contacts to develop more robust relationships.

Subaim 2.1.2: Define the Collaborative Opportunities

We have developed many different collaborations over the years. Some of these we will need to expand and some may need to be abandoned depending on the sense of interest. Regardless, there are many opportunities and we will need to spend effort developing these ideas.

Outcome Measures

The natural outcome measure will be relationships developed and fostered. The board will monitor those new relationships and will charge the group with increasing the number of partners. As we develop partnerships, the board will monitor the value of these relationships by ensuring a zero-sum contract.

Aim 2.2: Engage Senior Leadership to Attract Younger Members

Subaim 2.2.1: Identify the Senior Leaders Who Are Less Engaged

We clearly have many senior members who are academic leaders. Many of these members remain actively involved while others have become less involved. In order to develop this, we will have to develop a program for the senior members of the society that engages them in a positive way. With such a program, we can ensure those involved stay that way and those who have lost interest have a reason to reengage.

Subaim 2.2.2: Develop a Program to Encourage Interaction Between Senior Leaders and Younger Members

Having the proper venue to encourage this interaction will be the key to success.

Outcome Measures

We will want to monitor both senior members’ level of engagement as well as new members. We will evaluate offerings of the senior members to ensure they are in line with our mission and priorities. We will also have to monitor new members and their participation in these events.

Aim 2.3: Develop a Task Force for Community Surgeons to Further Develop Value Proposition

Subaim 2.3.1: Develop Task Force for Community Surgeons

We know from our latest membership survey the majority of our surgeons are members of academic practices. However, we also know that we have a significant number of private practice surgeons in our membership and the needs of this group may differ from our academic members. We also recognize that a general gastrointestinal surgery practice will likely be in the private practice setting. Therefore, it is important we understand how to engage this group of physicians.

Subaim 2.3.2: Develop Value Proposition

The creation of value for this group of surgeons will require intention and careful consideration. CME courses, surgical coaching, and consensus guidelines are all potential opportunities. Many of these are current offerings but will require redesign.

Outcome Measures

The natural measures will be the number of new offerings for community surgeons. We will also want to track the size of our community membership pool.

Goal 3: Demonstrate Leadership in the Field

The leadership and senior members of the SSAT represent experts and thought leaders in their respective fields. This expertise can be utilized and leveraged to create opportunities that can further strengthen the SSAT position as a leader in the field.

Aim 3.1: Cross Specialty Collaboration Across Societies

As a society, SSAT is unique that it encompasses multiple subspecialties including foregut, hepatobiliary, and colorectal surgery. This provides for a unique opportunity to provide a platform to bring together subspecialty societies to identify common challenges and identify solutions that would be mutually beneficial.

Outcome Measures

Multisociety collaborative including subspecialty societies to identify challenges for professional surgical organizations and solutions. Examples of collaborative efforts include courses for CME, opinion/position manuscripts, and multispecialty summits.

Aim 3.2: Multidisciplinary Engagement at DDW

The SSAT by virtue of being an integral part of the DDW has access to multiple gastrointestinal societies. As a majority of gastrointestinal diseases are managed in a multidisciplinary environment including medical, endoscopic, and surgical specialties, the SSAT can provide a platform for other non-surgical societies at DDW to develop multidisciplinary programs that can enhance patient care and advance scientific investigation.

Outcome Measures

Increase multidisciplinary engagement of DDW societies to develop cross-disciplinary programs and sessions.

Aim 3.3: Development of Acute Gastrointestinal Surgical Emergencies Program

Acute care surgery has become an established surgical specialty. A significant proportion of acute care surgery involves surgical management of gastrointestinal surgical illnesses. An organized curriculum and/or program around managing these conditions leveraging the expertise of SSAT represents a unique opportunity to support a nascent surgical subspecialty.

Outcome Measure

Development of offerings for the acute gastrointestinal surgeon. Such offerings might include courses, webinars, literature, opinion pieces, or position statements.

Aim 3.4. Multidisciplinary Expert Review Series

In collaboration with the Editors of JoGS, we will identify topics of interest to the membership and publish a series of manuscripts that involve multidisciplinary management approaches.

Outcome Measures

Six manuscript series of multidisciplinary reviews from respective experts in gastrointestinal surgery.

Board Initiatives

In addition to these 3 broad goals that will ultimately be championed by the committees, the leadership felt responsibility of the following initiatives should stay at the level of the board of directors.

  1. 1.

    Develop an advanced GI fellowship program. The concept of an advanced GI fellowship has been discussed for many years by the SSAT. Under the leadership of Dr. Fabrizio Michelassi, this concept became a reality 5. Dr. Michelassi established a task force which met and wrote a manuscript detailing the framework of these fellowships 6 and in 2017, the first SSAT-accredited programs were established. Since its inception, we now have 12 accredited programs that are training 14 fellows per year and new sites are being actively recruited. We are now faced with the challenge of understanding the role of this fellowship in the space of surgery and ensuring its sustainability.

  2. 2.

    Refashion SSAT board with representatives from other societies. As a multispecialty program in an era of subspecialization, it is critically important we develop strong relationships with the subspecialty societies. To this end, we will engage the different subspecialty groups to nominate their society members who are also SSAT members to serve as their representatives to the SSAT Board of Directors. This will ensure communication with these societies as we move forward with other collaborative initiatives. We will initially approach SAGES, ASMBS. ASCRS, and AHBPA.

  3. 3.

    Conduct a financial realignment. The SSAT is currently on strong financial ground. However, many of our programs are supported by the corpus of the society. This is not sustainable as it ultimately leads to a significant decrease in our resource. Therefore, it is important the BOD spends a significant amount of effort to strengthen our financial structure. This will include codifying the relationship between the SSAT and its foundation.

  4. 4.

    Develop global chapters of the SSAT. The SSAT has enjoyed tremendous support from members of the international community who comprise 25% of the membership (Table 1). GI surgery is a very important specialty in many countries as subspecialization has yet to reach most of these areas. In particular, interest in Central and South America is quite high. We have laid the ground work for establishing chapters in Mexico, Brazil, and Argentina. These countries are of particular interest because of the relationships the board has established with different societies in these countries. The challenge we face is understanding what value the SSAT can bring to these different countries.

Table 1 Change in membership makeup over time. Baseline is data from 2016
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Conclusions

The strategic retreat has bolstered our commitment to the SSAT and its role in American surgery. We have come up with the 3 goals which will be overseen by task forces consisting of committed SSAT members. We believe that this process will lead us to a stronger, more purpose-driven place and allow us to continue to support GI surgeons over the next several decades.