Interview with Robert Cunningham: The Post-Discharge Gap: Why the First Ten Days After Surgery Still Break Down

Interview with Robert Cunningham: The Post-Discharge Gap: Why the First Ten Days After Surgery Still Break Down

What really happens after a patient leaves the hospital—and why does so much still break down in the first 10 days? In this episode, Dr. Robert Cunningham, a fellowship-trained bariatric and metabolic surgeon, shares what it takes to build a surgical program from the ground up in one of the most underserved regions in the Midwest. From launching a de novo bariatric program at Methodist Jennie Edmundson to navigating real-world access challenges, he offers a candid look at the operational and human realities behind growth. The conversation goes beyond program building. Dr. Cunningham breaks down how GLP-1 medications are reshaping—and in some cases complicating—the surgical pipeline, and why the biggest gaps in care still happen after discharge. Despite advances in technology, the first week at home remains one of the most vulnerable periods for patients. This is a practical, on-the-ground discussion for health system leaders, surgeons, and operators focused on access, outcomes, and the parts of recovery that clinical pathways and digital tools still struggle to solve. 0:00 Introduction to NovaNav 0:55 Guest Introduction: Dr. Robert Cunningham 1:00 Dr. Cunningham's background: Ireland, MGH, and UNMC 3:40 Fellowship training at Geisinger and entering practice during COVID 4:15 Launching the bariatric program at Methodist Jenny Edmondson 5:52 Technology's impact on surgical safety: AI image overlays and intraoperative guidance 7:21 Bile duct injury and the holy grail of cholecystectomy safety 9:07 Molecules and nerve identification for inguinal hernia repair 10:25 Patient-facing technology: what patients actually experience 12:13 Immediate result release in patient portals and the cancer diagnosis problem 15:48 The host's personal experience: discharge instructions and post-op confusion 17:55 Where perioperative navigation platforms fit into the care continuum 20:46 Building the bariatric program: institutional support and proforma negotiation 23:55 Program components: dietitians, physical therapy, psychiatric evaluation 26:07 First surgical outcomes and the role of the program coordinator 27:32 Post-discharge follow-up, phone calls, and the literature on outcomes 29:13 GLP-1 medications and their effect on bariatric volume 35:20 Cost analysis: surgery versus lifelong GLP-1 therapy 36:41 Rural healthcare, critical access hospitals, and workforce challenges 39:06 The limits of AI and the risks of removing human interaction from care 43:00 Loneliness, social isolation, and surgical logistics for older patients 44:17 Advice for surgical residents: communication as the defining non-technical skill 48:40 The full spectrum of communication: bad news, colleagues, and conflict 50:30 Malpractice data and surgeons who communicate well 51:44 Closing remarks

Interview with Robert Cerfolio: Remote Monitoring, Readmission Reduction, and the Case for Extending Surgical Accountability

Dr. Robert Cerfolio, Chief of Clinical Thoracic Surgery at NYU Langone and former COO of an $11 billion academic health system, joins The Surgical Journey to discuss what nearly 20,000 operations have taught him about the difference between technical excellence and true episode management. Drawing on decades of surgical and executive leadership experience, he explains why better outcomes depend not only on what happens in the operating room, but on what happens before surgery, after discharge, and across the recovery journey at home. Exploring direct physician access, wearable-based remote monitoring, pre-op home assessment, and the structural barriers that keep health systems from adopting approaches already shown to reduce readmissions and improve recovery, Dr. Cerfolio makes the case that extending surgical accountability beyond the hospital is not simply a patient experience initiative. It is a quality, operational, and financial imperative. He also reflects on the cultural changes required to make this model work: physician transparency, personalized recovery goals, stronger continuity after discharge, and a willingness to redesign care around the patient's actual environment rather than the assumptions of the inpatient setting. For surgical service line leaders, CMOs, CNOs, and operators building infrastructure beyond the hospital walls, it's all about what it takes to manage the full episode well. Episode Contents 0:00 Introduction to NovaNav 0:55 Guest Introduction: Dr. Robert Cerfolio 2:27 Why Cerfolio Gives Every Patient His Cell Phone Number 3:44 Accessibility as a Clinical Standard, Not a Personal Quirk 4:52 How Residents Respond and Whether This Model Scales 5:34 Leveraging Digital Technology: Telemedicine and Pulse Ox Papers Rejected Before COVID 6:37 Innovation Resistance and Hiding Behind the Safety Card 7:52 The Three-Month Standardization and Continuous Improvement Cycle 9:10 Consumer Wearables in Post-Op Monitoring: Whoop, Apple Watch, and Actionable Data 10:09 The Pneumonia Catch: How Remote Metrics Prevented a Potential Death 11:43 Care as a Spectrum: Before Admission Through Long After Discharge 13:18 Scaling Post-Op Visibility and Where AI Fits 14:25 Video Navigation for Surgical Patients: A Practice Started in 1996 16:00 Barriers to Scaling Across Education, Technology Access, and Demographics 19:44 Accountability, Culture, and Ownership Across Surgical and Medical Teams 20:08 The Efficiency Quality Index: Physician-Defined Metrics That Stick 22:47 Building the Ideal System-Wide Perioperative Infrastructure 23:05 Pre-Op Virtual Home Walkthroughs and Environmental Safety 24:19 Personalized Post-Op Goals and Real-Time Metrics at Home 25:00 Why Getting Home Faster Produces Better Outcomes 26:25 Pre-Op Home Visits, Fall Prevention, and Leading Before the Adverse Event

Interview with Dr. Nizar Wehbi: Incentives, Handoffs, and the Rural Care Gap (With Insight into the $50B Rural Health Transformation Program)

Dr. Nizar Wehbi, physician, health policy expert, and former North Dakota State Health Officer, joins the NovaNav Surgical Journey to examine why perioperative outcomes are decided far more by what happens outside the hospital than inside it. He breaks down fragmented episode-of-care ownership, misaligned post-acute incentives, and how tiered alert systems can function as a genuine workforce capacity lever. The conversation closes on the Rural Health Transformation Program and why the real opportunity is not self-sufficiency for rural hospitals but connectivity to regional and urban hubs. His expertise and insights are perfectly framed for CMOs, CNOs, CFOs, and health system strategists who are accountable for what happens after discharge. Episode Contents 0:00 Introduction to NovaNav 0:55 Guest Introduction: Dr. Nizar Wehbi 6:11 Biggest Gaps Between Discharge and Full Recovery 10:25 Social Determinants and the Case for Navigation Support 14:46 CMS Bundled Payments and Outpatient Shift: How Leaders Should Prepare 19:15 Process Mapping the Episode of Care and Cross-Team Accountability 22:42 Standardizing Patient Management Across Sites and Teams 25:30 Policy Opportunities to Improve Patient Experience at the System Level 29:38 Fragmentation as a Design Problem and the Role of Incentive Alignment 32:48 30-Day Readmission and the Misaligned Incentives Across Post-Acute Facilities 35:24 Risk Stratification, Yellow and Red Flag Alerts, and Clinical Escalation 36:50 Workforce Shortage, AI, and the 80-20 Principle in Post-Discharge Monitoring 41:45 The $50 Billion Rural Health Transformation Program and Infrastructure Investment 48:51 Hub-and-Spoke Models, Rural-Urban Connectivity, and Community-Based Recovery 51:37 Closing Thoughts and Full Circle on the Process Map

Interview with Fred Neis, RN (Fellow of the Academy of Emergency Nursing): What Surgical Patients Actually Want (And Why Systems Miss It)

In Episode 11 of The Surgical Journey, Fred Neis — best-selling author of The Disciplined Leader, registered nurse, and healthcare executive — joins the show to discuss what makes the surgical experience feel coordinated, reliable, and well designed. Patients may not use those exact words, but they know when care feels predictable and when it does not. Neis explains why stronger follow-up, better coordination, and more consistent standard work are essential to perioperative operations. He also makes the case that high reliability requires leadership that is willing to reduce unnecessary variation across teams and build a more dependable experience for both patients and staff. Episode Contents 00:00 NovaNav Introduction 00:51 Guest Introduction: Fred Meese 02:16 What patients really want: service, predictability, and tailored interactions 07:35 The biggest disconnect after surgery: what happens once patients go home 11:41 High reliability, standardization, and reducing variation in care 16:20 Value-based care, risk-based contracts, and where AI can improve outcomes 20:49 Nurse coordinators, workforce strain, and using AI to extend clinical capacity 24:41 Why healthcare technology adoption fails and how to build trust 30:18 Fred's book: The Discipline Leader 33:49 Referrals, reputation, and preventing network leakage 37:21 Where to find Fred and his book 38:25 Closing Remarks

Interview with Dr. Lisa Attebery: Care Transitions: Why the Critical Window in Cancer Care Lies Between Appointments

Most cancer patients experience their worst anxiety not during surgery, but in the days between diagnosis and treatment. Dr. Lisa Atterbury, a board-certified breast surgical oncologist with 18 years of experience, and Dr. Dupree, a breast radiologist, walk through the specific operational breakdowns that turn clinical delays into worse outcomes. They explain why the standard discharge instruction model fails, how 48-hour biopsy windows correlate with patient outcomes, and why post-operative ER visits often signal gaps in structured follow-up rather than true emergencies. This episode offers a clinical operations perspective on patient navigation, caregiver coordination, and the friction points that health systems can address without adding headcount. If you manage cancer programs or surgical services, this is a rare look at how two clinicians think about the space between appointments. Episode Contents 00:00 NovaNav Introduction 01:02 Guest Introduction: Dr. Lisa Attebery 02:43 What clinicians often miss between appointments 06:40 Common post-op issues patients face at home 08:52 How technology can support patients before and after surgery 11:54 Why delays in care can worsen outcomes 15:43 Reducing unnecessary ER visits with better guidance 18:18 Redesigning the space between appointments 20:33 The first days after diagnosis: delivering news with hope 22:05 Biggest friction points in the cancer journey 24:58 Access challenges, workforce strain, and rural care realities 28:08 Mobile mammography and meeting patients where they are 29:13 The role of families and caregivers in cancer care 32:27 What it means to care for breast patients for life 35:11 Closing Remarks