When John Monson, MD, first visited Florida Hospital as a guest lecturer in colon and rectal surgery in 2013, he was impressed by what he saw; a comprehensive program led by internationally renowned physicians and surgeons, delivering care across five hospitals in the Central region, and a range of clinics around Central Florida. He returned annually to teach an international course at the Orlando campus location, but when he was first approached about leading the colorectal group, he originally declined. He wanted to do more than lead a colorectal surgery group, for him this was a larger, more expansive mission encompassing a broader vision to redefine patient delivery beyond one subspecialty. His vision aligned with leaders at Florida Hospital, who recognized that developing their colorectal surgery program was indeed a bigger undertaking. The bigger project would need to include a focus on overall digestive health and also a focus on the patient experience and building a program based on specific patient needs of this specialty area.
When Dr. Monson joined the team in April of 2016 as Executive Director of Colorectal Surgery for the Florida Hospital System, he began immediately on a multi-phase plan to expand upon the health system’s mission of quality and service excellence and expanding the fields of training, education and research to navigate and be a part of the changing healthcare landscape.
Credited with leading the development of laparoscopic colorectal surgery in the United Kingdom, Dr. Monson brings to Florida Hospital a fellowship-trained background in colon and rectal surgery, surgical oncology, and vascular surgery. His areas of expertise include the use of minimally invasive technologies in colorectal cancer treatment, including Transanal Endoscopic Microsurgery (TEMS) and Transanal Total Mesorectal Excision (TME), laparoscopy, and robotic surgery. On the research side, his work includes investigation of a broader range of cancer-related areas including development of national standards of cancer care and qualitative assessments of decision-making in cancer care. His research into how cancer care is delivered is a building block for his dual role at Florida Hospital.
Taking a High-Level View
In addition to heading up the development of the specialty colorectal practice, he is also taking a broader, higher level view of delivery of digestive health services across the Florida Hospital system and the development of the emerging Digestive Health Institute. As a first step this requires growing and implementing changes in the colorectal surgery program to accommodate the needs of patients at multiple locations, further streamlining and developing the clinical practice and skills across the system and expanding and building new office areas. He is also tasked with beginning a comprehensive research program focused on delivery of care and developing a much-needed national accreditation program in the care for patients with rectal cancer. As he embarks on this work and successful implementation of these projects across the Florida Hospital system, Monson keeps his focus on the basics.
Treating the Whole Person
“The most basic level is to deliver care in a patient and family centered way, recognize that the patient is more than an organ, they are human beings who have a lot going on in their lives. Consultations are about more than just surgery. How are families going to cope with this issue? What can we do to help them with this process? It’s about providing care in a seamless way, not driving hours for a 15 minute X-ray, for example – patients need someone leading coordination of care,” says Monson.
He also believes that when it comes to meeting the needs of patients, its about knowing what you are up against. That will include concentrating much-needed attention on an area in healthcare that is lagging here in the United States – colorectal cancer care. The research that Monson led at the University of Rochester, where he spent eight years prior to coming to Florida Hospital, found that nationally, one in four colorectal cancer patients did not get the care they should have received simply based on where they lived and what facility they went to.
“Despite well-established guidelines, not all patients were getting the care they needed,” says Monson.
Enter in The Digestive Health Institute, a collaboration of Florida Hospital specialists including gastroenterologists, pancreatic surgeons, liver surgeons and colorectal surgeons focused on coordination of care. Florida Hospital is putting resources behind the Digestive Health Institute and The Center for Colon and Rectal surgery, to lead what Dr. Monson calls a major re-design of digestive care in central Florida.
“The goal of the Digestive Health Institute is to focus not just on a single organ, but on the whole person and to have the physicians, surgeons, and other care providers work it all out as a seamless process for patients in one package,” says Monson.
Setting the Standard of Excellence
Monson and other researchers also saw the need for a National Accreditation Program for Rectal Cancer care. The NAPRC is being developed by the American College of Surgeons and the Commission on Cancer along with the OSTRiCh Consortium, a group of healthcare institutions dedicated to providing access to high-quality rectal cancer care for all Americans. Florida Hospital was one of six sites chosen to launch the new accreditation program, joining Baylor University Medical Center in Texas, The Cleveland Clinic in Ohio and Florida, The John Muir Medical Center in California, and The University of Rochester Medical Center in New York to serve as a model and test site for how colorectal cancer care should be delivered and best practiced. According to Monson, whose research has spanned both sides of the Atlantic, the United States needs to look to Europe, where leaders in the field have completely changed how colorectal cancer care is delivered. Subsequently, it has changed the way other cancer care is delivered in Europe.
Delivering Care Where it’s Needed
According to the American Cancer Society more than 131,000 new cases of colon and rectal cancers will be diagnosed in 2016. Colorectal cancer is expected to cause more than 49,000 deaths making it the second leading cause of cancer-related deaths among men and women combined. While the death rate has been dropping for decades, due in part to screenings and early diagnosis, Monson points out a concerning disparity among colorectal cancer survival based on a person’s zip code and the access they have to life saving screenings and specialists.
“It’s referred to as the zip code lottery, where a person lives directly translates into outcomes,” says Monson.
Florida Hospital continues to make enormous investments in brick and mortar, technology, and equipment to further the focus on colorectal surgery and digestive issues, and to bring services to the patients, rather than requiring them to travel for care.
Monson and his team are tasked with organizing and overseeing the program and overcoming the challenges faced by healthcare systems. Monson calls it the 30,000 foot view.
“How do you navigate an efficient, seamless, high-quality, trouble-free, patient-friendly journey? That’s what all medical centers around the world are now trying to work out. Our job is to say to the patient ‘We will look after you, whatever you need. You don’t have to worry. The right hand will talk to the left hand. You just have to focus on being a well person. Our job is to figure everything else out for you and to listen to your needs.’”
To further meet the needs of its patients managing digestive and colorectal health issues, Florida Hospital is beginning with aggressive recruitment of additional colorectal surgeons. The colorectal surgery practice is expected to grow from six surgeons to at least nine, adding services at Florida Hospital campuses in Apopka, Celebration and Winter Garden over the next two to three years. Florida Hospital will also increase its presence at the downtown Orlando campus and at campuses in Altamonte Springs, East Orlando, Kissimmee and Winter Park.
“Our communities are in need of this coverage,” says Monson. “They know our services are very high quality. They want more of this. We are not there all the time. They want more.”
In addition to improving patient access across its hospitals and facilities, Florida Hospital is also taking on one of the biggest challenges faced by health care systems: delivering patient-and family-centered care.
“In most countries in the world, it is a human characteristic that we want the best quality care on our doorstep and we don’t want to have to travel,” says Monson. “In the past decade, healthcare systems are pressing the reset button, becoming more family- centric, having specialists travel to regional and satellite centers. These coordinated approaches are complex dynamics to resolve, but worthy of resolving.”
Committed to pioneering how healthcare is delivered, Florida Hospital is building a brand new research facility on the Orlando campus dedicated solely to health services research.
“We will research the way we deliver care to patients,” says Monson. “What drives successes in clinical care, what drives obstacles, why is there such a spectacular level of diversity of care provided to people around this country?”
Research will also look at everything from managing electronic medical records, to connecting care to address geographical challenges.
For Monson, Florida Hospital is the perfect location to investigate these issues and implement new ideas. “In the last 15 years most of my research has been focused on analyzing delivery of care, developing new treatments with clinical trials. One of the most attractive qualities I saw here was the fact that the colorectal group, specifically, was very active from a research and education standpoint. They are, by a comfortable margin, the most prolific and productive colorectal group in Central and Northern Florida. They are a very well-known group with an exceptional reputation both nationally and internationally, and are among the most productive group in the entire Florida Hospital system.”
Monson recognizes that implementing new ideas to benefit the patient care experience, especially in a system such as Florida Hospital, which has its origins in private practice, is a big project. But with population growth and the demand for highly specialized practices, the leadership of Florida Hospital is well poised to meet those needs and develop a Digestive Health Institute by laying the foundation in education, training, and research.
“Any sensible individual attempting to redefine healthcare delivery programs looks at examples of best practices around the world. Because of my background, I do that all the time. No one has the patent on excellence across the board, but partnering with national consortiums and developing a true Center of Excellence, we will continue to build on the training and research that we have access to here in the Florida Hospital system and we will make great strides in the delivery of care for our patients,” says Monson.
Monson knows this success depends on a group of people focused on the broader, balcony-level view of healthcare. And, he believes that from the overseas observers and the fellows that come to Florida Hospital for the specialized training, to the new surgeons joining the team, to research outcomes, that Florida Hospital is well-positioned to change the way healthcare is provided for patients in need of digestive health and colorectal surgery specialists.
John R.T. Monson, MD practices at The Center for Colon & Rectal Surgery which offers comprehensive treatments and minimally-invasive surgery for colorectal disorders, conditions and cancers. The multi-disciplinary practice consists of six highly-trained physicians and board-certified colon and rectal surgeons. To learn more visit www.CenterColon.com or call 407.303.2615.
John R.T. Monson, MD, Executive Director of Colorectal Surgery for the Florida Hospital System.
Conditions Treated at Center for Colon and Rectal Surgery
- Anal Abscess/Fistula
- Anal Cancer
- Anal Fissure
- Bowel Incontinence
- Colon cancer
- Colorectal Cancer
- Colostomy Avoidance
- Crohn’s Disease
- Diverticular Disease
- J-Pouch surgery
- Pelvic Floor Dysfunction
- Polyps of the Colon and Rectum
- Rectal Cancer
- Rectal Prolapse
- Rectovaginal Fistula
- Ulcerative Colitis
By Katie Dagenais