Innovation in surgery: from imagination to implementation

Surgeons, perhaps more than any other specialists, recognize the concept of furthering the current state of the art by making conscious changes, whether by tweaking how a surgical procedure is done to push the envelope of minimally invasive techniques, finding novel means of advancing surgical education in the face of work-hour restrictions, or advancing quality initiatives in an era of health care reform. Indeed, innovation seems to be the imperative to moving the field forward, for surgeons recognize that without continual process improvement, we stagnate in the status quo. This article pays tribute to Dr Edgar J. Poth by describing innovation in surgery as an iterative cycle beginning with an imaginative idea that is subjected to a series of “plan, do, check, act” quality cycles and ultimately is implemented as a new initiative, only to yield further creative ideas for improvement.