Brigham and Women's Hospital Department of Surgery Harvard Medical School External Review 2017-2021

Faculty, Leadership and Administration A. OVERVIEW Many of the faculty in the Department of Surgery are internationally recognized surgeons and leaders at the Brigham, Mass General Brigham, and other health care institutions in New England, as well as national and international organizations. Our faculty are also top educators. They hold leadership roles at Harvard Medical School, lead residency and fellowships programs, travel as visiting professors to top medical programs throughout the country and the world, operate labs funded by some of the country’s most prestigious medical and governmental institutions and conduct important research that is changing lives and creating new, innovative ways to treat patients. Currently, there is a total of 176 faculty members in the department, nearly all of whom hold a Harvard Medical School (HMS) appointment. Most are members of the Brigham and Women’s Physician Organization (BWPO) and only a small percentage are fiscally supported outside of the Department of Surgery. Please refer to Exhibit 24 below to see the breakdown. All faculty are board certified, and nearly all are board certified in the United States. There are a few faculty members who have board certifications through a foreign process. Those are evaluated on a case-by-case basis by the Brigham credentialing process to ensure equivalent qualification. For a full list of the faculty, please refer to Appendix 1. There are 157 faculty members who are members of the Brigham and Women’s Physician Organization. The BWPO’s strategic vision is of an integrated medical group providing the highest quality care to patients and providing physicians with the highest quality work life. Focused on optimizing and 197

streamlining operational performance, the BWPO centralizes some of the administrative and compliance functions that previously resided within each department -- including the organization and management of billing, administration, and financial components. The BWPO also provides medical management support for physicians so they can provide high quality, efficient care. Exhibit 24: BWPO/Non-BWPO and Harvard Appointments in the Department of Surgery The physician-governed BWPO provides for cooperative business relationships between the BWH and MGH physicians; it also allows BWH physicians to join physicians across Mass General Brigham to negotiate contracts with third-party payors. Today, the BWPO employs more than 1,800 physicians. 198

Leadership The department is led by Gerard M. Doherty, MD, with support from C. Keith Ozaki, MD, the executive vice chair. Gerard M. Doherty, MD Surgeon-in-Chief, Brigham and Women’s Hospital & Dana-Farber Cancer Institute Crowley Family Distinguished Chair, Department of Surgery, Brigham and Women’s Hospital Moseley Professor of Surgery, Harvard Medical School C. Keith Ozaki, MD Executive Vice Chair, Department of Surgery, Brigham and Women’s Hospital John A. Mannick Professor of Surgery, Brigham and Women’s Hospital Professor of Surgery, Harvard Medical School Dr. Smink is the chief of surgery at Brigham and Women’s Faulkner Hospital. Douglas S. Smink, MD, MPH Chief of Surgery, Brigham and Women's Faulkner Hospital Vice Chair for Education, Department of Surgery, Brigham and Women’s Hospital Associate Professor of Surgery, Harvard Medical School 199

Vice Chairs Starting in 2017, eight vice chair positions were established by Dr. Doherty to lead across the department in the areas of: education, clinical operations, digital health, faculty development, research, surgical critical care, multidisciplinary oncology, and quality and patient safety. These individuals have been highly successful in their respective areas. Ronald Bleday, MD Tari King, MD Elizabeth A. Mittendorf, Louis L. Nguyen, MD, Vice Chair for Quality and Vice Chair for MD, PhD MPH, MBA Multidisciplinary Patient Safety Vice Chair for Research Vice Chair for Digital Oncology Health Systems Malcolm K. Robinson, MD Ali Salim, MD Jennifer J. Shin, MD, SM Douglas S. Smink, MD, Vice Chair for Faculty MPH Vice Chair for Clinical Vice Chair for Surgical Development Vice Chair for Education Operations Critical Care • Dr. Bleday, vice chair for Quality and Patient Safety, oversees the monitoring/reporting of surgeon quality metrics, clinical care pathways and patient safety reports. He also enables safe and efficient approaches to inpatient surgical care and is responsible for optimizing the quality and safety of inpatient care provided by practitioners in the Department of Surgery at Brigham and Women’s Hospital and Brigham and Women’s Faulkner Hospital. • Dr. King, vice chair for Multidisciplinary Oncology, oversees the optimization of patient access, ambulatory care and care coordination for oncology care provided by practitioners in the Department of Surgery. She also leads and enables innovative and efficient approaches to oncology patient care at the Brigham and Dana-Farber Cancer Institute. 200

• Dr. Mittendorf, vice chair for Research, oversees research space management, grants preparation, pre- and post-award management, the clinical trials office, shared core services, clinical trials and innovation, and the DOS Research Oversight Committee, which is comprised of 18 members representing each division and center. • Dr. Nguyen, vice chair for Digital Health Systems, oversees the design and implementation of the electronic health record and other information systems across the Department of Surgery. He leads and enables digital practice innovation with the goals of increasing practice efficiency and safety, enabling practice growth through novel patient management interactions and optimizing the provider-facing presence in eCare. He also advises various Brigham IT committees and works with DOS faculty members and leadership to continually evolve our information systems in a progressive manner. • Dr. Robinson, vice chair for Clinical Operations, oversees the integrated strategy of the DOS with the Brigham and the BWPO. He leads and enables innovative and efficient approaches to patient care and is responsible for optimizing patient access, ambulatory care, ambulatory documentation and charge capture, as well as operating room access for the department. • Dr. Salim, vice chair for Surgical Critical Care, oversees the 24-hour operational management of the surgical-directed intensive care units (S-ICU), including general surgery, trauma/burn, thoracic and cardiac surgery. He collaborates with medical directors and division chiefs in the development of S-ICU service programs and processes, while also working to implement effective cost-containment measures. • Dr. Shin, vice chair for Faculty Development, oversees the Office of Professional Development (OPD), which assists faculty with career planning, faculty initiatives, training programs, and development and diversity. The OPD supports the career development of the department’s faculty members through programs designed to optimize their work life and present them with opportunities for achievement, direct interactions, and contributions to the DOS and BWPO policy development. • Dr. Smink, vice chair for Education, oversees the Surgery Education Office and the educational activities of the DOS, including medical student programs, as well as ACGME and non-ACGME resident and fellow programs. He guides enterprise-wide innovations in surgery education, leads and enables novel research in surgical education, and serves as a mentor to the program and clerkship directors. 201

Division Chiefs The faculty is arranged into 11 divisions, each with a division chief who reports directly to the department chair. Open division chief roles have been filled through national searches; five of the 11 division chiefs are new to their roles in the last five years: • Tari King, MD – Breast Surgery • Andrea L. Pusic, MD – Plastic and Reconstructive Surgery • Chandrajit P. Raut, MD, MSc – Surgical Oncology • Ali Tavakkoli, MD – General and Gastrointestinal Surgery • Ravindra Uppaluri, MD, PhD – Otolaryngology—Head & Neck Surgery Tari King, MD Ali Tavakkoli, MD Nathaniel S. Treister, DMD, Ravindra Uppaluri, MD, PhD Chief, Division of Breast Chief, Division of General DMSc Chief, Division of Surgery & GI Surgery Chief, Division of Oral Medicine Otolaryngology-Head & Neck Surgery Andrea L. Pusic, MD Chandrajit P. Raut, MD, MSc Raphael Bueno, MD Ali Salim, MD Chief, Division of Plastic & Chief, Division of Surgical Chief, Division of Thoracic Chief, Division of Trauma, & Cardiac Surgery Burn & Surgical Critical Care Reconstructive Surgery Oncology Stefan G. Tullius, MD, PhD Adam S. Kibel, MD Michael Belkin, MD Chief, Division of Transplant Chief, Division of Urology Chief, Division of Vascular & Surgery Endovascular Surgery 202

Administrative Leadership and Structure Phillip D. Roberts, MBA, is the executive administrator of the department and leads a group of six senior staff as well as 11 division administrators. Roberts reports to Dr. Doherty and Kevin Giordano, MBA, FACHE, senior vice president of Clinical Services. Exhibit 25: Administrative Organization Chart for the Department of Surgery B. PROCESS FOR DECISION-MAKING Brigham and Women’s Hospital is a collaborative, consensus-driven organization, and the department’s decision-making reflects this philosophy. The DOS also believes in a “servant leader” approach to leadership, which shapes the way the department supports its divisions, centers and faculty. The chair is the academic and administrative leader of the Department of Surgery and works closely with the executive administrator. In the absence of the chair, the executive vice chair is able to act on behalf of the chair in all matters. While the chair holds the ultimate responsibility for all departmental decisions, the DOS pushes responsibility for decision-making as far down the organizational structure as possible. The main business unit of the department is the division, and division chiefs are responsible for making decisions on all clinical, research and education matters within their areas. For those divisions large enough to have sections, many decisions are delegated to the section chief. 203

Decisions regarding department-level matters are often delegated to one of the vice-chairs. Decisions significant enough to require broad leadership input are brought to the DOS Advisory Committee, a meeting composed of the division chiefs, the vice chairs and administrative leaders of the department. Decisions on department-level administrative matters are made in a weekly operations group meeting consisting of the chair, executive vice chair, vice chair for Operations, BWFH surgeon-in-chief, the executive administrator and the administrative leadership (directors of Communications, Education, Finance, Network Strategy, Operations and Research). C. FACULTY AFFAIRS Successful faculty recruitment and promotion are vital to the Department of Surgery. Over the past five years our faculty has grown significantly in number, as well as diversity. The department is seen as an institutional leader in diversity, equity and inclusion best practice, which includes formal searches for each open faculty position. We aim to cast a wide net in pursuit of the highest quality faculty member for each position, while simultaneously enriching the diversity of our faculty. We continue to iterate and improve these processes and remain a resource for other departments seeking to enhance their recruitment functions. We also look through a diversity lens when creating and filling leadership positions within the department, which has resulted in remarkable diversity among our eight vice chairs. The data that follows provides information about gender diversity; ethnic diversity is also provided later in this section. Appointments and Promotions Exhibit 26: Growth in Faculty Appointments Growth in Faculty Appointments 2016 vs. 2021 70 Associate Assistant Instructor 60 Professor Professor 50 40 30 20 10 0 Professor 2016 2021 204

The department is currently comprised of 176 physicians; compared to about 150 when Dr. Doherty became chair in 2016. Since then, the number of faculty in every rank, apart from instructor, has grown, with assistant professors growing by 55% and associate professors growing by 30%. Currently, female physicians make up about 32% of the faculty in the Department of Surgery, compared to 24% in 2016. The number of women at every rank (except Instructor) has increased significantly. Exhibit 27: Current Faculty Appointments by Gender Exhibit 28: Growth in Female Faculty Appointments Growth in Female Faculty Appointments 2016 vs. 2021 25 Associate Assistant Instructor 20 Professor Professor 15 10 5 0 Professor 2016 2021 205

The promotions process is initiated by the division chiefs on behalf of their faculty and led by the department chair. Proposals for promotion are put forward to the HMS Department of Surgery Executive Committee, which is comprised of surgical chairs from four HMS-affiliated academic medical centers – Beth Israel Deaconess Medical Center; Boston Children’s Hospital; Brigham and Women’s Hospital; and Massachusetts General Hospital – before they are sent along to HMS for review and approval. The total number of faculty promoted each year has been consistent and evenly distributed. Between 2016 and 2021, 73 faculty members were promoted. • 51 to assistant professor • 15 to associate professor • 7 to professor Although the numbers are small, women made up 43% of the professor promotions and comprised almost 40% of the assistant professor promotions. For assistant professor female promotions, there was significant growth from 11% in 2016 to 67% in 2020. Exhibit 29: Promotions in the Department of Surgery by Gender Year Assistant Professor Associate Professor Professor Total 2016 Men Women Total % Men Women Total % Men Women Total % Per Year 2017 Women Women Women 2018 2019 8 1 9 11% 2 1 3 33% 1 0 1 0% 13 2020 2021 5 2 7 29% 1 1 2 50% 1 0 1 0% 10 Total 5 2 7 29% 3 0 3 0% 1 1 2 50% 12 4 3 7 43% 3 0 3 0% 0 2 2 100% 12 3 6 9 67% 1 1 2 50% 1 0 1 0% 12 7 5 12 42% 2 0 2 0% 0 0 0 0% 14 32 19 51 37% 12 3 15 20% 4 3 7 43% 73 Recruitment The Department of Surgery conducts open searches for all faculty positions and pays deliberate attention to diversity, both visible and invisible, including race, ethnicity and gender, but also training background, sexual orientation and career aspirations. When Dr. Doherty joined the Brigham as chair of surgery, he committed to ensuring that all searches for faculty, trainees and staff would be open to all qualified candidates. Most notably, this required changing the way the department hired new faculty members. A selection committee process was instituted across all divisions to ensure diversity in hires. The priorities for identifying the best clinical faculty candidates include clinical excellence, sophisticated interpersonal skills and specialized skills that add value (whether in the form of an unusual clinical niche, innovative research, or commitment to teaching or administration). 206

Clinical skills are evaluated through references and discussions with surgeon-colleagues and other staff with direct insight into clinical performance. We note interpersonal skills throughout the interview process and confirm impressions with references. Finally, understanding how the candidate would make the faculty better requires careful planning to define both opportunity and expectations. Between 2016 and 2021, 80 faculty members were recruited. Of those 80 physicians, approximately 40% were female. Exhibit 30: Recruitment in the Department of Surgery by Gender Division/Center 2016 2017 2018 2019 2020 2021 TOTAL Breast MFM F MF MF MF MF MF Cardiac Surgery 04 General and GI 1 1 3 61 Surgery 2 31 Oral Medicine Otolaryngology 3 30 Plastic & Reconstructive 1 11 21 Surgical Oncology 111 Thoracic Surgery 1 21 11 4 5 Thoracic & Cardiac TBSCC 1 1 12 11 43 Transplant Surgery Urology 1 21 1 32 Vascular CSPH 11 2 14 72 PROVE Center Other 12 1 2 TOTALS 2 11 21 24 5 1 10 1 12 2 1 12 82 21 1 31 12 21 1 1 11 1 01 8 4 1 4 8 4 13 5 13 9 6 5 49 M 31 F Note: Breast Surgery became a division in 2019, and the Division of Thoracic and Cardiac Surgery was created in 2021 via the combining of separate Cardiac and Thoracic Surgery divisions. 207

Following is a divisional breakdown of each faculty member that has been recruited to the Department of Surgery in the last five years. About 84% of faculty members recruited are still with the department. Exhibit 31: Recruited Faculty by Year Year Faculty Name Division Cristina Carpio, MD Acute Care Surgery/Surgical Critical Care 2016 Ben Christian, MD Plastic and Reconstructive Surgery George E. Haleblian, MD Urology Year Alice Maxfield, MD Otolaryngology 2017 Edward J. Marcaccio, Jr, MD Vascular and Endovascular Surgery Gita Mody, MD, MPH Thoracic Surgery Deepika Nehra, MD Acute Care Surgery/Surgical Critical Care Marc P. Pelletier, MD, MSc Cardiac Surgery Vidya Sankar, DMD, MHS Oral Medicine Samir Kaushik Shah, MD Vascular and Endovascular Surgery Steve Singh, MD Thoracic Surgery Ravindra Uppaluri, MD, PhD Otolaryngology Faculty Name Division Elodi J. Dielubanza, MD Urology Lydia Helliwell, MD Plastic and Reconstructive Surgery Jason I. Kass, MD, PhD Otolaryngology Lindsey M. Korepta, MD, RPVI Vascular and Endovascular Surgery Anna C. Weiss, MD Surgical Oncology Year Faculty Name Division 2018 Regan W. Bergmark, MD​ Otolaryngology​ Mark Fairweather, MD Surgical Oncology​ Andrea Pusic, MD, MHS​ Plastic and Reconstructive Surgery​ Chris Gibbons, PhD​ PROVE Center Matthew Mossanen, MD​ Urology Anthony Coppolino, III, MD​ Thoracic Surgery Gustavo Bauza, MD​ Acute Care Surgery/Surgical Critical Care ​ Matthew D. Ingham, MD​ Urology Molly Jarman, PhD​ Center for Surgery and Public Health ​ Steven Piantadosi, MD, PhD​ Surgical Oncology​ Matthew Rochefort, MD​ Thoracic Surgery Elizabeth A. Mittendorf, MD, PhD​ Surgical Oncology 208

Year Faculty Name Division 2019 Joel T. Adler, MD, MPH​ Transplant Surgery​ Year Shailesh Agarwal, MD Plastic and Reconstructive Surgery​ 2020 Justin Broyles, MD​ Plastic and Reconstructive Surgery​ Tanujit Dey, PhD​ Center for Surgery and Public Health ​ John C. Kubasiak, MD​ Trauma, Burn and Surgical Critical Care​ Arthur Little, MD​ Urology M. Blair Marshall, MD, FACS​ Thoracic Surgery Christina A. Minami, MD, MFA, MS​ Breast Surgery Anju Patel, MD​ Otolarynology​ Eleni M. Rettig, MD ​ Otolarynology​ Daniel E. Rinewalt, MD​ Cardiac Surgery Jamie Robertson, PhD, MPH​ Director of Innovation in Surgical Education ​ Ashraf A. Sabe, MD​ Cardiac Surgery Thomas C. Tsai, MD, MPH​ General and Gastrointestinal S​ urgery​ Gil Welch, MD, MPH​ Center for Surgery and Public Health ​ Daniel A. Wollin, MD​ Urology James Yoo, MD​ General and Gastrointestinal ​Surgery​ Andrew Resnick, MD, MBA​ General and Gastrointestinal ​Surgery​ Faculty Name Division Geoffrey Anderson, MD, MPH​ Trauma, Burn and Surgical Critical Care​ Marie Billaud, PhD​ Cardiac Surgery William Boysen, MD​ Urology Matthew Brian Couger, PhD​ Thoracic Surgery Maria Edelen, PhD PROVE Center Thomas Gleason, MD​ Cardiac Surgery Jennifer Guerriero, PhD​ Breast Surgery Mohamad Hussain, MD, PhD, RPVI​ Vascular and Endovascular Surgery​ Olga Kantor, MD, MS​ Breast Surgery Hassan Khalil, MD​ Thoracic Surgery Anastasios Konstantakos, MD​ Cardiac Surgery Alison Laws, MD ​ Breast Surgery Anupama Mehta, MD​ Trauma, Burn and Surgical Critical Care​ George Molina, MD, MPH​ Surgical Oncology​ Kathy Golbarg Niknejad, MD​ Urology Matthew Pommerening, MD​ Thoracic Surgery Kavitha Ranganathan, MD​ Plastic and Reconstructive Surgery​ Nakul Raykar, MD, MPH​ Trauma, Burn and Surgical Critical Care​ Farhad Rikhtegar Nezami, PhD​ Cardiac Surgery Rosh Sethi, MD, MPH​ Otolaryngology – ​Head and Neck Surgery​ Piamkamon Vacharotayangul, DDS, PhD​ Oral Medicine​ John Young, MD​ Thoracic Surgery 209

Year Faculty Name Division 2021 Timothy Clinton, MD, MPH​ Urology Alexander Cole, MD​ Urology Christopher Dwyer, MD​ Otolaryngology – ​Head and Neck Surgery​ Enobong Efiong, MD Trauma, Burn and Surgical Critical Care​ Kentaro Ikeda, DDS, MPH, FDS​ Oral Medicine​ Stella E. Lee, MD​ Otolaryngology – H​ ead and Neck Surgery​ Kristin A. Sonderman, MD, MPH​ Trauma, Burn and Surgical Critical Care​ Desiree Steimer, MD​ Trauma, Burn and Surgical Critical Care​ Erin Taylor, MD​ Plastic and Reconstructive Surgery​ George Tolis, Jr., MD​ Thoracic & Cardiac Surgery​ Paula A. Ugalde, MD​ Thoracic & Cardiac Surgery​ Mentoring Programs and Faculty Development Mentoring Programs Mentoring is a key component of a trainee’s development, and therefore a foundational part of our training philosophy. All the DOS training programs have adopted the mentoring structure most appropriate for their residents or fellows. In the general surgery residency, for instance, one of the associate program directors oversees mentoring. New interns are paired with a faculty member and a near-peer mentor. The goal is to introduce the trainees to all that the department has to offer and to provide support in the transition from student to physician. During the residency, other mentorship relationships develop organically out of clinical, research and personal interests. To reinforce the importance of mentorship, residents are asked at their semi-annual meetings to identify their mentors, and those without sufficient relationships are given additional direction on creating mentoring interactions. The Office of Professional Development also supports the new BWPO Faculty Sponsorship Mentorship Program, which leverages a digital platform to build connections and enhance mentorship over a six- month experience. The program launched in December 2021 for all faculty members. The project was developed as a mentored grant for a female faculty member of the DOS. Faculty Development The Office of Professional Development (OPD) was founded in 2017 by Zara Cooper, MD, MSc, the first incumbent of the vice chair for Faculty Affairs. The OPD is dedicated to supporting faculty in reaching their professional goals and aspirations. Jennifer Shin, MD, SM, assumed the role of vice chair for Faculty Development in 2019 and has continued to grow the OPD's offerings. The OPD benefits from an Advisory Council, which includes representation from across the department. Through daily operations, and in consultation with the Advisory Council, the OPD has focused on a variety of faculty needs, including: 210

• Academic Advancement • Career Development, Values and Well-Being • Community and Collegiality, among others. Grants Grant funding helps support the work of the OPD. The department has received more than $100,000 of funding over the past two years from the BWPO “BWell” MD Grant Program, which aims to advance performance in culture, systems improvement and/or personal well-being. In the DOS, these grants have supported the Outstanding Citizenship Award, leadership dinners and interdepartmental events, along with the development of new CME series such as the Professional Fulfillment Series and COVID-19 Faculty Support Sessions. OPD has also been awarded external funds through the American Academy of Otolaryngology–Head and Neck Surgery Women in Otolaryngology Endowment Award, which provides grants for actionable research designed to benefit the professional development of women faculty. A mentored grant application was submitted and culminated in a 2021 award for the grant titled, \"Validation of a Surgeon Experience Instrument to Assess the Impact of Gender and Parental Status.” This project addresses the critical and time-sensitive need for a more comprehensive understanding of the female physician experience, crossing the full spectrum of issues which may culminate in women leaving their current job or the profession, particularly within vulnerable groups such as young women and women of color. Clinical Intake System to Support Academic Advancement and Relief of Documentation Burden The OPD manages an ambulatory clinical intake system designed to help alleviate systems-based issues impacting clinical productivity and physician burnout. Our electronic interface streamlines clinical workflow, easing the burden of medical documentation, and generating practical and research-ready information to synergistically align with daily health care. Traditionally, being clinically busy precludes protected time for research and vice versa. Similarly, slowing to provide educational and academic opportunities during daily practice has often been considered additional and uncompensated work, which creates cognitive dissonance and stress for our faculty. With significant effort, platforms have been implemented to support clinicians in a variety of practices within the department, including bariatric surgery, colorectal oncological surgery, general surgery, vascular surgery and thoracic surgery. We have additionally developed platforms for requesting clinicians in other departments, as well as in a variety of practice types in the U.S. and five international sites. An aim of this work is to streamline clinical processes in order to ultimately create time and opportunities for faculty academic and research pursuits. Professional Fulfillment Series The Professional Fulfillment Series is designed to educate faculty and trainees in techniques and concepts needed for professional fulfillment and career advancement. Topics include understanding the options for research and academic pursuits, particularly those most accessible to busy clinicians. It also 211

includes leadership development, adaptations amidst COVID-19, and opportunities to interface with national and international leaders. We purposely invite female speakers and those from “underrepresented in medicine” groups to provide the faculty with a range of role models. Faculty Centralized Input System Our electronic system was designed as a centralized hub to support faculty members in various areas: professional development, recruitment, wellness, burnout and others. The centralized system contains the Faculty Annual Review Form, Faculty Experience Survey, Candidate Evaluation Form for recruitment, Physician Self-Care Survey, feedback forms from hosted programs and other resources. Diversity Data The Department of Surgery follows the guiding principle that diversity, equity and inclusion (DEI) work is embedded, not delegated. We believe in the value of diverse opinions and backgrounds contributing to the richness of our culture and decision-making process. We feel that many of our decisions and their subsequent actions will ultimately be strengthened by viewing the situation from a DEI perspective. Diverse leadership improves decisions. Since 2017, Dr. Doherty has created a diverse group of eight vice chairs. In that time period, the department has also hired five new division chiefs, each adding to the diversity of our department leadership. We have also paid close attention to Black, Hispanic and female representation among our endowed chair recognitions. Most recently, the department obtained funding to inaugurate two new chairs, appointing Zara Cooper, MD, MSc, as the inaugural Michele and Howard J. Kessler Distinguished Chair in Surgery and Public Health at Brigham and Women’s Hospital; and Ali Salim, MD, the inaugural BWH Distinguished Chair in Surgery at Brigham and Women’s Hospital. These are the first Black surgeons at the Brigham to hold endowed chairs Exhibit 32: Current Department Leadership by Ethnicity Ethnicity Dept. Hospital ACGME Endowed Total Leadership Program Chairs Leadership Leaders Directors 3 3 4 Asian 5 0 0 2 2 Black 3 1 0 2 31 Hispanic 1 0 0 13 24 Non-Hispanic 19 5 7 10 33 White 12 4 7 15** TOTAL 20* 5 7 * 23 roles - 3 hold dual roles ** 2 Open Chairs 212

Exhibit 33: Department Leadership Ethnicity Breakdown Dept. Leadership Ethnicity Breakdown 35 Asian Black Non-Hispanic Hispanic 30 25 20 15 10 5 0 White Dept. Leadership (Chair, Vice Chairs, Division Chiefs, Center Directors) Hospital Leaders ACGME Program Directors Endowed Chairs Total Leadership Exhibit 34: Current Department Leadership by Gender Gender Department Hospital Leaders ACGME Program Directors Endowed Chairs Total Leadership Leaders Male 15 3 5 10 23 Female 5 2 2 5 10 Dept. Leadership by Gender Total Leadership Endowed Chairs ACGME Program Directors Hospital Leaders Dept. Leadership (Chair, Vice Chairs, Division Chiefs, Center Directors) 0 5 10 15 20 25 Female Male 213

Among our residents and trainees, we are also focused on maintaining a diverse and inclusive group. Exhibit 35: Residents and Fellow by Gender 2021-22 RESIDENTS AND FELLOWS BY GENDER Male Female 52% 48% Exhibit 36: General Surgery Residency Program - Underrepresented in Medicine (URM) 2021-22 GENERAL SURGERY RESIDENCY UNDERREPRESENTED IN MEDICINE URM 16% NON-URM 84% 214

Initiatives for Diversity, Equity and Inclusion (DEI)/Underrepresented in Medicine (URM) • As part of the department’s response to the police brutality events of 2020, a tablet-based resource was developed to help address the needs of faculty members who identify as part of a group underrepresented in medicine (URM). The content was based on interviews of DOS faculty, experts in the experience of people of color (both at Mass General Brigham and beyond), our Brigham leaders in the Center for Diversity and Inclusion, our Mass General Brigham human resources colleagues and others. The resources provided were a direct result of needs which URM faculty members expressed in confidential one-on-one interviews. This initiative also included an anonymous survey where URM faculty members could share any unfavorable interactions they had experienced. • To provide ongoing support for our URM faculty, the DOS hosts quarterly Zoom meetings. Within this series, for example, we invited Gezzer Ortega, MD, MPH, a DOS faculty member with experience discussing works of art. Dr. Ortega, led a session using visuals to begin conversations and understand colleagues more in depth. In addition, we also hosted a meeting to review data regarding the faculty experience which was specific to URM faculty. • To support our female faculty, we started a series of Female Faculty Listening Sessions to review the BWPO wellness survey results and discuss needs specific to the female faculty. Concerns are forwarded to leadership to address. In response, for example, there is an ongoing salary assessment which evaluates the female factor as a predictor variable. In addition, female- specific modules have been developed within the Faculty Experience Survey. • To foster an environment where we discuss diverse topics and opinions, the OPD intentionally invites speakers from a variety of backgrounds. We have had international speakers from the Philippines and Brazil. We have hosted URM and female speakers and facilitators, researchers, surgeon leaders, administrative experts, among others. Anticipated Retirements/Departures Career transition plans are part of every annual review, and are a specific discussion for all surgeons over 60 years of age, as they enter the last phase of their clinical career. We've used guidance from the Society of Surgical Chairs position paper on managing aging surgeons, and make deliberate plans for career transitions and for recruiting successors. Currently, there are no anticipated departures or retirements. 215

D. COMMUNICATION WITH FACULTY The department strives to maintain a transparent line of communication with faculty members. In addition to standing faculty meetings (which include all faculty members) and advisory council meetings (which include the chair, vice chairs, division chiefs and senior staff), departmental committee meetings and division meetings, the Department of Surgery leadership team communicates with members of the department using a variety of mediums. Some examples include: • Office hours – Dr. Doherty holds weekly office hours, which allow faculty members (and trainees) a casual and informal space to drop by, have lunch and catch up. • Monday morning email – This is a weekly email from Dr. Doherty to faculty, trainees and staff with pertinent information such as news from the previous week, important reminders, and upcoming lectures and events. An example of a “Monday morning” email can be found below. • Department emails and personal communications – The department also utilizes several separate mailboxes each week to disseminate real-time updates and information. 216

E. NAMED CHAIRS Exhibit 37: Brigham Distinguished Chairs Distinguished Chair Name Current Incumbent The Professor Walter Morris-Hale Graeme Steele, MD Distinguished Chair in Urologic Research The Rob and Karen Hale Distinguished Elizabeth Mittendorf, MD, PhD Chair in Surgical Oncology The Crowley Family Distinguished Chair Gerard Doherty, MD in the Department of Surgery The John A. Mannick Distinguished Chair C. Keith Ozaki, MD in the Department of Surgery BWH Distinguished Chair in Cancer Care Chandrajit Raut, MD, MSc The Roberta and Stephen R. Weiner Matthew J. Carty, MD Distinguished Chair in Surgery Joseph E. Murray Distinguished Chair in Stefan Tullius, MD, PhD Transplant Surgery The Fredric G. Levin Distinguished Chair in Thoracic Surgery and Lung Cancer Raphael Bueno, MD Research The Cynthia and John F. Fish Atul Gawande, MD, MPH Distinguished Chair in Surgery The Department of Surgery Distinguished Ravindra Uppaluri, MD, PhD Chair in Otolaryngology Steven C. and Carmella R. Kletjian Foundation Distinguished Chair in Robert Riviello, MD, MPH Global Surgery BWH Distinguished Chair in Surgery Ali Salim, MD DiNovi Distinguished Chair in Urology To be named Michele and Howard J. Kessler Distinguished Chair in Surgery and Public Zara Cooper, MD, MSc Health Canepari Family Distinguished Chair in Scott Swanson, MD Thoracic Surgery 217

Exhibit 38: Harvard Medical School Professorships F. FACULTY HONORS/AWARDS Many faculty members in the Department of Surgery hold important leadership roles at the Brigham and across Mass General Brigham. They also hold leadership positions in prestigious institutions and societies that are responsible for a lot of the innovation occurring in surgery today. Below, are some of the top honors and awards that have been bestowed on faculty members within the last five years. Exhibit 39: Faculty Honors/Awards by Year 2016 Division Honor/Award Institution Faculty Member Stan Ashley, MD ​ GGI President Society for Surgery of the Alimentary Tract​ Reza Askari, MD ​ TBSCC Richard E. Wilson Award for Excellence​ Brigham and Women's Hospital President-Elect American Society of Clinical Oncology​ Monica Bertagnolli, MD ​ OSS International Association of Endocrine President-Elect Surgeons Gerard Doherty, MD​ GGI Association for Academic Surgery​ President-Elect Adil Haider, MD​ TBSCC Eric Sheu, MD, PhD ​ GGI Eleanor and Miles Shore Junior Faculty Award​ Harvard Medical School Douglas Smink, MD, MPH ​ GGI Editor-in-Chief Journal of Surgical Education 218

2017 Division Honor/Award Institution Faculty Member GGI Executive Committee ACGME Board Stanley W. Ashley, MD TBSCC Student Clerkship Director Brigham Department of Surgery Reza Askari, MD Plastics Bernard Lown Teaching Award Harvard Medical School Stephanie A. Caterson, MD ​ Plastics Chair Northeastern Society of Plastic Surgeons Yoon S. Chun, MD Elected Trustee BWPO Department of Surgery Yolonda L. Colson, MD, PhD Thoracic Zara Cooper, MD, MSc​ Board of Directors American Association for Thoracic Surgery ​ Gerard M. Doherty, MD TBSCC Editorial Board Annals of Surgery Atul Gawande, MD, MPH ​ Adil Haider, MD, MPH GGI President International Association of Endocrine Tari A. King, MD Surgeons Sayeed K. Malek, MD Michael O’Leary, MD GGI Honorary Doctorate of Science and McGill University Commencement Speaker Ali Salim, MD TBSCC President Association for Academic Surgery 2018 Surg Onc Fellow American Surgical Association Transplant Director HMS Global Surgery Leadership Program Urology Elected Chair/President Boston Athletic Association Board of Governors 50+ Most Influential People of Color in Life Boston Business Journal Science and Health Care TBSCC Member Brigham Health Board of Trustees​ 219

2019 220

2020 221

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Department of Surgery Finances A. OVERVIEW Over the past five years, the Department of Surgery (DOS) has sustained its historically strong financial performance, while continuing to grow within the walls of the Brigham and beyond. • Both revenue and expenses increased between FY17 and FY21, and the department met its margin requirement every year (excluding FY20 when the requirement was waived for all departments). • Major financial funds flow changes have clearly defined the division as the fundamental business unit of the department, which has led to enhanced financial performance, especially in the area of expense management. • A complete overhaul of the DOS compensation plan was fully implemented in FY20, which furthered the concept of the division as a group practice. In addition, elements of equity and opportunity were added for the participating faculty members. • The DOS maintained hiring to support increased volume and other demands on the divisions. B. BWPO OPERATING PERFORMANCE Over the past five years, with the exception of FY20, the DOS has met its margin target each year, signaling the strength and stability of the department finances. While the department typically manages its finances to achieve margin targets precisely, the target was exceeded in FY21, primarily from significant CME-related expense savings due to a reduction in face-to-face professional meetings/travel. Exhibit 40: BWPO Revenue and Expenses for the DOS (in thousands) FY17 FY18 FY19 FY20 FY21 85,560 105,836 NPSR $ 91,246 $ 94,262 $ 97,406 $ 43,378 $ 46,011 Other Revenue $ 151,847 Total Operating Revenue 30,818 34,631 37,366 128,938 $ 122,064 $ 128,893 $ 134,772 $ MD Comp $ 55,111 $ 57,741 $ 60,703 $ 61,505 $ 73,053 Non-MD Comp 26,031 28,501 30,956 27,963 29,856 Employee Benefits 17,430 18,151 18,867 18,642 21,121 Supplies 2,218 2,523 2,806 2,127 3,170 Corporate Operating Services 3,766 3,833 2,815 3,044 3,307 Utilities 408 393 413 406 388 Space Related Cost 2,518 2,643 2,779 2,812 2,824 Purchased Prof Services 1,290 1,465 2,005 2,151 2,601 Equipment Related Exp 276 400 567 619 158 Other 10,275 10,324 9,849 8,651 9,273 Depreciation 249 254 258 341 433 Total Operating Expenses $ 119,572 $ 126,228 $ 132,018 $ 128,261 $ 146,184 Income (Loss) from Operations $ 2,492 $ 2,665 $ 2,754 $ 677 $ 5,663 223

Exhibit 41: BWPO DOS Net Income (in thousands) BWPO Revenue Total DOS revenue increased by 25% over the past 5 years, from $122 million in FY17 to $152 million in FY21. Net patient service revenue increased by 16% during that same time period, driven largely by increased volume year-over-year, including a strong bounce-back year post COVID-19 in FY21. Other revenue (non-patient service revenue) increased by 49% during the same time period, primarily due to: • An increase in support from the Brigham related to surgeon and physician assistant hires • Higher contract revenue from network sites and Dana-Farber Cancer Institute (DFCI) • CARES Act funding of $1.2 million in FY21 Exhibit 42: DOS Total Revenue Trends (in thousands) 224

BWPO Expenses Total DOS expenses increased by 22% between FY17 and FY21, from $120 million to $146 million. This increase was mainly driven by major changes in the physician compensation plan starting in FY20, on top of average faculty member salary increases since FY17, as well as faculty hires over the past three years. Non-MD compensation increases were also included and are due in large part to significant physician assistant and staff hiring over the past two years to accommodate the growth in the number of faculty members and clinical volume. With staffing being the largest component of our expense base and driving much of the year-over-year increase, non-personnel expenses only increased by 5% from FY17 to FY21. We had unwelcome significant savings in CME-related expenses (travel, food, transportation, etc.) in FY20 and FY21 due to travel restrictions related to the COVID-19 pandemic. Exhibit 43: DOS Total Expense Trends (in thousands) BWPO Full-Time Equivalents DOS Full-Time Equivalents (FTEs) increased by only 4% from FY17 to FY21. Although there was an overall increase in surgeon hires (9%) over the past few years, as well as physician assistants (20%), there was a decline in clerical staff. This is likely a direct result of the implementation of the new physician compensation plan in FY20, which gave the divisions more autonomy to change their business model (e.g., surgeon to assistant ratios). Overtime usage also dropped by 50% from FY19 to FY21 due to a department-initiated effort to encourage the divisions to appropriately reduce overtime expense. 225

Exhibit 44: DOS FTE Trends FY17 FY18 FY19 FY20 FY21 122.6 128.5 130.0 128.3 133.1 MD 1.2 0.1 0.1 0.6 2.1 PhDs 10.7 11.0 8.1 5.3 3.5 Fellows 5.5 5.8 5.6 6.4 7.8 RN 127.7 134.6 144.1 150.3 152.9 Non-RN Patient Care 64.2 63.8 73.6 69.9 80.9 Professional 154.5 154.7 149.4 148.6 135.7 Clerical 0.9 0.0 0.0 0.0 0.3 Service 13.6 14.5 14.6 9.7 7.0 Other 500.9 513.0 525.5 519.2 523.2 Total FTEs 2.42% 2.44% -1.21% 0.78% % Increase/(Decrease) C. BWH OPERATING SUPPORT The Brigham supports DOS programs through several hospital cost centers, with the majority of hospital support coming in two forms: direct salary support to faculty with hospital administrative roles, captured in the “Salaries and Wages” category in our financial statements; and indirect support reflected in the “Other” category. Specific examples of indirect hospital support are as follows: • Residents and fellows • PAs, RNs and perfusionists • Trauma call payments • Backstop support for new faculty (deficit split 50/50 between DOS and BWH) Additionally, Oral Medicine, one of the 11 DOS divisions, is financially housed by the hospital (instead of the BWPO) for two reasons: DMDs are not BWPO employees, and the division’s billing requirements fit better with hospital billing. Other than a dip in FY18 and FY20, revenue has increased at a greater percentage than expenses, resulting in higher positive margins. The division continues to look for ways to expand their clinical presence in the hospital and across the network. As our faculty and support staff have grown, so too has hospital support for new faculty backstops – a major driver of the increase in BWH support over the past five years. A breakdown of hospital support to the department over the past five years is shown in Exhibit 45. 226

Exhibit 45: BWH DOS Operating Support (in thousands) FY17 FY18 FY19 FY20 FY21 Patient Service Revenue $ 2,027 $ 1,855 $ 2,020 $ 1,725 $ 2,468 Other Revenue - 11 - - - BWH Total Operating Revenue $ 2,027 $ 1,866 $ 2,020 $ 1,725 $ 2,468 Salaries and Wages $ 12,687 $ 13,346 $ 14,003 $ 14,567 $ 16,930 Benefits $ 3,668 $ 3,759 $ 3,930 $ 4,051 $ 4,811 Supplies Utilities 104 125 91 112 105 Space Related Costs 80 75 76 77 78 Purchased Professional Service 13 - - - - Equipment Related Expense 512 504 1,574 1,468 2,042 Other 39 40 29 47 135 BWH Total Operating Expenses 15,833 17,865 17,577 22,368 24,232 32,936 35,714 37,280 42,690 48,333 Exhibit 46: BWH DOS Total Operating Expenses (in thousands) 227

Hospital Supported Full-Time Equivalents Brigham-supported FTEs have increased by 17% from FY17 to FY21 primarily due to the reduction in resident recoveries. We have decreased the number of our residents rotating at other institutions. Exhibit 47: Hospital Supported FTE Trends MD FTEs FY17 FY18 FY19 FY20 FY21 Fellows FTEs 7.7 8.4 8.5 6.9 9.2 Residents FTEs 8.9 Rotating Residents FTEs 15.8 17.0 15.2 12.8 MD Group 102.5 101.7 101.8 102.2 104.9 - RN Regular FTEs 3.1 3.5 1.5 - RN Overtime FTEs 129.1 130.6 127.0 121.9 123.1 RN Temps FTEs RN Group 1.0 1.0 1.0 1.0 1.0 0.0 - - - - NonRN Patient Care FTEs - - - 0.0 - Clerical FTEs 1.0 1.0 1.0 1.0 1.0 Professional FTEs Other Overtime FTEs 4.2 5.1 5.7 5.6 13.1 Other Temp FTEs 1.7 1.2 1.4 1.3 1.2 NonRN Group 14.0 13.6 14.6 15.1 16.4 0.1 0.1 0.2 0.2 1.0 Other Recoveries FTEs 0.1 0.8 0.8 0.2 - Res Recoveries FTEs 20.0 20.9 22.6 22.3 31.7 Misc Group FTEs (3.7) (3.9) (4.6) (4.4) (4.2) Grand Total FTEs (29.5) (27.7) (20.2) (15.7) (15.3) (33.2) (31.7) (24.8) (20.2) (19.5) 116.9 120.8 125.8 125.1 136.3 D. CAPITAL EXPENSES Over the past five years, the department has invested significantly in the needs of the DOS clinics. The DOS has allocated approximately $1.9 million toward capital expenditures in that time, in order to address the needs of clinical operations across the department. Examples of large investments include rhinoscopes for Otolaryngology and cystoscopes for multiple clinics in Urology. Some investment has been made to renovate existing clinic space as well. Exhibit 48: DOS Capital Expenditures (in thousands) FY17 FY18 FY19 FY20 FY21 Total Equipment $ 287 $ 375 $ 66 $ 769 $ 326 $ 1,823 Construction Grand Total - 67 67 $ 287 $ 442 $ 66 $ 769 $ 326 $ 1,890 228

The DOS also receives capital support from the hospital, which usually takes the form of clinic and office space renovations. Some hospital-funded projects over the past five years include new administrative and renovated clinic space for Otolaryngology, with funds also budgeted for a new Plastic Surgery clinic renovation. E. HARVARD MEDICAL SCHOOL FUNDING Annually, the Department of Surgery has access to about $2 million of surgery endowment income that is managed by the Harvard Corporation. These dollars are used to support eight named chairs, lectureships, and basic science research efforts across the department. DOS surgeons also teach in first- and second-year HMS courses, as well as the Principle Clinical Experience and Advanced Experience courses, and are paid by HMS for their efforts. Exhibit 49: Harvard Medical School DOS Support (in thousands) Endowment Support FY17 FY18 FY19 FY20 FY21 Total Teaching Support $ 1,969 $ 1,996 $ 2,053 $ 2,124 $ 2,026 $ 10,168 Total HMS Support 659 549 564 561 583 2,916 $ 2,628 $ 2,545 $ 2,617 $ 2,685 $ 2,609 $ 13,084 F. RESEARCH FINANCES Research expenditures in the Department of Surgery totaled $38.2 million in FY21, compared to $40.4 million in FY20 and $40 million in FY19. The decrease in research revenue from FY19 and FY20 to FY21 was driven by COVID-19, and it should be noted that direct-cost revenue actually increased during this period. For more information regarding the DOS research program, please refer to the Research section of this report. G. PHYSICIAN COMPENSATION PLAN The current DOS compensation plan was fully implemented on October 1, 2019 (FY20), which aimed to address some longstanding issues and also provide new opportunities for our faculty. The overall aims of the new plan are: • Maintain an emphasis on clinical productivity while recognizing and compensating for non- clinical work (administrative roles, research) • Compensate faculty members for work performed, irrespective of payer mix or site of practice • Provide incentives for individual and group productivity • Reward faculty for promotion and enable academic productivity • Enhance life and career opportunities through the creation of a part-time faculty status, mid- career sabbatical opportunities and clear parental/medical leave benefits 229

• A transparent plan that is simple to understand • A system for regular communication about compensation through the year • A nimble plan that is able to adapt to changing demands and market uncertainty • A division incentive component to incentivize efforts in support of the Brigham, DOS and Division goals and strategy The former compensation plan, structured as an individual faculty member P&L model, had been in place for decades and was determined to be incompatible with these academic, financial and faculty development goals of the department. Design of New Plan • Base salary o $200,000 base salary with $15,000 increases per Harvard promotion, plus $1,000 per year increase in rank (up to 10 years), plus 85% projected productivity-based incentive compensation for the year • Incentive-based compensation o Two wRVU productivity tiers with different $/wRVU rates, which reward faculty members for RVU generation once a surgeon’s portion of shared expense is covered o 2% of division revenue set aside for individual and divisional goals • Encouraging and incentivizing group practice o Stated base expectations o Clear RVU targets prorated for supported non-clinical time o Individual/divisional incentives set by the division chief o Standard $/wRVU rates for each division eliminates ability to manipulate payer mix • Other Compensation Components o Standard BWH disability and retirement benefits o Up to $10,000 per faculty member per year for continuing medical education expenses o Establishment of “part-time” status for faculty members and development of mid- career sabbatical opportunities • Managing Under-Performers o Following monthly productivity reporting from DOS Finance Office, division leadership has ample opportunity to intervene and discuss ways to improve productivity 230

• Managing Over-Performers o Productivity is also reviewed with respect to the 90th percentile benchmark for RVU generation. As a faculty member approaches the 90th percentile, a meeting is triggered to assess quality, safety and sustainability at the level of productivity • Annual Review Process o The annual review process has been enhanced to include explicit discussion about monthly compensation, productivity targets (wRVU), incentive compensation rates ($/wRVU), and division goals Modular Design Surplus accrues to division and can be distributed as bonus Individual/Division Incentives - division chiefs set goals for group Direct supplemental pay for specific roles or work Productivity tiers 1 and 2 are levels of incentive compensation, where RVUs generated determine incentive payments Base pay is minimum pay for a full- time surgeon in DOS 231

Faculty Compensation Compared to National Benchmarks For those faculty in the Department of Surgery compensation plan, our goal is to compensate at or above the AAMC 75th percentile for compensation, per specialty and rank, for productivity at the median national benchmark (CPSC) for each specialty. Exhibit 6.11 reflects this effort across all Harvard Medical School ranks and all DOS divisions. We are fortunate to be able to support this level of compensation across nearly all the divisions. Active discussions are underway with the Brigham to support bringing the Division of Thoracic Surgery closer to the 75th percentile for median productivity. Exhibit 50: DOS Faculty Compensation Compared to AAMC 75th Percentile Surgical Instructor Assistant Professor Associate Professor Professor Division Average AAMC 75th Average AAMC 75th Average AAMC 75th Average AAMC 75th Breast $ 459,422 $ 400,000 $ 860,737 $ 566,000 Cardiac NA $ 369,000 1,076,296 606,000 NA $ 467,000 General & GI NA 390,000 NA 845,000 NA 1,018,000 Oncology $ 471,017 326,000 486,274 425,000 $ 419,910 518,000 357,546 598,000 Otolaryngology NA 369,000 403,588 400,000 572,510 467,000 634,324 566,000 Plastics 428,890 315,000 467,535 418,000 351,704 553,000 NA 618,000 Thoracic 509,084 438,000 796,843 492,000 968,200 698,000 720,040 800,000 Transplant 314,039 390,000 345,732 606,000 NA 845,000 526,449 1,018,000 Trauma/Burn/Critical Care NA 280,000 515,352 394,000 NA 580,000 775,188 694,000 Vascular 497,939 441,000 709,583 448,000 399,937 506,000 NA 564,000 Urology 511,599 404,000 707,475 461,000 474,276 530,000 544,088 596,000 363,423 345,000 455,535 424,000 430,565 511,000 327,128 632,000 232

Resources A. SPACE: CLINICAL, RESEARCH, ADMINISTRATIVE Within the scope of Brigham and Women’s Hospital, faculty and staff execute on the missions of the department across multiple locations: • BWH Main Campus (BWH) • Brigham and Women’s Faulkner Hospital (BWFH) • Foxborough Health Care Center • Pembroke Health Care Center • Westwood Health Care Center • Dana-Farber/Brigham Cancer Center - Main Campus and Chestnut Hill In addition to BWH-owned/operated facilities, our surgeons also provide care for patients in local communities. More information on these locations can be found in the Network section of this report. Clinical and Administrative Space The department operates within approximately 80,000 square feet across the distributed BWH campus, which includes clinics, faculty offices and administrative space. While the size of the department has grown significantly over the past decade, we have not seen commensurate growth in space. In general, our divisions have sufficient clinic space in which to work, but office space for a few faculty members is now particularly challenging. On the BWH main campus, most ambulatory care takes place in clinics run by the DOS. General and Gastrointestinal Surgery (GGI), Surgical Oncology and Trauma/Burn all see patients in a shared general surgical specialties clinic. The Cardiac Surgery and Vascular and Endovascular Surgery divisions see patients in the multidisciplinary Shapiro Cardiovascular Center, which is run by the Department of Medicine on behalf of the hospital. Breast Surgery, Oral Medicine, Otolaryngology, Plastic and Reconstructive Surgery, Thoracic Surgery, Renal Transplant and Urology each have their own dedicated clinics on main campus. 233

Proximate to the BWH main campus is the Dana-Farber Cancer Institute (DFCI), where the majority of Breast Surgery, Otolaryngology and Surgical Oncology patients are seen; Colon, Thoracic Surgery and Urology each also have a regular presence, as part of DF/BCC. Recently our multidisciplinary clinics have expanded to a nearby DF/BCC community setting known as Chestnut Hill. Each of our divisions has administrative office space on the main campus, with the majority of Surgical Oncology and Breast Surgery faculty offices located within DFCI. Adequate faculty office space to accommodate our growing divisions continues to be a challenge for the department. The DOS will need to continue to find creative ways to meet the needs of our faculty, with hopes that a hospital-wide solution for all academic department administrative office needs is in the offing. At BWFH, our divisions of Plastic and Reconstructive Surgery, Otolaryngology and Urology run their own dedicated clinics, with GGI operating a clinic where Surgical Oncology and Vascular also practice. GGI, Plastic Surgery and Urology each have administrative office space at BWFH. As for our community-based health care centers, Foxborough hosts Otolaryngology and Urology with dedicated clinic space, while GGI, Plastic and Reconstructive Surgery, Surgical Oncology, Thoracic Surgery and Vascular Surgery have smaller but regular presence in shared clinic space. The newer locations of Pembroke and Westwood each have a small presence of GGI and Urology. Exhibit 51: Department of Surgery Clinical and Administrative Locations – Offsite Health Care Centers 234

Research Space The Department conducts its research in wet lab and dry research space on or near the BWH main campus, with clinical trials taking place at both BWH and BWFH. While research space is a scarce resource across the institution, the DOS has been successful in finding suitable research space for new faculty recruits or expansion needs for our existing faculty. The Department of Surgery currently occupies 35,968 square feet of assigned research space. For more detail on the DOS research footprint, please see the Research section of this report. B. MAJOR EQUIPMENT The DOS has many pieces of major research equipment spread throughout our various labs and care areas across the institution. A categorized sampling of this equipment is shown here: • General Lab o Flexcell Tension System • Microscopy o Olympus FV3000 Confocal Microscope • Quantification o Luminex MAGPIX Analyzer System o Molecular Devices M3 Multimodal Microplate Reader o Agilent Seahorse Mini Analyzer o QuantStudio 6 RealTime PCR o 10x Genomics Gene Expression Analyzer o Flow Cytometer • Imaging o Biotek Cytation 5 Cell Imaging Multi Mode Reader • Surgical o Intuitive Xi Surgical Robot (Thoracic Surgery) In addition to research equipment, the department also has access to major equipment in the ORs, which include: • Surgical robots o BWH main campus (3) o BWFH campus (1) • “Pheno” hybrid operating room imaging device • Operative microscopes (4) 235

C. FUNDRAISING The Brigham and Women’s Hospital Department of Surgery works in collaboration with the Brigham Development Office to engage donors, community members and grateful patients to secure philanthropic support for our many robust clinical and research initiatives. Over the past five years, the Development Office has added significant resources to ensure strong partnerships with faculty and staff within the department. Development Office team members meet regularly with division faculty, attend periodic departmental meetings, and work with individual physicians to cultivate and steward donors, deepen donor engagement and increase philanthropic support. Major Gifts Thornton Gifts Michael and Amy Thornton have donated $6 million over the past five years to support the International Mesothelioma Program (IMP). The IMP is a clinical treatment paired with a robust research and sequencing program that is the largest of its kind focused on mesothelioma. The program is dedicated to developing novel treatments and expanding tumor banking and research for this orphan disease. Additionally, it provides access to on-campus housing for mesothelioma patients and their families who are traveling great distances to receive treatment. Canepari Gifts The Caneparis made several gifts totaling $2.8 million in support of Thoracic Surgery. During the pandemic, the donors’ gifts were used to purchase new technology and machines, such as ECMO and other operating room equipment, that could be used both to help patients during the COVID-19 pandemic, and to support a wider variety of surgical needs. In addition, the donors are funding the Canepari BWH Distinguished Chair in Thoracic Surgery. Scott Swanson, MD, will be the first incumbent of the chair, which was celebrated in February 2022. Corporate and Foundation Relations Corporate & Foundation Relations (C&F), within the Development Office, primarily focuses on raising money for strategic priorities that align with the interests of foundations and corporations. Funding from institutional sources requires a coordinated approach to solicitation and stewardship to maximize support. Working in collaboration with department administrators, as well as the Office for Interactions with Industry (OII) and Research Management, the C&F team connects researchers and programs to sources of external funding support. C&F works closely with faculty at all stages of their careers by securing support from non-governmental sources. Significant corporate and foundation gifts are described below. 236

Gates Foundation The Gates Foundation has donated more than $10 million to support Atul Gawande, MD, MPH, and Ariadne labs, a joint center for health systems innovation at Brigham and Women’s Hospital, and the Harvard T.H. Chan School of Public Health. The goal of the program is to equitably improve care for patients everywhere, while fostering international collaborations and establishing global standards of measurement in more than 170 countries, touching hundreds of millions of lives. Jack Satter Foundation The Satter Foundation donated $3 million to support the Stepping Strong Center for Trauma Innovation. The center is dedicated to inspiring research and collaborations across medical disciplines and institutions, while providing funding to talented physician-scientists, all with a goal of transforming trauma care for civilians and military heroes who suffer from devastating traumatic injuries. Their core work focuses on trauma innovation and injury prevention and intervention. Development Staffing and Revenue The addition of three major gift officers allowed the Development team to take a more specialized division- and disease-based approach to fundraising within the Department of Surgery. This has led to stronger relationships with donors and stronger partnerships with physicians. The ability to specialize has led to an increase in donor conversations and new gifts in areas such as Breast Surgery, Surgical Oncology, Transplant Surgery and Urology At the close of FY21, the Development Office completed the largest campaign in the history of Brigham and Women’s Hospital, raising $1.75 billion. During the Life. Giving. Breakthroughs. Campaign, one HMS professorship and 17 new endowed chairs were created in the Department of Surgery. In the final five years of the campaign, more than $124 million in philanthropy was raised for the DOS, and 12 out of the 17 endowed chairs were established during that same period. Future Direction The Development team will continue to expand their successful major gift-grateful patient fundraising paradigm and build additional partnerships with physicians in the Department of Surgery. In the current competitive health care fundraising environment, a high level of collaboration with physicians will be necessary to ensure quick and appropriate outreach to prospects and donors and to secure increased support for departmental clinical and research projects and significant transformational gifts. 237

Our goal for FY22 and beyond is to continue to increase philanthropic revenue for the department in each fundraising area – Major Gifts, C&F, Planned Giving, Annual Giving and Events – to cumulatively raise a minimum of $30 million per year. Exhibit 52: Department of Surgery Giving by Fiscal Year, 2017—2021 Department of Surgery Giving by Fiscal Year $30,000,000 $27,088,970 $24,759,569 $25,107,172 $25,000,000 $23,527,950$23,980,463 $20,000,000 $15,000,000 $10,000,000 $5,000,000 $0 FY17 FY18 FY19 FY20 FY21 Annual Giving Corporate/Foundation Events Major Gifts Planned Giving D. COMMUNICATIONS/MARKETING/MEDIA RELATIONS Department of Surgery Communications In 2016, the Department of Surgery created its own internal communications structure to support the overall communications needs of the department. The team consists of a director of Communications, who brings 15 years of academic medical center communications, marketing and media relations experience to the role; and a communications specialist with a general communications background in addition to technical editing/publishing, web development and graphic design skills. 238

DOS Communications is responsible for the strategy and execution of all department communications. The team works closely with both hospital leadership and departmental leadership to shape the image and values, as well as the appropriate methods to communicate them, while identifying opportunities and developing content to be distributed via many communication vehicles (web, social media, newsletters, press releases and other distribution channels). Additionally, the team serves as the department brand ambassador and promotes our mission, brand, services and people, while ensuring messaging and visual identity aligns with key business strategies and brand guidelines. The department communicates on a nearly daily basis with faculty members, trainees, PAs and staff utilizing several mailboxes to deploy relevant messaging from, including: • Operations Mailbox: For all operational updates • Surgery News Mailbox: For major news items, general DOS updates and non-academic event information • Education Mailbox: For communication to trainees • Alumni Mailbox: For communications with DOS Alumni (former trainees and faculty members) • Grand Rounds Mailbox: For event information and calendar invites • Office of Professional Development Mailbox: For OPD newsletter, updates and events • Center for Surgery and Public Health Mailbox: For CSPH newsletter, updates and events Monday Morning Email This weekly email from Dr. Doherty is sent to faculty, trainees and staff to provide pertinent information such as news from the previous week, important reminders, upcoming lectures and events. This email goes out at the beginning of every week, year-round. Annual Meeting The DOS holds an Annual Meeting at the beginning of each calendar year, retrospectively looking back at the previous calendar year. This meeting comprehensively highlights: • Faculty Recruitment, Promotions, Honors and Achievements • Clinical Care • Education • Research • Financials including Development/Philanthropy • Goals for the following year 239

Annual Report The DOS develops an Annual Report each academic year that goes out internally within the Brigham and MGB network and out externally to more than 8,000 individuals at HMS, DFCI, Brigham DOS alumni, donors and VIPs, as well as to academic surgery chairs and departments around the country. (These reports can be viewed in Appendix 5.) Web and Social Media DOS Communications manages, in collaboration with MGB Marketing, the Brigham and Women’s Hospital consumer website for all DOS pages. In addition, they support numerous WordPress websites, including our SurgeryNews site; Office of Professional Development (OPD) website; and Research website. DOS Communications manages the department’s email marketing platform (Mailchimp) and also manage the department Twitter account, which has more than 8,100 followers, while overseeing numerous other social media channels throughout the divisions and education office. In addition to managing the Department of Surgery communications strategy, the DOS Communications team also works closely with the Brigham Office of Strategic Communication (OSC), including the Media Relations team, on press plans and media opportunities. Brigham and Women’s Hospital Office of Strategic Communication The Brigham Office of Strategic Communication (OSC) oversees internal communications and media relations for more than 18,000 employees and medical and research staff. Enterprise Communication The Enterprise Communication team is comprised of experienced health care writers, editors and campaign managers who strive to keep the Brigham community informed, inspired and engaged. Serving as an in-house journalism team capturing hospital-wide news, features and need-to-know information, Enterprise Communication writes, produces and manages several weekly and monthly broadcast and targeted publications. The team also advises on communication planning and messaging for various hospital-wide and priority initiatives, and provides communication guidance alongside editorial support to hospital leaders, faculty and staff across the hospital. • Internal Publications, Campaigns and Channels • PikeNotes Intranet • Digital Signage • Lobby Displays • Emergency Communications Media Relations The Brigham Media Relations team responds to thousands of inquiries each year from local, national and international media outlets seeking information on our groundbreaking research, medical 240

milestones and expert opinions on a broad range of health care topics. They manage the News section on the Brigham's website, which includes important awards and honors, and Brigham milestones. They promote new research, respond to breaking news and facilitate expert interviews on various health topics for the media. The team provides hands-on support to all staff who interact with the media, advising and providing research/background information about reporters and media outlets, as well as helping prepare staff for interviews. Mass General Brigham Marketing In 2021, the Brigham and Women’s Hospital Marketing Department was integrated into a new centralized system-wide Marketing Department, overseeing communications and marketing for the Mass General Brigham system. The team is led by Mark Bohen, chief marketing officer, for Mass General Brigham. At this time, we have very little insight into how the team functions or how we at the department-level are impacted. It seems that all marketing plans and initiatives will be focused on strategic service lines throughout the system and those marketing plans and work will be executed by the Mass General Brigham Marketing teams. 241

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Strategic Planning A. CLINICAL STRATEGY MGB System Role Over the past several years, recognizing the emergence of an increasingly competitive marketplace and with an awareness of its potential to better leverage the collective strengths of its constituent hospitals, Mass General Brigham (MGB) made a series of decisions to change its operating model. These changes brought a new, centralized approach to clinical operations across the system. Jeff A. Weiss who serves as Chief Strategy and Transformation Officer at MGB now leads strategic decision-making for the system. The leadership structure also features a central MGB chief operating officer to whom the COOs of both Massachusetts General Hospital (MGH) and Brigham and Women’s Hospital (BWH) report directly. Thus, operational collaborations and decision-making as well as strategic planning for clinical programs are centralized at MGB. While still very much involved in the process, academic departments at BWH and MGH have ceded ultimate decision-rights for clinical strategic planning (other than cancer services as outlined below) to central coordination. Strategic Community Expansion A prime example of MGB strategic planning is the launch of a new organization of community-based ambulatory sites known as MGB Integrated Care, or iCare. BWH DOS leadership is now actively collaborating with both MGH DOS and MGB leadership in the design and clinical staffing of those ambulatory sites. This work will remain a departmental focus over the near term. The intent of the iCare project is to provide distributed sites of service for primary care, imaging and laboratory services, selected subspecialty care and ambulatory procedures. The selected sites for initial iCare expansion are in the areas surrounding Boston where many of our patients live. The sites will be non-hospital licensed, and will provide MGB-care at lower cost than the same care provided by the same clinicians on-campus at either academic medical center. BWH (and MGH) DOS provider involvement is likely to begin with high-volume subspecialties providing low-intensity care that can be completed without visiting Boston. Examples currently being planned include urology, breast care and selected general surgery conditions (e.g., hernias, lumps and bumps, symptomatic gallstones). Programming for these practices, including planning for necessary adjuncts in imaging, for example, is underway. Determination of need evaluation is in process with state regulators. 243

BWH DOS Network Strategy While work is underway to launch this new network of MGB iCare sites, the Department of Surgery continues to manage and expand its own, well-established network of affiliated hospitals in which the DOS faculty practice. For more than 10 years, the DOS has partnered with local hospitals to recruit high quality surgical specialists and to build surgical programs, both of which can be difficult for community hospitals to do on their own. Providing this expertise in these local markets allows hospitals to keep care local whenever possible, which has been an aim of the BWH DOS for many years. We plan to continue to grow and develop our network relationships. While this work primarily involves DOS, the effort is also coordinated through MGB network planning structures. Current DOS network relationships include a substantial cohort of surgeons at South Shore Hospital, where we also have a full general surgery resident team, and perform about 50% of the inpatient operations. We have plans to maintain and expand this relationship. We have smaller numbers of surgeons, often focused in specialty areas such as thoracic surgery or urology, who work in other sites including Milford Regional Medical Center (MA), Kent Hospital (RI), Charlton Hospital (MA), Cape Cod Hospital (MA), Good Samaritan Hospital (MA) and St. Elizabeth’s Hospital (MA). These clinical practice sites are important to DOS to (a) bring Brigham care to communities that might not otherwise have access to specialty care; (b) increase the clinical footprint of DOS to provide practice opportunities that support faculty development; and (c) expand the revenue base for DOS to support its missions. Continued strategic consideration of these opportunities is planned. Dana-Farber/Brigham Cancer Center Strategy The close clinical relationship between Dana-Farber Cancer Institute (DFCI) and BWH has been in place since the mid-1990s, with the BWH DOS playing a major role in its creation and ongoing operations. The relationship between the two institutions remains vibrant and has been recently strengthened through a significant contract restructuring. The continued development of operations on the main campus, combined with the expansion of our combined offerings in the community, will be a significant part of our work in the coming years. Cancer programs strategic planning is necessarily separate from MGB strategic planning, because the Dana-Farber/Brigham Cancer Center is not contained within MGB. Since the Mass General Cancer Center is contained within MGB, strategic planning for these two competitors cannot be coordinated, and so are separated by an internal firewall. Dr. Doherty, with his role as Surgeon-in-Chief at DFCI, is the lead clinical contact from the Brigham in DF/BCC daily activity and strategic planning, and sits on the DF/BCC side of the firewall. Community expansion is an important piece of DF/BCC strategy. Sites of care for DF/BCC currently include the Longwood campus care provided at DFCI and the Brigham, the Brigham and Women’s Faulkner Hospital, the DF/BCC ambulatory site at Chestnut Hill, and Dana-Farber sites at Milford 244

Regional Medical Center, Patriot Place in Foxborough and South Shore Hospital. Additional sites and clinical activity are planned with the same goals for DF/BCC as in iCare – providing high-quality care for patients closer to their homes and within the systems where they receive other care, while expanding the clinical practice and clinical research opportunities for DF/BCC, including BWH DOS. Clinical Service Line Strategy The DOS has been at the forefront of the design and implementation of service lines at both BWH and MGB. Traditionally, clinical operations have been siloed within academic departments; however, service lines are an attempt to reorganize around multidisciplinary patient care. The work to develop, implement and manage these service lines will continue to be a major part of the department’s work over the next several years. One current example of the service lines within the BWH activities is the Center for Weight Management and Wellness. This multidisciplinary effort to provide weight management services to patients has been extremely successful and is targeted for expansion. The service line includes providers from endocrinology, bariatric surgery and gastroenterology, arrayed to provide consultation and care for patients using all available modalities. This has proved especially successful at managing patients in complex situations requiring revision, which are often multi-provider procedures. Other areas of multidisciplinary practice include the Lung Center, and the Heart and Vascular Center. There is a concurrent effort to build service lines across Mass General Brigham, in order to increase the volume of complex care, improve patient access, decrease total medical expense, and maintain high quality care. The best example of a service line in this model so far is Sports Medicine, which involves the departments of orthopedic surgery from BWH and MGH. For DOS, the most advanced example so far is the Cardiovascular Service Line, within which an MGB cardiac surgery clinical service has been established. The goals of harmonized clinical practice, building of unique cross-system subspecialty care, and single-point patient entry are still aspirational, but will be achieved in the coming months and years. Additional strategic targets for MGB service lines may include trauma services, urology and digestive health. Site of Service Optimization Strategy Resource constraints and the pursuit of cost containment and margin enhancement have led leadership at both MGB and BWH to make concerted efforts to provide surgical care for patients at the most appropriate location. Significant progress has been achieved in the Brigham system over the last few years, primarily by moving programs such as breast surgery, bariatric surgery and joint replacement from BWH to BWFH, and moving ambulatory procedures, mainly from orthopedics, to the Foxborough ambulatory site. Ongoing strategic planning to further this process will likely involve utilization of the MGB iCare sites as they become available, as well as the inclusion of other MGB care sites and BWH DOS network partners. 245

Virtual Care Strategy The COVID-19 pandemic has spurred along the adoption of virtual care, and the DOS has widely adopted its use. The department will continue to explore the optimal use of virtual patient care in each practice, as the applicability is not uniform, but it does offer novel opportunities for patient support. This work is led within DOS by the Vice Chair for Digital Health Systems. Surgical Innovation Strategy BWH DOS has a long history of innovations in care; in some cases, doing things first, like the first open heart valve operation and first kidney transplant, and in others as being an early adopter and regional leader, as in minimally invasive surgery. Current innovative efforts include reconsideration of extremity amputation procedures, including the development of the Ewing amputation to provide a dynamic stump that can communicate volitional control of a mechanical prosthesis, and innovative applications of robotic surgery platforms. DOS currently has a research Xi platform in place from Intuitive to support the development of new approaches to thoracic surgery, and is in negotiation for an Sp platform for similar work. The Susan and Stewart Satter Robotic Whipple Surgery Program provides financial support for the implementation of robotic approaches to pancreas surgery. We also have an IRB-approved, BWH supported interdisciplinary program for uterine transplantation that is prepared to launch. DOS will continue to develop support for the innovative approaches to solving patient problems that our imaginative clinicians devise. B. RESEARCH STRATEGY The strategy for enhancing the impact and scale of our research includes optimizing DOS support for the administration of research programs. One goal is to make the application for research funds as frictionless as possible, while we educate faculty members and trainees on optimal approaches to research funding. To this end, we have renovated the research administration process to make it more supportive of the researchers, and partnered with the departments of surgery at MGH and Beth Israel- Deaconess Medical Center to provide annual grants application training. We will continue to support and depend on the six DOS-affiliated research centers to provide research homes for DOS members, to cultivate their work. These are the Patient Reported Outcomes, Value and Experience (PROVE) center, the Center for Surgery and Public Health (CSPH), Ariadne Labs, The Gillian Reny Stepping Strong Center for Trauma Innovation, the Alliance for Clinical Trials in Oncology and the Laboratory for Surgical and Metabolic Research. 246