My philosophy is to avoid the traditional sternum splitting procedure (i.e. saw open the chest) if the same exact cardiac surgical procedure can be done without compromising the long term surgical result (that is true for about half of all patients referred for surgery). All physicians innately recognize that patients fear surgical incisions that are morbid and take a long time to heal. An incision that requires a saw to create is clearly morbid. Developing a less invasive practice is the logical conclusion of these obvious facts, yet 99% of heart surgeons in the US only use open chest incisions to operate on patients referred to them. I also believe that patients need to know the following: there currently exists no ethical or legal imperative for a surgeon that only operates using open techniques to disclose that there is a less invasive alternative to the patient or their referring provider, even they would be appropriate for the less invasive technique with another surgeon.
From 2011 until 2014, Dr. Poston was the Chief of Cardiothoracic Surgery at the University of Arizona. In this role, he developed into the type of leader which could best be summarized as a "pragmatic visionary". The three years for his division under his stewardship demonstrated a track record 8 major innovations that were all new to Tucson and many were new to the country. These innovations and the overall accomplishments of the program at UA are outlined in a presentation available at his website.
Dr. Poston's leadership has become more pragmatic based on lessons learned from leading major change at Tucson and other institutions. He has insisted on each of these innovations being subject to the scrutiny of peer review research and publication. He also focused his efforts on developing and maintaining a high performance team in both the OR and ICU that was able to manage both conventional and less invasive surgery at this highest level. These initiatives required a leader that fosters an environment where team members are willing to speak up about the unique challenges posed by these new programs and patients. He challenges the team to continuously improve safety through regular briefings, debriefings, and rehearsals. (more information about this leadership style is available on his website).
When feasible, Dr. Poston approaches problems with patient care using a multidisciplinary approach to bring the best possible solutions rapidly forward. In general, he has tried to apply the lessons for team management learned from the aviation industry. This approach, termed crew resource management, has yielded dramatic improvements in airline travel and has only recently been adopted to improve surgical safety.
In February 2015, Dr. Poston started his position as chairman of theDepartment of Cardiothoracic Surgery at St. Francis Medical Center. At St. Francis, he has continued his leadership philosophy and developed a robotic heart surgery practice focusing on heart bypass and mitral valve repairs that has quickly become the 5th busiest robotic heart surgery program in the country. The cardiac surgical department that he leads was recently honored by the hospital's "Healing Hands Award".