Kenneth Strachan, Director of Medical Services, North Carolina Specialty Hospital

In an interview with Invest:, Kenneth Strachan, director of medical services for North Carolina Specialty Hospital, discussed the shift toward outpatient specialty care, the growing role of perioperative medicine and AI, strategies for sustainable growth, and the importance of coordinated care. “Ultimately, patients benefit most when care is delivered as a continuous, connected experience rather than a series of isolated encounters,” he said.

What changes have you seen in specialty care over the past year, and how are those changes shaping care delivery at North Carolina Specialty Hospital?

One of the most significant changes we continue to see is the ongoing shift in site of service. Payers are increasingly recognizing that many procedures traditionally performed in hospitals can be safely and effectively delivered in outpatient settings.

For clinicians, this represents a substantial change in perspective. Procedures such as total knee and hip replacements have long been viewed as inpatient hospital-based surgeries for good reason. Being asked to consider these same procedures in an outpatient environment, with patients returning home the same day, naturally raises questions about safety, complications, and whether the hospital remains the most appropriate care setting.

What experience has shown, however, is that success depends on a structured and disciplined approach. Careful patient selection is essential. Not every patient is a candidate for outpatient surgery, but for the right patient with the right clinical profile, outpatient procedures can be both safe and highly effective. As clinicians gain experience and see positive outcomes in appropriately selected patients, confidence grows, and it becomes clear that care delivery can evolve while maintaining a strong commitment to quality and patient safety.

There are also important long-term implications to this transition. Delivering care in the most appropriate setting can reduce overall healthcare costs, creating value for patients and payers while improving healthcare efficiency. It can also help support sustainable growth in procedural volume as demand continues to increase. However, those advantages are only realized when the clinical foundation is firmly established. Appropriate patient selection, standardized processes, and consistently positive outcomes must come first. Cost savings and growth are benefits of doing it right, not the primary reason for making the change.

How is your team evolving its strategies in response to changing patient needs and expectations around care delivery?

We made a deliberate decision to create a more structured and standardized approach to evaluating surgical patients, particularly as the volume and complexity of outpatient surgery continue to grow. That effort led to the development of a dedicated perioperative medicine service designed to ensure patients receive the right care in the right setting.

The evaluation process is intentionally layered. It begins with a comprehensive nursing assessment that establishes the patient’s overall health status and identifies potential areas of concern. Patients then undergo more detailed discussions that clarify medical history, medication use, functional capacity, and other factors that may influence surgical risk. This information is subsequently reviewed by an advanced practice provider or physician who assesses surgical readiness, evaluates comorbid conditions, and determines whether additional optimization is needed before proceeding.

Anesthesia provides an additional level of review, applying specialty-specific criteria to evaluate both the planned procedure and the appropriateness of the proposed surgical setting. Only after these perspectives have been considered and aligned do we move forward with surgery.

The goal of this process is consistency, transparency, and patient safety. Surgeons rely on these evaluations to make informed decisions, and when a patient is not adequately optimized or is not an appropriate candidate for a particular setting, that determination must be communicated clearly and supported by objective clinical reasoning. Success requires close collaboration among surgeons, anesthesia professionals, perioperative clinicians, and nursing staff.

Ultimately, our responsibility is straightforward: to place the right patient in the right setting at the right time. By applying a disciplined and consistent evaluation process, we can expand access to outpatient care while maintaining the highest standards of safety and quality.

How are innovation and technology influencing your work, particularly in perioperative care?

Artificial intelligence has become an increasingly important part of perioperative medicine. Many of the tools clinicians have relied on for years, including risk stratification platforms, clinical decision support systems, and medication interaction databases, now incorporate AI-driven capabilities. Electronic medical records are also beginning to generate summaries and insights that help providers quickly understand a patient’s medical history, risk factors, and potential areas of concern.

These advances offer meaningful opportunities to improve efficiency and support clinical decision-making, particularly as patient complexity continues to increase. AI can help identify patterns, organize large amounts of information, and surface relevant clinical considerations that might otherwise require significant time to uncover manually.

The technology must also be applied thoughtfully and responsibly. AI is a tool, not a substitute for clinical judgment. Its recommendations and summaries are only as valuable as the clinician reviewing them. Information must still be validated against the medical record, current evidence, and the provider’s experience. Human oversight remains essential, particularly when decisions have significant implications for patient safety and outcomes.

The future of perioperative care will likely include increasingly sophisticated AI support integrated directly into clinical workflows. The goal is not to replace clinicians, but to augment their capabilities by providing timely, actionable information at the point of care. As adoption continues, the challenge will be ensuring that AI enhances decision-making, improves safety, and reduces cognitive burden without creating overreliance on technology. When implemented thoughtfully, AI has the potential to strengthen perioperative care while preserving the clinical expertise and judgment that remain at the center of patient care.

What challenges is the hospital facing, and how are you navigating them?

Growth remains one of the most significant challenges facing healthcare organizations today, particularly when it comes to generating meaningful new volume. Sustainable growth requires attracting new patients to the system, which often means expanding service lines, recruiting physicians, or strategically investing in areas where patient demand is increasing.

As a specialty hospital, we operate within a highly competitive healthcare market. Large academic and integrated health systems offer extensive resources, broad specialty coverage, and strong brand recognition. Competing effectively in that environment requires a clear understanding of who we are and where we can provide exceptional value.

Success does not come from trying to be everything to everyone. Instead, it comes from identifying areas where a focused, specialized approach can deliver outstanding outcomes and an exceptional patient experience. That requires understanding what larger health systems do well while recognizing opportunities where a specialty hospital can differentiate itself through expertise, efficiency, access, and quality. Orthopedics is a prime example of an area where that strategy has been successful, where focused specialization has built a strong reputation among patients and physicians.

Maintaining and expanding that success requires constant attention. Healthcare organizations face ongoing reimbursement pressures, increasing competition for physicians and staff, and rising patient expectations regarding access, convenience, and outcomes. Growth must be balanced with maintaining quality and preserving the culture that made the organization successful in the first place.

Despite these challenges, patients continue to choose our hospital, and physicians continue to build and grow their practices here. That trust is earned through consistent performance and high-quality care. Sustaining that momentum while thoughtfully pursuing new growth opportunities will remain essential to our long-term success.

Looking ahead three to five years, what are your top priorities?

Growth remains a strategic priority. In today’s healthcare environment, maintaining stable volumes is not enough. To continue advancing the quality of care we provide and ensure long-term sustainability, we must pursue thoughtful and deliberate growth. That includes expanding services locally, strengthening physician partnerships, and leveraging our relationship with Surgery Partners to benefit from the resources, expertise, and scale of a larger organization.

Technology represents another critical area of focus. Innovations in artificial intelligence, surgical techniques, data analytics, and operating room technology can enhance clinical decision-making, improve efficiency, and drive better patient outcomes. Realizing those benefits, however, requires careful evaluation and responsible investment. The challenge is not simply acquiring new technology, but integrating it in a way that creates meaningful value for patients, physicians, and the organization.

Underlying both growth and innovation is a commitment to patient safety. Expanding services and adopting new technologies are important objectives, but they must never come at the expense of quality or consistency. Every strategic decision should be evaluated through the lens of its impact on patient care. Safety, outcomes, and the patient experience remain the foundation upon which all other initiatives are built.

Ultimately, success is measured not only by growth or technological advancement but by our ability to deliver safe, reliable, and high-quality care. Keeping patients at the center of every decision is not simply a goal — it is a fundamental responsibility and the principle that guides our future direction.

How are you working to improve the patient experience and outcomes throughout the care journey?

One of the most important aspects of our approach is continuity of care. Over the past several years, my professional focus has shifted from primarily acute inpatient medicine to perioperative medicine, with an emphasis on evaluating and preparing patients for surgery. Additionally, I continue to spend time in clinical care settings because maintaining a direct connection to patients and the day-to-day realities of healthcare delivery is essential to understanding how systems and processes perform in practice.

What differentiates our model is the ability to maintain continuity throughout the entire surgical journey. Patients undergo a comprehensive evaluation before surgery, receive coordinated care during their procedure, and are supported postoperatively by hospitalists who work closely with the same perioperative team involved in their preoperative assessment. This creates a seamless transition across phases of care and ensures continuity of information throughout the patient’s care journey. 

That level of coordination reduces unexpected issues, improves communication among care teams, and enhances patient safety. When clinicians understand the patient’s medical history, risk factors, and perioperative plan before complications arise, they are better positioned to anticipate needs and respond effectively to complications.

Ultimately, patients benefit most when care is delivered as a continuous, connected experience rather than a series of isolated encounters. The ability to provide coordinated, end-to-end perioperative care, from evaluation and optimization through recovery and discharge, is one of the defining strengths of our hospital and a key contributor to the quality outcomes we strive to achieve every day.