Joining a Specialized Institution
My relationship with the 127th Hospital of the Ministry of Railways began in 1996, when I accepted the position of Chief Surgeon during a significant period of institutional transition. After spending a decade at Wuhu Changhang Hospital, this move represented both professional advancement and new challenge—leading surgical services at an institution undergoing modernization while maintaining its specialized focus on railway workers and their families.
The railway hospital system occupied unique position within Chinese healthcare, combining features of both public health service and sector-specific institution. Originally established to serve transportation workers operating across geographic regions, these hospitals developed distinctive organizational cultures combining military-like efficiency with specialized expertise relevant to transportation-related health issues. The 127th Hospital exemplified these characteristics while facing adaptation challenges during China's broader healthcare reforms.
My recruitment to this institution occurred through professional networks rather than formal application. Several surgical colleagues had moved from Changhang Hospital to the railway system previously, establishing connections that led to discussions when the Chief Surgeon position became available. The hospital administration specifically sought experienced leadership to guide surgical modernization while maintaining service continuity during transition period.
Initial impressions of the institution revealed both strengths and challenges. The hospital maintained excellent basic infrastructure, reliable supply chains through ministry connections, and stable funding compared to many public hospitals increasingly dependent on patient fees. Staff demonstrated strong organizational discipline and procedural consistency reflecting the railway system's operational culture. However, surgical capabilities had fallen somewhat behind contemporary standards, with limited adoption of newer techniques becoming standard elsewhere.
The hospital's patient population presented interesting clinical profile combining characteristics of both occupational medicine and general community practice. Railway workers presented distinctive injury patterns and occupational exposures requiring specialized knowledge, while their families required comprehensive general medical services across all age groups. This diverse patient mix created both challenges and opportunities for surgical service development.
My appointment came with significant expectations for modernization while respecting institutional traditions. Rather than revolutionary change, the administration sought evolutionary improvement building upon existing strengths while addressing identified limitations. This balanced approach matched my own leadership philosophy developed through previous experience with institutional transitions.
Building the Surgical Department
The surgical transformation strategy I implemented focused on four key elements: staff development, technology integration, protocol modernization, and quality assurance systems. This comprehensive approach recognized that sustainable improvement required attention to human resources, technical capabilities, standardized processes, and continuous evaluation rather than isolated initiatives in any single area.
Staff development began with careful assessment of existing surgical team strengths and limitations. The department included several experienced surgeons with excellent technical skills in traditional procedures but limited exposure to newer surgical approaches. Younger staff demonstrated greater comfort with emerging technologies but sometimes lacked fundamental surgical principles that remained relevant regardless of technical evolution. This complementary distribution of capabilities created foundation for mutual learning rather than hierarchical knowledge transmission.
Rather than imposing change through administrative authority, I emphasized demonstration and education—showing colleagues the benefits of updated approaches through my own practice while respecting their existing expertise. This strategy proved particularly effective when introducing modifications to post-operative care protocols. By implementing early mobilization approaches with my own patients and documenting improved outcomes, I gradually built support for these changes even among initially skeptical colleagues.
Technology integration proceeded incrementally rather than through wholesale replacement. The hospital administration supported acquisition of laparoscopic equipment in 1997, beginning our transition toward minimally invasive surgery. Rather than restricting this technology to younger surgeons as often occurred elsewhere, I encouraged participation across age groups, personally undertaking training in these techniques at age 63. This inclusive approach eventually created surgical team with productive balance between experienced senior surgeons and technically innovative younger practitioners.
Protocol modernization addressed both clinical pathways and administrative processes affecting surgical care. We systematically reviewed existing protocols against current literature and professional guidelines, making evidence-based modifications while maintaining practices that functioned effectively within our institutional context. This selective approach preserved valuable institutional knowledge while addressing outdated elements requiring revision.
Quality assurance development represented perhaps the most significant long-term contribution to institutional improvement. We implemented systematic case review processes, complication tracking systems, and regular morbidity and mortality conferences that created culture of continuous improvement. Rather than focusing on individual blame for adverse outcomes, these processes emphasized systemic factors and learning opportunities—an approach initially unfamiliar within railway hospital culture but gradually accepted as valuable organizational improvement tool.
Throughout this development process, I maintained active clinical practice alongside administrative responsibilities. This continued surgical involvement served multiple purposes: demonstrating new techniques directly, maintaining credibility with clinical staff, remaining connected to patient care realities, and providing advanced surgical capabilities for complex cases. The combination of administrative authority with continued clinical excellence proved more effective than purely managerial leadership would have been in this context.
Distinctive Aspects of Railway Medicine
The railway hospital system developed distinctive approaches reflecting both the unique needs of transportation workers and the organizational culture of China's railway ministry. Understanding these distinctive elements proved essential to effective leadership within this specialized institution.
Occupational health considerations significantly influenced surgical practice within the railway system. Transportation workers experienced distinctive injury patterns related to their work environments: crush injuries, electrical burns, toxic exposures, and traumatic amputations occurred with greater frequency than in general population. These occupation-specific patterns required specialized expertise, equipment, and protocols optimized for railway-related trauma.
The geographical distribution of railway operations created unique continuity of care challenges. Workers might sustain injuries or develop medical conditions far from their home facilities, requiring coordination across institutions throughout the railway medical system. We developed standardized documentation, communication protocols, and transfer procedures facilitating seamless care transitions for patients moving between facilities—an early version of integrated healthcare networks that would later become more common throughout Chinese medicine.
Administrative systems within railway hospitals reflected the broader organizational culture of China's transportation ministry. Highly structured reporting relationships, standardized procedures, and emphasis on operational reliability created environment quite different from typical public hospitals. This organizational discipline provided certain advantages—particularly in emergency response capabilities and supply chain reliability—while sometimes limiting flexibility for innovation outside established channels.
The railway hospital funding model offered relative stability during period when many Chinese healthcare institutions faced financial pressures from market-oriented reforms. While still affected by broader healthcare system changes, railway hospitals maintained stronger base funding through ministry support, reducing dependence on procedure-generated revenue that sometimes created problematic incentives elsewhere. This financial stability enabled care decisions based more consistently on clinical rather than economic considerations.
Patient expectations within railway system also presented distinctive characteristics. Transportation workers and their families typically maintained long-term relationships with railway hospitals, creating continuity rarely experienced in more fragmented healthcare environments. This longitudinal relationship fostered trust and communication advantages but also created higher expectations for personalized care and institutional responsiveness to individual needs.
The railway medical system's military-influenced organizational heritage created distinctive emergency response capabilities particularly valuable during disasters. Railway hospitals maintained disaster preparedness protocols, equipment caches, and staff training specifically designed for mass casualty events affecting transportation infrastructure. These capabilities, routinely exercised through drills and occasionally activated for actual emergencies, represented significant community resource extending beyond routine healthcare provision.
Understanding and respecting these distinctive aspects of railway medicine proved essential to effective leadership within this specialized environment. Rather than imposing standardized approaches from general hospital experience, successful integration required adapting improvement initiatives to complement existing institutional strengths while addressing specific limitations. This balanced approach maintained valuable aspects of railway medical culture while facilitating necessary modernization.
Modernization Amid Tradition
Leading surgical services during period of significant healthcare transformation required careful balance between embracing necessary modernization and preserving valuable traditions. This balancing act characterized my thirteen years as Chief Surgeon at the 127th Hospital, requiring continuous assessment of which elements deserved preservation and which required change.
The most visible aspect of modernization involved technological advancement, particularly the introduction of minimally invasive surgical techniques. Prior to 1997, virtually all procedures at the hospital employed traditional open surgical approaches. The introduction of laparoscopic equipment that year initiated gradual transition toward less invasive techniques for appropriate cases. Initially focused on basic procedures like cholecystectomy, our capabilities progressively expanded to include more complex interventions as team experience developed.
This technological transition required significant investment beyond equipment acquisition. Staff training, procedure development, complication management protocols, and modified perioperative care pathways all required development to support successful implementation. Rather than rushing adoption, we proceeded methodically with careful case selection and comprehensive preparation, gradually expanding application as experience accumulated.
Imaging technology represented another significant modernization area, with dramatic advancement from basic radiography to sophisticated CT, MRI, and eventually enhanced functional imaging. These improved diagnostic capabilities transformed surgical planning and intervention timing, enabling more precise procedural approaches and better risk stratification. Integration of these technologies required not only equipment acquisition but development of clinical decision pathways appropriately utilizing advanced imaging without overreliance.
Anesthesia modernization paralleled surgical advancement, transitioning from primarily general anesthesia toward greater utilization of regional techniques, improved monitoring capabilities, and enhanced recovery protocols. This evolution significantly improved patient comfort, reduced complications, and enabled more rapid post-operative recovery—benefits particularly valuable for railway workers requiring return to duty obligations.
While embracing these technological improvements, we simultaneously preserved valuable traditional elements deserving continuation. The railway hospital system's emphasis on comprehensive patient responsibility—the physician's obligation extending beyond specific procedures to overall well-being—represented tradition worth maintaining despite healthcare trends toward fragmented specialist care. We preserved this holistic approach while incorporating technological advancement, maintaining primary surgeon responsibility throughout perioperative period rather than delegating to specialized teams.
The tradition of meticulous clinical examination received continued emphasis despite growing reliance on advanced imaging. Railway hospital culture historically emphasized thorough physical diagnosis before technological investigation—an approach sometimes neglected amid imaging availability. We maintained requirement for comprehensive clinical assessment prior to imaging studies, preserving valuable diagnostic skills while incorporating technological advantages appropriately.
Administrative traditions of standardized documentation, detailed handover procedures, and structured communication pathways similarly deserved preservation despite modernization in other areas. These systems, developed through decades of experience with geographically dispersed operations, provided reliability advantages worth maintaining while updating specific content to reflect contemporary practice.
Perhaps most importantly, we preserved the railway medical system's distinctive commitment to worker-focused care considering both clinical needs and occupational context. Treatment planning routinely incorporated considerations beyond medical factors alone: work requirements, geographic constraints, and family circumstances received attention within decision-making processes. This holistic approach, historically central to railway medicine, remained valuable despite broader healthcare trends toward increasingly specialized and fragmented care delivery.
This balanced approach—selective modernization while preserving valuable traditions—proved more successful than either wholesale transformation or rigid preservation would have been. By distinguishing between elements requiring change and traditions deserving continuation, we maintained institutional strengths while addressing limitations. This nuanced strategy facilitated staff engagement with necessary changes while respecting their existing expertise and the legitimate value of established practices.
Educational Leadership and Legacy
Throughout my thirteen years at the 127th Hospital, teaching assumed increasingly central role alongside clinical and administrative responsibilities. The distinctive railway medical environment provided valuable educational setting combining specialized occupational health perspectives with general surgical principles—a combination offering unique training opportunities for developing surgeons.
Formal teaching responsibilities included supervision of surgical residents rotating through our department from affiliated medical schools, visiting physicians from other railway hospitals seeking specific procedural training, and continuing education for practicing surgeons throughout the railway medical system. These structured educational roles carried explicit expectations and formal evaluation processes within institutional framework.
Beyond these formal responsibilities, informal teaching through case-based discussion, observed procedures, and mentoring relationships provided equally important educational impact. Regular case conferences I instituted focused particularly on surgical decision-making rather than merely technical execution—addressing when to operate, when to wait, when to refer, and how to manage complications. These discussions drew participants from throughout the hospital and occasionally from other institutions, creating valuable forum for continuing education.
Between 1996 and 2008, I formally mentored 16 surgeons at various career stages, many of whom subsequently assumed leadership positions throughout the railway medical system and beyond. My mentoring approach emphasized progressive independence within structured framework—giving trainees increasing responsibility while maintaining appropriate supervision. This developmental model proved particularly effective in producing surgeons capable of practicing across varied settings with adaptability and sound judgment.
Perhaps the most meaningful teaching initiative developed during this period involved "return to basics" seminars designed primarily for younger surgeons. While enthusiastically embracing new technologies myself, I recognized that excessive reliance on sophisticated equipment could atrophy fundamental skills. These seminars focused on techniques essential when technology fails or is unavailable: physical diagnosis without imaging, surgery without specialized instruments, and management of complications with limited resources.
These sessions drew on experiences from my early career in resource-limited settings, reminding younger surgeons that technology supplements but cannot replace surgical judgment and fundamental skills. The popularity of these seminars suggested genuine hunger for this historical perspective alongside technological training—recognition that certain surgical principles transcend particular eras or equipment availability.
My educational philosophy emphasized integration of technical skill with ethical practice and clinical judgment—three dimensions equally essential to effective surgical care. Technical instruction naturally occupied substantial teaching time given surgery's procedural nature. However, equal emphasis on ethical decision-making and clinical judgment development distinguished our educational approach from programs focused primarily on technical execution.
This comprehensive educational orientation reflected commitment to developing complete surgeons rather than merely technically proficient operators. Trainees learned not only how to perform procedures but when intervention was appropriate, how to select optimal approaches for individual patients, and how to manage expected and unexpected outcomes responsibly. This integrated perspective prepared them for independent practice in various environments rather than dependency on specific technologies or settings.
As administrative responsibilities gradually transferred to younger leadership in my later years at the 127th Hospital, educational roles assumed increasing prominence. By 2008, teaching activities occupied approximately 40% of my professional time, with proportional reductions in administrative duties while maintaining selected clinical responsibilities. This transition leveraged my accumulated experience while creating space for new administrative leadership to emerge.
The educational legacy extending from this period continues influencing railway medicine and beyond through surgeons trained under this comprehensive approach. Former students now direct surgical departments, lead quality improvement initiatives, and conduct their own training programs throughout China's healthcare system. This multiplication effect extends influence far beyond direct patient care I provided, creating ripple effects through subsequent generations of surgical practice.
Looking back on these educational contributions from current perspective, I consider them perhaps the most significant and durable aspect of my work with the 127th Hospital. While administrative systems evolve and clinical technologies advance, the transmission of surgical wisdom combining technical skill with ethical practice and sound judgment creates legacy continuing through successive generations of practitioners influenced by these educational principles.
Concluding a Chapter
My formal leadership role at the 127th Hospital concluded in 2009, when I stepped down as Chief Surgeon at age 75 after thirteen years directing the department. This transition represented planned succession rather than abrupt departure, implemented through phased reduction of administrative responsibilities while continuing clinical practice and educational activities at reduced intensity.
The succession planning process began approximately two years before formal transition, with systematic delegation of specific administrative functions to identified successor candidates. This gradual approach allowed observation of leadership capabilities in actual practice rather than merely theoretical assessment, creating opportunity for mentorship through incremental responsibility increases with appropriate support and feedback.
Dr. Zhang Liang, my eventual successor, demonstrated exceptional combinations of clinical expertise, administrative capability, and interpersonal skills throughout this evaluation period. Having joined the department in 1998, he had absorbed both the traditional railway medical culture and modern surgical approaches, positioning him ideally to continue balanced modernization while respecting institutional heritage. His selection received broad support from both department members and hospital administration.
The formal transition ceremony in January 2009 appropriately emphasized continuity alongside leadership change. Rather than focusing exclusively on my contributions, the event highlighted departmental accomplishments and future directions, positioning the transition within context of ongoing institutional development rather than mere personnel change. This approach reflected my conviction that sustainable organizations require smooth leadership transitions preserving institutional momentum beyond individual tenures.
Following formal leadership transition, I continued clinical practice at progressively reduced schedule while maintaining educational responsibilities. This continuing involvement provided consultative support for the new leadership while avoiding interference with their authority. The arrangement benefited the institution through continuing access to my experience while supporting my own gradual transition toward eventual retirement.
This phased approach to leadership succession reflected lessons learned through hospital transitions observed throughout my career. Abrupt leadership changes often created unnecessary disruption, institutional knowledge loss, and implementation discontinuity for ongoing initiatives. Our planned transition process significantly reduced these risks while facilitating knowledge transfer and relationship continuity during leadership change.
Reflecting on the thirteen years at the 127th Hospital from current perspective, I recognize both accomplishments and limitations characterizing this career chapter. The department successfully modernized surgical capabilities while maintaining valuable institutional traditions, improved quality assurance systems while preserving operational efficiency, and enhanced education while continuing clinical excellence. These balanced achievements reflected the collaborative efforts of the entire surgical team rather than individual leadership alone.
Limitations during this period included slower-than-optimal implementation of certain technological advances, particularly in areas requiring significant capital investment beyond departmental control. Information system integration proceeded more gradually than ideal, creating transitional inefficiencies during paper-to-electronic conversion. These limitations reflected broader institutional constraints rather than departmental resistance, illustrating leadership realities within complex organizations with multiple competing priorities.
The relationships formed during these thirteen years have endured beyond formal institutional connections. Former colleagues continue seeking occasional consultation on complex cases, invitation to educational events, and personal connection during significant life events. These continuing relationships represent perhaps the most meaningful personal outcome from this career chapter—professional connections that evolved into enduring human bonds transcending institutional affiliations.
The 127th Hospital itself has continued evolving since my leadership tenure, adapting to ongoing healthcare system changes while maintaining its distinctive railway medicine heritage. The surgical department under subsequent leadership has continued advancing capabilities while preserving the balanced approach to modernization established during my tenure. This continuing institutional development represents the true measure of successful leadership—creating sustainable systems that continue functioning effectively beyond individual leadership tenures.
This significant career chapter, spanning ages 62 to 75, demonstrates the potential for meaningful late-career contributions within appropriate institutional frameworks. Rather than arbitrary retirement at conventional age thresholds, this experience suggests value in creating flexible arrangements allowing experienced practitioners to continue contributing while gradually transitioning responsibilities to subsequent leadership generations. Such arrangements benefit institutions through knowledge preservation while supporting individual transitions through graduated role evolution.
