Earning a spot in U.S. News & World Report’s 2026-27 Best Hospitals rankings, let alone a top spot, is an exemplary accomplishment for any hospital.
University of California San Francisco Medical Center has managed to rank among the top three programs nationally for neurology and neurosurgery for the past eight years.
When Edward Chang, MD, chair of the department of neurological surgery, talks about what has kept UCSF’s neurosurgery department in the top three for almost a decade, he credits his team’s dedication to ingenuity.
“We’re not following trends,” he said. “We’re leading ideas.”
Dr. Chang connected with Becker’s to discuss his methods for helping lead what he said is the No. 1 NIH-funded neurosurgery program in the country for the last 20 years.
A culture built around innovation
Dr. Chang said there is no one thing that creates an elite department. Surgical talent matters. So does the ability of surgeons, anesthesiologists, nurses and researchers to function as one system during complex cases.
But he points to a third ingredient to explain the gap.
“I would say one other thing that’s really critical, in addition to individual talent and teamwork … is a culture of innovation.”
He is careful to separate that from novelty for its own sake. The source of innovation among his faculty is not restlessness, he said. Instead, it is the notion that patient care can always be improved.
“You don’t want to innovate for the sake of innovating,” he said. “The source of innovation for a lot of our faculty and doctors is knowing that it could be a lot better. Our treatments could be more accurate. They could be more minimally invasive. They could be faster. They can be safer.”
Technology advances where human hands cannot
Dr. Chang said he believes that to keep the ball rolling, technology has to pick up where human capability ends.
“I have this thought that probably about 15 years ago, for the most part, as neurosurgeons, we kind of reached the limits of what we can physically do with your hands, and to some degree what you can see with your eyes,” he told Becker’s. For 100 years, he said, the field had been built around a simple question: What can one surgeon do? He believes that question has been answered.
That belief shows up in what the department has built. Faculty developed what Dr. Chang described as the first neuromodulation systems for the brain that adjust based on real-time brain activity — closed-loop adaptive deep brain stimulation aimed at conditions such as chronic pain, depression and obsessive-compulsive disorder. Colleagues built AI tools that can diagnose brain tumors intraoperatively in seconds, replacing a process that once took an hour and a pathologist’s manual read. Others are using gene editing on tumors previously considered inoperable.
Care does not end when surgery does
Not every advance Dr. Chang pointed to is clinical. One of the department’s contributions has nothing to do with the operating room.
UCSF built a caregivers program for the families of people with brain tumors, providing support and education for the people caring for the patient at home.
Dr. Chang described it as one of the things he is proudest of, on the same list as gene-editing research and AI diagnostics.
“It kind of gets us back to the roots of why we went into medicine in the first place, to help people, and helping people goes beyond the surgery,” he said.
The balance of economics
Dr. Chang said an important aspect of the job is balancing the tension between the academic mission of research and innovation and the financial pressures of operating inside a large, complex health system.
“One of the most important things I do as department chair is making sure that we do both,” he said. “Making sure that we can meet our goals of innovation, improving care at the same time … succeeding in a really complex economic environment.”
He does not accept that innovation and financial sustainability are opposing forces, though he acknowledges the relationship is not automatic. It depends on leadership choosing to treat them as connected.
“It doesn’t have to be that way, but it takes really skilled leadership to be able to make that true,” he said. “Innovation should bring down costs. It should have shorter hospital stays. People should be doing better, and in the end, that should improve the economy.”
He compared it to a J-curve: short-term investment before the payoff shows up. But he was careful to add a caveat: not every idea deserves that investment.
“You have to have a taste for what is good and what is not good,” he said. “What are the things you actually want to invest in? That’s the most important thing.”
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
