====== Stakeholder ====== A stakeholder is a member of "groups without whose support the organization would cease to exist", as defined in the first usage of the word in a 1963 internal memorandum at the Stanford Research Institute. The theory was later developed and championed by R. Edward Freeman in the 1980s All stakeholders, whether [[hospital]], [[payer]], or [[patient]]s are now focusing on [[cost]] containment, [[quality]] improvement, and reducing [[length of stay]] for surgical patients. The natural extension of this is a shift in care from the [[inpatient]] setting to [[outpatient]] and [[ambulatory surgery center]]s (ASCs). Due to advances in both [[surgery]] and [[anesthesiology]], many [[operation]]s are now possible in the outpatient setting. For [[spine surgery]] alone, annual cost savings of $140 million have been reported with the use of ASCs ((Silvers HR, Lewis PJ, Suddaby LS, Asch HL, Clabeaux DE, Blumenson LE. Day surgery for cervical microdiscectomy: is it safe and effective? J Spinal Disord. 1996 Aug;9(4):287-93. PubMed PMID: 8877954. )).