The Amazing Doctor X

Some years back I did Process Improvement work for a regional healthcare provider…7 hospital campuses around a major metropolitan area. They ranged from the huge flagship campus with a Tier 1 Trauma Center and close to 1,000 beds to a small one-building hospital with four operating suites and forty beds.

It was at this smaller hospital that I had the pleasure of seeing one of the most amazing examples of efficiency and effectiveness I’ve ever seen…not only in healthcare, but in any setting.

There was a doctor, whom we’ll call Doctor X. The good doctor was an orthopedic surgeon within the region. He treated patients at several of the campuses, but he operated only at the small hospital,

And he only operated on Tuesdays, which were known as “Dr. X Day.”

On Tuesdays, no other procedures were scheduled in the operating suites at the small hospital, as Dr. X took over everything.

Dr. X did knee and hip replacement surgeries. And he had it down to an art. The hospital was small , but well laid out. There was a pre-op area with four bays. Then four Operating rooms next to each other, then a post-op recovery area that could accommodate up to 8.

Dr. X’s support team schedule all knee and hip surgeries on Tuesdays. Hips in the morning, knees in the afternoon. Hip replacements averaged 45 minutes to 2 hours. Knees were 1 to 3 hours. As there was more variation with knees, they went later in the day as it had less impact on the schedule if one went over.

The support team (the real heroes here) did so much more than the patient scheduling. They ensured the replacement hips and knees were ready, along with all the operating supplies. And that it was laid out: sterilized trays set up for each surgery. And there were more than patients to put in order: nurses, anesthesiologists, and all the support personnel needed to be organized. The entire day was expertly choreographed.

The process had the patients prepped and put into pre-op waiting. Then into the operating suites, where Dr. X would begin his work…then leave closing to his associates, so he could begin the next surgery. Upon completion, the patients were moved to post-op. And so, the day flowed…like a well-oiled machine.

I am tempted to say it was like an assembly line…but that would do Dr. X’s work an injustice. The patient’s well-being was always top priority. Safety never trumped speed. The teams realized each person was different, and that variation was inevitable. If there was the slightest hint of a problem, it was addressed. The team never blew off something in an attempt to keep to a timeline. This was constantly stressed…and was thoroughly ingrained into the culture.

This approach did sometimes have an impact on the schedule. So lower priority patients, ones who would be able to wait a week, would be scheduled later in the day. So that if somebody did need extra time, it wouldn’t jeopardize another patient’s well-being.

There were a variety of benefits from Dr. X’s work; high-quality care delivered in a short amount of time, satisfied patients, highly efficient use of facilities, and above average results. I don’t recall the specific stats, but I do remember the recovery rates and patient satisfaction scores were significantly higher for Dr. X when compared to other surgeons who did similar procedures.

As I was working on other events at the small hospital, I was able to observe Dr. X and his team numerous times. It was impressive, and initially, I had an idea to try to develop standard work from the team and try to replicate it throughout the region. But the more I saw, the more I realized it wasn’t feasible.

Dr. X and his team, and their results, were an anomaly. The results were from the Doctor’s personal leadership, vision, and motivation. From this, a culture was created. As I worked on other events at the hospital, I observed Dr. X and his team, talked with them, and took copious notes. I’d hope to be able to glean lessons and best practices that would help us replicate Dr. X’s success with other teams…but I realized it was never going to work. Dr. X’s success was a lucky happenstance of charisma, drive, handpicked team, medical processes that lent themselves to an assembly line format, and leadership that supported his vision. There were too many variables to try to duplicate. Instead, I just enjoyed watching him work and learning what I could.

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