Who Is The Most Important Person In Your Operating Room?

Who is the most important person in your operating room?

Is your answer the right answer? Not sure, keep reading!

I seem to be asking this question a lot these days, and it's kind of funny. Surprisingly and most unexpectedly I hear many different answers.  In fact very few of them primarily answer the "patient". You might ask yourself the same question, or perhaps your colleagues the next time you’re at work, comparing answers so you may better determine your specific workplace culture and/or mission.

By the way, the top answer was usually the surgeon. 

As if you didn’t know by now (and I know you do), the correct answer to the question should always be the patient, no matter what the culture.  But is this a reality or a fantasy?  Do we really mean it, or is it just lip service? 

In most instances even if the right answer was given, actions within the OR usually imply the opposite.  Are our missions and actions truly aligned for the care and safety of our patients?  Or do we get mired down by our daily tasks and responsibilities, allowing them to overshadow our primary objective?

Is there an unseen hierarchy that exists in our healthcare institutions, and does it affect the safety of our patients?  Do your professional credentials place you within distinct zones of that hierarchy? Do they limit the power you have, or the respect you deserve when it comes to advocating on your patient’s behalf?  Do you let certain things slip by because you don’t want to get yelled at or buck the system?  Or do we just look the other way and roll the dice, playing the odds, and hoping this patient doesn’t get hurt today?

The ALPHAs and Everyone Else

By nature most clinicians feel they are their patient’s strongest advocates, they are the alphas in the room. But are they the most important person in the OR because of their stewardship or responsibility to the patient?  Is this answer justifiable? What does this say about their position? Better yet, does a cultural system of checks and balances truly exist? Or have we established a system built upon non-confrontation and apathy, a culture that inadvertently allows bad things to happen to our patients as consequence to our lack of advocacy?  The real question is, do we really stand firm and act on our patient’s behalf under a team approach?  Is there a team, and if there is one, do we get support from others on the team?

We all know from experience the many dynamics, politics, and mini bureaucracies that exist within our healthcare systems, but despite these shortcomings, can or do they affect efficacious and safe care?

Digression ONE

I’ll digress a bit by giving a little personal background and disclaimer. I have been a nurse anesthetist for over thirteen years and in that period of time I have traveled to a few states, working in various locales and institutional cultures.  I have always been amazed at the differences, the good and the bad.

Fast forward: These days I am the owner of a small business operating on the other side of the “drape,” my primary role is now that of the “REP”! This position by far has given me an even better opportunity to sit back and observe different institutional work cultures from afar. So far it has been an enlightening journey.

Developing a start-up business and a medical product is challenging enough.  It is the one calling I feel privileged and blessed to have.  When I first started this company I believed altruism would guide my way to developing a series of impactful and intuitive products. We would develop devices and/or services that would optimize and improve upon current processes of care, creating solutions that minimized or eliminated costly liabilities related to variances despite defined care standards. It seemed like a no brainer right? Why wouldn't it?  After all I had heard the grumblings and seen the same struggles day after day, year after year, with no real optimally addressed market solutions.  Ultimately this endeavor was an attempt to use my clinical experience to create evidence based products of daily use that seeked to improve the safety of both our patients and fellow providers.

Boy, was I naive! To be honest, it’s been a bit more challenging than originally anticipated, but not insurmountable (we here at iMT happily welcome the challenge). What my experience to date has afforded me and my team, is the opportunity to change and align our message to others as to what’s coming, and that is the future arrival of more value driven, patient centric metrics. Those very metrics that will begin to define every aspect of healthcare: its accessibility, its provision, its efficacy, and its reimbursements. If we could some how create solutions that guided process improvements that improved measurable and quantifiable data, then we have expanded value to both our cusomers and our start-up. But, is this change something to run from, or one to embrace (early)? 

Digression TWO:

In short we created a product that improved upon the current standard of care and techniques currently employed for a specific surgical position. One process that needed improvement, and for may many reasons. In our minds it should have been a slam dunk, especially with the initial feedback gained and knowing firsthand what’s currently being done. This is where both clinical experience and altruism ended (only briefly) and reality began set in!

So was it our message, our value proposition, our cost, or the small size of our unknown company that stood in the way of early adopters?  Was my product not as good as I thought it was?  These were just a few of the questions that awoke me nightly in a sweat soaked bed, knowing full well that I had chosen to walk this path of non-convention, placing my family in the crosshairs of financial ruin should we fail.  But again, I always held strong in faith and understanding that “this too shall pass.”  So we continue to press on in the true spirit of entrepreneurship.

Certainly, it is possible that all my obstacles may be a combination of all aforementioned questions. Or, it could be that there was one more unforeseen obstacle. Is it possible that my issues were related to the adoption and implementation of a new product into a rigid culture, an existing culture that shuns any perceived change or realignment? A culture that is preoccupied with many other daily requirements and tasks, with me just adding one more distraction to a full day of thankless work. Like the buzz term “alarm fatigue”, were they all suffering from a new form of  “innovation and/or process fatigue.”

So how do you embrace or institute change in a culture that is overworked, overburdened, and on the brink of an epidemic of apathy?  How do you begin to focus on the team approach and realign or remove the individuals who stand in the way of optimized care delivery?  How can they become your allies?  How do you approach that team without making your corporate mission go up in flames, to have them follow or champion a new approach, a new technique, or a proverbial reboot (reorganization)?  Let's try and answer that one. 

Look I get it, what we do is hard emotionally draining work.  But, should care providers just dismiss new products, services, or ideas without ever giving them a chance, even if if they have the potential to actually make their lives easier?  Or do they just embrace the misery they know, over the tasks of learning something new? 

So it comes back full circle, back to the main question. Who is the most important person in the OR?

If David Letterman could write me a TOP TEN list for the obstacles of introducing a new device in the OR it would usually start out as:

1. “I don’t know if the surgeon will like that?”
2. “I’ll have to ask the surgeon!”
3. “Did the surgeon request this?”
4. “Will this cause any issues for the surgeon?”
5. “How much does it cost?”
6. “Did this get value committee approval?”

Etc……etc……

The point made here is that very few questions ever centered around its value to the patient!  In contrast, it was all about how it would affect every other person in the room except the patient. This bothered me and my team a great deal. We began to doubt our objectives, our message, the product, and ultimately our mission (briefly).  

The simple fact is, people readily dismiss opportunities every day, even good ones. All because of bias, opinions, preconceived notions, or the simple fact it might mean more work or tasks.  It’s a sad state that actually contributes to the chaos we find our nation in, on many fronts?  Our innate ability to run from change, even in miserable conditions.  No amount of committees will ever overcome this hurdle. It’s almost as if people will only change when confronted with the actual threat/action, or better yet, forced to.  Does this make sense?  Look, at least embracing an opportunity allows an individual to remain in control, even contribute to a greater good, over coercion, consequence, or force.

What we need in healthcare (and throughout the world) is strong leadership, those who by virtue of their skills and personal abilities pass on empowering principals, drawing others to embrace and even seek improvement in both themselves and their careers.

Opinions on healthcare leadership will follow in another post.

Rest assured, improvements and opportunities are coming, whether we like it or not.  It’s like a storm on the horizon and it’s heading our way, albeit at a snail’s pace.  Healthcare is changing before our very eyes, being forced into a more accountable industry.  Everyone who is tied to it will be affected.  Very soon we will be able to gain valuable patient safety metrics through the use of EHR.  Healthcare will begin to point to the problems, processes, and the players contributing to less than optimal patient outcomes.  Those facilities will then be forced to confront and improve upon those metrics, or risk losing vital reimbursements tied to performance.  But again, this process shouldn’t be a witch hunt.  It should be a positive experience, requiring strong leadership and oversight so that providers and patients can begin to learn their individual roles. As in life, it’s about professionalism, personal responsibility, and accountability.

Some institutions are even beginning to embrace military culture and the airline industry (CRM), in order to create new accountable and high reliability organizations (HRO).  They will openly share the good and the bad (without the witch hunt), so that process improvements can be shared by all.  This is also the intent of the National Patient Safety Database.

Lastly, this isn’t a blog seeking sympathy or even business.  I don’t really care one way or another if a competitive product wins the sale.  We embrace capitalism and choice here at iMT!  I would just be happy to see more passion and advocacy in the OR when it comes to products, services, and ideas that serve to improve the welfare of our patients.  To see providers take a more active role, even if it means changing a process so that their patients benefit. 

There are many new and emerging products out there, especially from small niche companies.  We just ask that you give them a chance without denying them access solely based on their size and their sticker shock. They lack the resources and ability to disperse pricing among the rest of their tired old product lines (like the big players).  They are forced to try and make up their R&D costs (hence the costs).

What I can say, is that their tailored and niched approach readily provides a value that only enhances your ROI, making up for the initial price point by improving efficiency, care, and expansion of efficacy.  You may be surprised at how well they help improve your processes and your bottom line!

As a care provider I am dedicated to the well-being of my patients and yours.  It is something my team and I have great passion for.  So if raising the question and bringing awareness to the real elephant in the room is needed, we gladly take that burden on.

May you all continue to strive for greatness in yourselves and your institutions for the sake of those you care for.