Plays well with others (?)

Had an interesting conversation with an OR nurse earlier this week. She was upset about something that had happened in the theatre she was working in. (Not my theatre, but it easily could have been.) In addition to the planned major surgery, the patient unexpectedly required an additional minor procedure done that was within the general ability of the surgeon, but not within his area of expertise. When that additional procedure didn't seem to be going well (and eventually required calling in another surgeon), she was at a loss over how to suggest that the attempts be stopped and the other surgeon be called in sooner. There was some minor injury from the attempts, but that should heal without ill effect.

So, why couldn't she just speak up and voice her concern for the safety of the patient?

It's because the OR culture won out.

There is a definite hierarchy in health care generally, but it is very rigid in the operating room. From the top down: Doctor (surgeon slightly edges out anaesthetist), nurse, patient. Orders flow one direction. Suggestions coming up the other way are not always well-received. The nurse didn't feel safe in making a comment because she was afraid of being verbally abused in return.

Sometimes, the surgeon needs to overrule everyone else, based on his/her training, experience and ultimate responsibility for the patient's outcome. But there are many times where other OR staff's judgement and experience make them aware of risks to patient safety. If they are afraid to speak up, patients suffer harm. The silent staff will be upset and feel guilty that they didn't advocate on behalf of their patient.

Solutions?

Educate OR staff (?role-playing, ?simulations) how to tactfully (yet firmly) express a safety concern to the surgeon

Convince surgeons that their patients may have a better outcome if everyone on the OR team is welcomed as an active participant in patient safety and quality improvement initiatives

Let all the crotchety old surgeons retire and train the new ones to play well with others

Any suggestions?

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Getting started

The first survey forms are going out this afternoon. We'll give out 5 today and 5 tomorrow. They're a test run to see if anyone responds. The surveys we're using for our Advanced Access project are a paper-based survey and we ask patients to complete them before they leave the office. Our response rate is pretty close to 100%. Let's see how it goes for these internet-based surveys.

Here's the text of the survey:

How was your visit with us?

Thank you for taking the time to complete this Internet survey. It should take about 5 minutes.

I want my patients to have the best experience possible at my office. I hope to improve by finding out about your experience.

Enter this address into your internet browser: http://kishorevis.blogspot.com/

You'll find the link to survey in the upper right corner of the web page ("Plain Brown Wrapper" blog)

This survey is: Week of XXXX

After you click to start the survey, you'll be asked for a password.

The password is : XXXXXXX

This password is to ensure that people who visited me this week will complete the correct survey. It will not identify you personally.

If you have trouble completing the survey, please leave a message on the web page.

Thanks again.

Kishore Visvanathan, MD
306-653-3255

I may need to tweak this to improve responses, but I wanted to get the project started and make changes on the fly. (PDSA for you Quality Improvement wonks!)

Anyone have any suggestions on how to improve this letter?

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1-800-How's my doctoring?

Am I doing my work well? Are my patients satisfied with the service I provide? I've been practicing urology for 15 years with no formal feedback on my performance. Like anyone, I appreciate a pat on the back or kind word for a job well done, but I'd also like to hear about the areas I can improve on.

My interest in surveying patients started with another project we have underway in my office. In our urology practice, my partners and I wanted to shorten our appointment waiting times. Click here to find out about our "Advanced Access" project. (The story starts at the bottom of the page.)

An important part of the Advanced Access project is getting feedback from our patients. We currently use the same survey that I'll be using here, but the results are pooled. That is, we don't record which physician got which responses. I want to measure my own personal results.

I also want to share my results and that's why I've started this blog. Once the first week's results are collected, I'll post a link to make them available to you.

Why share the results? I'll have more to say about this in future posts, but if you are familiar with RateMDs, you already have an idea of what the future holds for physicians regarding feedback on performance.

I'm a little nervous about how this is going to work. It's an experiment in openness and collaboration. I have no control over how my patients respond to the survey. If the results make me uncomfortable, my only recourse will be to decide not to share them. Let's see how brave I'll be.

It's also the first time I've used web-based software this extensively. The first week will be a test to see if everything works properly. If you have problems with the patient survey, please post a comment on this blog and I'll try to fix it.

Wish me luck!

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