INNOVATIVE STRATEGIES FOR IMPROVING SURGICAL PERFORMANCE
Interview with Justin Dimick, MD, FACS; Chief of the Division of Minimally Invasive Surgery, and Director of the Center for Healthcare Outcomes & Policy at the University of Michigan.
Along the theme of quality improvement, Justin Dimick MD, our guest lunchtime speaker presented “Innovative Strategies for improving Surgical Performance“ in which he described the development of the Michigan Bariatric Surgery Collaborative and its use of video-based peer coaching to address variability in bariatric surgery outcomes across Michigan.
Dr. Dimick noted that the traditional learning paradigm of didactic and skills sessions for teaching is not ideal to promote change. He reported a 10% success in long term skill acquisition using lectures, 19% success rate in feedback and a 95% long term success rate utilizing coaching. In his program, Dr. Dimick attempted to address these issues by using video-taping to address the dissimilarity between what one thinks he/she did and what actually occurred and coaching by an expert in the field to assure that the learner had real-time processes to learn, reflect and adapt.
We posed a few questions regarding the collaborative:
This collaborative involves an equal mix of academic surgeons and private community surgeons, so how did they attain buy-in from the busy private practice surgeons? This was intended to be a state-wide performance improvement project and gaining the trust of those in the community was a clear key objective.
Several others have objected to the use of videotapes during their patient care or during team based training due to the fear of the tapes being utilized negatively for performance or legal action. So how do they avoid this?
What are some of the success stories and lessons learned we can pass onto others?
Dr. Dimick responded that his project is in a preliminary stage, he has not yet analyzed the transcripts and therefore has no feedback. Nonetheless, he was successful in obtaining the cooperation of several very busy private practice MD’s who agreed to join an established quality improvement collaborative which meets three times a year. When establishing a collaborative, it is important to establish a rapport within its members; linking the individuals together using a common goal of quality improvement was extremely important. One must recognize and individual’s discomfort and alleviate it with the goal of making members relax and benefit from the group.
While the focus of his presentation was on video assessment of laparoscopic skills, many use video assessment of the entire surgical team membership to the same end. As team members may not be focused, (Bowermaster) video (black box) review may lead to improved communication. As there may be concerns regarding medicolegal use of these tapes, Dr. Dimick clarified that all videos are de-identified and therefore not discoverable. Additionally, the collaborative was deemed a Performance Improvement project so that the most sensitive data are outcome measures.
Dr. Dimick concluded his presentation by saying “Human trust is the most valuable part of capital one can gain when developing these projects, for with it you can achieve significant changes, but without it you will likely fail.”
Bowermaster R, Miller M, Ashcraft T, Boyd M, Brar A, Manning P, Eghtesady P. Application of the Aviation Black Box Principle in Pediatric Cardiac Surgery: Tracking All Failures in the Pediatric Cardiac Operating Room. J Am Coll Surg 2015;220:149-155.