A study and a related editorial in Wednesday's Journal of the American Medical Association remind us of a fundamental, yet elusive truth of the operating room: two (or more) heads are better than one, especially if they're working together, toward a shared goal.
In the OR it's not the superstar surgeon working as a solo act who has the best outcomes; it's the surgeon who has gathered a staff of strong individuals and led them to act as a finely calibrated team.
But, as an unrelated study puts it: "Sadly, teamwork among the various professionals within the OR is often flawed: Communication is poor, roles are at best ambiguous, and the organizational structure of the team is often unwanted. Furthermore, team members tend to underestimate their individual weaknesses and overestimate their own teamwork abilities and contributions."
These behaviors can lead to medical errors. Among the most common, hemorrhage complicating a procedure, accidental puncture or laceration during a procedure, hematoma complicating a procedure, or mechanical complication of a cardiac device, implant, or graft. But don't expect a shout if something goes wrong in the OR.
The post-9/11 mantra, "if you see something, say something," so familiar to riders of public transportation, is as welcome in the OR as a muddy boot. Says the JAMA editorial: " in many health care sentinel events, a member of the health care team knew something was wrong but either did not speak up or spoke up and was ignored." It's not just in the OR, by the way, that colleagues don't report colleagues. The practice is widespread.
Even though the American Medical Association's code of ethics requires colleagues to report those they suspect are unable to practice medicine safely because of impairment or incompetence, we know that one in three physicians balks at reporting an incompetent or impaired colleague.
And for surgeons in rural hospitals, improving teamwork can be especially challenging. Surgeons at critical access or acute care facilities can be short-staffed and overworked, conditions not conducive to teambuilding drills and exercises, effective though they may be.
A 2009 study, Improved Operating Room Teamwork via SAFETY Prep: A Rural Community Hospital?s Experience, examinedteam-related competencies in a rural setting:
"From July 2006 to February 2007, a prospective evaluation of teamwork among the OR staff working with a single general surgeon in a rural community hospital in Alaska was undertaken before and after the implementation of a preoperative protocol briefing designed to foster team competencies and interactions."
It concludes that team-related competencies may improve OR efficiency and, as a result, could improve patient care and safety. JAMA's wider study, published Wednesday, concludes that participation in a Veterans Health Administration medical team training program is associated with lower surgical mortality.
While it may take a trained village of OR staffers to lower surgical mortality, let it be noted: The villagers need a strong leader.