IHI: Getting Surgeons to Embrace Safety

The IHI session, so popular there were actually two, tackled the challenging  problem of getting recalcitrant surgeons to embrace safety and quality. It was formatted for attendees to go the mike and describe their hospitals' struggles to get surgeons—often the most difficult, headstrong members of any hospital team—on board with time-outs and checklists and to get them to stop being cowboys. No matter if they've been operating for 20 years and have never made a mistake.

Surgeons, non-surgeon physicians, nurses, CEOs, and clinical administrators eagerly rose to speak.

One, Verna Gibbs, MD, a surgeon at the University of California San Francisco/VA Medical Center, who developed a system to prevent retained sponges, explained the surgeon culture she witnesses as one of "monovoxoplegia," which she defined as "the loud voice of one that paralyzes."

"You can say you want to prevent retained surgical toys and tools inside our patients. It's the right thing to do. It's a moral argument. But the view that carries the day is how much is it going to cost for me to adopt this program, versus how much am I going to save from liability coverage or a lawsuit," Gibbs said.

"I can tell you," she continued, "I have been told, 'what is so bad about a little bit of harm? After all, it keeps everybody on their toes.' "

Additionally, when things go wrong in surgery, a surgeon's quick response is often to blame the nurses or techs. The count was their responsibility; they should have been more alert.

Another attendee said that at his hospital, he tried having meetings to improve guideline compliance, but only three surgeons showed up. "How do you go about starting these conversations?" he asked.