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Friday, April 16, 2010

Individuals and Institutions

Wife Marilyn just got a new knee. She was admitted to the New England Baptist Hospital in Boston early on a Friday, operated on later in the morning, and discharged to home the following Monday.

This was her second total knee replacement. Her first one was about a year and a half ago, also at the Baptist, but by a different surgeon.

When discussing the first operation, the Orthopedist said that surgery was a team effort. I haven’t dealt with many surgeons lately, but that was the first time I had ever heard one say that.

This time, it was clear that many of the procedures that were implemented during the extensive pre-operative work-up and the postoperative care had been standardized on an institutional basis. In earlier years they would have been based on the preferences of the surgeon.

The benefits of standardization can hardly be overstated. What is done has been collectively determined – hopefully based on evidence rather than on the preferences of individual doctors. It reduces the risk of error due to oversight or miscommunication. Standardizing protocols simplifies the work of all caregivers and makes them more efficient. It facilitates teamwork by increasing predictability.

It was also clear that the surgeon had the right to overrule the protocol – thereby avoiding the hazards potential in “cookbook medicine.”

It is to be noted that it is the hospital that provides the institutional framework together with the support, discipline and continuity that makes standardization and effective teamwork feasible.

Personal service will always play a major role in health care and so the qualifications, skills, and dedication of individual caregivers will always be critical. But we must accept that institutions are also essential. They must be trustworthy and we must learn to put our trust in them.

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