A Sudden Outbreak of Teamwork Among Doctors Could Boost Healthcare Performance
Most cars need a valve job after 80,000 miles. Pick a good repair shop and they'll do it in two days for under $1,000. You'll get more power and better gas mileage. Valve jobs in human hearts also boost performance -- but open-heart surgery is risky and costs 50-100 times more than repairing the Chevy.
All that is changing fast. As reported in The Huffington Post recently, a revolution in heart valve jobs is underway. It's a big step forward for patients -- perhaps even bigger for the hospitals where they're treated and the professionals who do the work. The buzzword is "teamwork."
Beyond the warranty -- heart failure
Just as engine valves control gas, air and exhaust flowing through the cylinders, heart valves control blood flowing through the heart. Heart valves open and shut with every beat. In 80 years, heart valves operate 3 billion times -- and high-mileage hearts get 'DVD' -- degenerative valve disease. The mitral valve, which controls high pressure blood flow between chambers on the left, gets floppy and allows backflow. The aortic valve, which controls blood blasting out of the heart into the body's main artery, gets narrowed and causes backpressure. Patients feel tired, short of breath, may have chest pain and sometimes have strokes. Unrepaired, the heart fails altogether.
Americans need $150 to $500 billion in valve repairs at today's prices
About 5 million high mileage Americans have heart valve problems. If they all showed up at once, our best hospitals would need to repair 14 patients a day for a year to clear the backlog. At $30,000 to $100,000 each, our cash-strapped health system would need an extra $150 to $500 billion. That kind of spending is not going to happen. But the problem isn't going away.
Now heart valve jobs can be done safely without open heart surgery. It saves lives in patients who can't handle surgery and matches surgery results in patients with aortic and mitral disease who can. Patients recover faster with less bleeding and less heart rhythm problems. It could save money as well. But there are limitations and unresolved questions. The new aortic valve jobs increase strokes from 1 percent to 5 percent. The new mitral valve jobs may not last for a whole year as well as open heart surgery. And experts are debating which patients benefit the most.
Serious teamwork among experts
One thing is already crystal clear. The new valve jobs demand serious teamwork among experts. Together, cardiologists, surgeons, anesthesiologists, radiologists, nurses, technicians and others must decide whether the patient is a good candidate; which type of valve job to do; and when and how to do it. Once in the repair shop, teamwork gets even more critical. New 'hybrid' operating rooms, bristling with high tech diagnostic, imaging and repair tools are being built at the best hospitals to enable the essential team-based repairs.
Forward-thinking heart surgeons find the new approach appealing. But after 20 years of battles with interventional cardiologists over who should treat heart blockages, some -- like mechanics -- may be reluctant to share workshops, tools and jobs. Surgical teamwork saves lives and complications -- but is very much in the eye of the beholder. An important study showed that surgeons rate themselves highly as team players 85 percent of the time. Anesthesiologists rate themselves high 96 percent -- but rate surgeons high only 70 percent of the time. Nurses are skeptical, rating anesthesiologists high 63 percent and surgeons high an unflattering 48 percent of the time.
Interventional cardiologists generally like the new approach. The new valve jobs promise alternative income as coronary angioplasty declines. Plus, these docs may be more used to teams. The American Heart Association recommends teamwork for coronary angioplasty -- especially for heart attacks - and according to leading experts saving lives in the middle of the night demands a strong predilection for collaboration -- even sometimes a willingness to ask for help from cardiac surgeons.
The sudden outbreak of teamwork for valve jobs among independent, previously competitive players in our best hospitals is encouraging. But teamwork is a complex topic which -- like engine repairs -- is not taught in medical school. Our hospitals -- especially our doctors -- need to turn serious attention to the enormous body of research on team effectiveness. Key themes include surgical team leadership, mutual performance monitoring, backup behavior, adaptability, and team orientation. Shared mental models within the team and closed-loop communication skills should be honed like scalpels. As the patient has to trust the team, the team has to trust one another -- a phenomenon that begins with performing competently.
Intense focus on teamwork may turn out to be the real inovation here -- and that could be a turbocharger for hospital effectiveness and efficiency. With such teamwork in place, hospitals won't blow heart valve jobs.