Monday, November 20, 2017
Perspective

Changing the DNA of health care in Tampa Bay

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It’s January 2013, and much of the last year was spent by those involved in leading health organizations wondering about health care reform — how the Supreme Court will rule, how the election will affect the affordability act and what impact all of this will have for patients and their doctors. The common denominator is that each of those issues is outside of our control.

I am proud to say right here in Tampa Bay at USF Health, we decided to take a different approach and look at the transformative changes that are necessary regardless of the political, legal or financial changes occurring in health care.

As we moved from thinking about health care reform to creating health care transformation, the most striking example of where health care has fallen behind other high-reliability organizations is in our ability to assess and certify technical and teamwork competence.

For example, when any of us travel on an airplane, we know our pilots are competent, because within the last year that they have had their technical competence assessed, and if their skills did not fall within a narrow mean and standard deviation, they are not flying your plane.

Even beyond technical competence, many of the crises that have been averted in aviation, such as the successful landing of the USAir "Miracle on the Hudson," were based on teamwork concepts learned in crew resource management training sessions; in essence, these are simulated opportunities for the entire team to practice emergency skills together while passengers' lives are not at risk.

Given our aging population of physicians and surgeons, we currently have no way of objectively assessing a physician who has an excessive amount of surgical complications. In a survey that we conducted around the country, we found that the most common means of dealing with an experienced surgeon who has had excessive surgical complications is that he/she is locally monitored. The obvious fallacy with that approach is the lack of objectivity — usually with the "proctor" being a colleague or a competitor with all the legal, emotional and subjective baggage you would expect from a physician judging another physician in the same community. The end result is inaction and an inability to protect our patients.

Most important, the entire "see one, do one, teach one" rubric for teaching surgeons in which trainees watch procedures and then are given the opportunity to perform procedures is both outdated and dangerous — especially for the "one" on the other side of the operating room table. It often takes decades to get a new drug approved in this country because we want to ensure that risks to patients are minimized before the drug has been exhaustively tested. Similarly, new medical devices take years to win approval with the same conservative "do no harm" mentality by the FDA regulators. However, once a new device is approved, all bets are off as to ensuring that the surgeon behind the instrument is as safe as the instrument itself.

Many of us lived through the "learning curve" days of early minimally invasive surgery when procedures such as cholecystectomy (gall bladder removal) or robotic surgery were proved "safe" by a cadre of early pioneers, with almost no objective way of teaching or accrediting the next wave of surgeons that want to perform the procedure. What we take as a given, that health care will be more inefficient and that patients will suffer higher morbidity during these "learning curves," will be even more inexcusable in a future in which payers and patients will expect technical and teamwork competence, excellence and efficiency.

I believe that those of us who have the honor of being doctors, nurses and other health care providers need to start today toward creating a different health care system, one that does more for less, that provides better care for less cost.

That's the driving force behind CAMLS, the Center for Advanced Medical Learning and Simulation, which we built in downtown Tampa in mid 2012. Much has been made of the exciting contribution to economic development that CAMLS represents. It will become a hub for visitors and as a result contribute to the mayor's vision of downtown Tampa.

The mission of CAMLS, however, goes beyond those benefits and is positioned as a place to reinvent the nation's health care — to ensure that tomorrow's care is safer, smarter and more affordable.

Here are some examples.

The key to controlling infections in hospitals is team training. Safety happens only when the entire team, the system of the hospital itself, is dedicated to prevention and control. Aviation has understood that for years through "crew resource management," and we're developing a parallel curriculum for health care right here at the University of South Florida.

The key to preventing readmissions is to do the procedure right in the first place. That means taking another lesson from our flight crew colleagues. The entire team must do new and complex procedures together in a simulated environment complete with checklists and best practice protocols — the rehearsal studios we have at CAMLS.

This challenge is personal to me. As one of the first gynecologic surgeons performing minimally invasive procedures, we published our good results and felt excited about a safer future. Shortly after, as patients demanded the new procedures, and as every surgeon felt the need to learn these new procedures, there were more complications in these procedures as physicians throughout the nation started the "learning curve" — that period of time it takes for your skills to mature.

Similarly, I performed my first resuscitation on a premature baby in the middle of a chaotic delivery room — on a real baby. At CAMLS, we now have young health professionals learning how to resuscitate newborns in a team setting, using realistic high-tech simulators.

From the beginning, these professionals learn how a smoothly functioning team can save a life. And they do all this using a simulator baby that can cry, alter its breathing and even turn blue. But, obviously, there's no patient being put at risk. We are defeating the learning curve for new physicians gaining skills on difficult new technologies such as robotic surgery by certifying competence standards.

The real excitement at CAMLS, however, goes beyond the technical, namely the ability to simulate and improve communication and empathy skills through the Virtual Patient Care Center. So now, at USF Health, we will be able to assure you that your doctor, nurse and other members of your health care team are not only technically able but have learned how to listen, communicate and work as a team for the benefit of the most important component in health care — you, the patient.

So, whether you are a Democrat or Republican, I believe that complaining about what others are doing to health care is so … 2012.

In 2013, let's work together in Tampa Bay to make us a healthier community. That will mean that health care providers need to look in the mirror and work better as teams, coordinate care for patients with chronic conditions, give better care with less. It means that patients will need to take more responsibility for their health care, be more cognizant of the quality metrics of their providers and hospitals and demand cost-effective, quality health care.

For hospital and health care leaders, our New Year's resolution should be to work together to make the lives of those of us who live in Tampa Bay better and healthier. That will mean new ways of "doing business," a closer relationship between USF and Tampa General Hospital, embracing the principles of the Tampa Bay Partnership's One Bay Healthy Community (myonebay.com), and taking full advantage of the USF Health System in creating scientific discoveries and training the next generation of physicians and other providers.

As the dean of Tampa's academic medical center, I am committed to changing the DNA of health care and having 2013 be the year Tampa Bay becomes known as a place where "tomorrow's health care happens today."

Stephen K. Klasko, MD, MBA, is dean of the USF College of Medicine and CEO of USF Health. He wrote this exclusively for the Tampa Bay Times.

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