Dr. Michael Vitale: 3 key themes for a culture of patient safety in spine

Written by Laura Dyrda | April 22, 2019 | Print  |

On April 26, spine surgeons, spine care team members and hospital executives will gather at NewYork-Presbyterian Hospital in New York City to learn about the newest trends in patient safety at the 4th Annual Safety in Spine Surgery Summit.

The event, chaired by Michael Vitale, MD, will include discussion around patient safety at the macroeconomic level, designing team culture and invigorating value-based care. Dr. Vitale is the vice chair of quality and strategy within orthopedic surgery at Columbia University Medical Center and co-director of the division of pediatric orthopedics and chief of pediatric spine and scoliosis service at Morgan Stanley Children's Hospital of NewYork-Presbyterian in New York City.

Here, Dr. Vitale discusses three key themes for this year's event:

1. Reduce variability. "Historically, we haven't done a great job in spine using the tools and science available to improve patient safety. We need to decrease unnecessary variability because variability creates risk and suboptimal care. Any way we can decrease variability moves us in the right direction."

The future of innovation in spine will focus on best practice development to reduce variability, Dr. Vitale said, instead of new implant systems and advanced technical skill. "In baseball, your ability to understand the opponent, environment and teammates will help you improve over time more than focusing on your mechanics," said Dr. Vitale. "The same is true in the operating room; the soft skills have been undervalued. We are all learning this at the Spine Summit and have an opportunity to improve that."

2. Optimize the power of the group. "Surgeons look at their role in the operating room as the captain, but really the captain's role is to be the focal point for all the smart people in the room," said Dr. Vitale. "The captain isn't supposed to be the smartest person in the room. We need to level the field and support ourselves with a diverse group of smart people that bring different skillsets to the table."

3. Think creatively. "As surgeons, we sometimes limit our decision-making to binary outcomes, either we will have one outcome or another," said Dr. Vitale. "This is especially true for surgeons when confronted with a decision during a crisis. However, thinking in binary terms limits your outcomes. There is a tendency in the OR to misinterpret the information in front of us, and if we can't expand the decision-making skills and use the power of the other people in the room, we may not make the best decision."

Instead, Dr. Vitale said surgeons have an obligation to their patients, peers and themselves to develop a pragmatic infrastructure and drive a culture that allows for better, more collaborative decision-making processes.

In 2018, the Summit's keynote speaker, U.S. Army Gen. Stanley McChrystal, addressed how he changed the culture of the American military personnel fighting in the Middle East. When he took over, the U.S. campaigns were not doing well and experiencing a high rate of casualties. Gen. McChrystal's focus on changing the culture was seen as a turning point in the war; he was able to level the playing field between team members, improve communication and create a shared consciousness.

The key message Dr. Vitale took away from Gen. McChrystal's presentation: Adapt or perish.

"If we don't change our culture and make an effort to do better, people who are less invested in our patients and profession will make rules that limit our ability to provide care," he said. "It's time for the profession and for spine surgeons to take the lead in developing a culture of patient safety. It's the essential obligation we have to our patients."

This year, the keynote speaker is Stephen Ondra, MD, a spine surgeon who previously practiced spine surgery at Northwestern Medicine in Chicago and has experience overseeing clinical operations for HCSC, the parent company of five Blue Cross Blue Shield plans.

More articles on spine surgery:
Spine reimbursement from CMS dropped 27% since 2000: 5 key notes
Medicare ACOs and spine surgery: 5 things to know
Dr. Joseph Schwab: Key concepts on AI and machine learning in spine


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