Can physician coaching improve care, bottom lines?


Atul Gawande is one of the most prominent healthcare journalists in the United States. He's a staff writer with The New Yorker magazine who also happens to be a Rhodes scholar and a Harvard-trained endocrine surgeon.

Despite an overachieving life that has left him at the pinnacle of two profoundly different professions, Gawande remains more an outsider than a bearer of the club colors. His 2009 article about the cardiac bypass assembly line that is McAllen, Texas, is an indictment of medical over-utilization. In an article published in The New Yorker earlier this month, Gawande popped a bubble in the medical side of his profession by proclaiming that "doing surgery is no more physically difficult than writing in cursive."

Not exactly the type of statement you'd expect from someone whose line of work is often held up by laypeople as God-like.

Gawande also admitted that after nearly a decade of practicing surgery, he had hit a plateau. His complications rate hovered somewhat below the national average, but stubbornly remained the same. "It started to seem that the only direction things could go from here was the wrong one," he conceded. And then he made an even more startling move: He hired a surgical coach.

Gawande makes an utterly cogent point. There are professional athletes who are closely coached, even though the consequences of their poor performance is nothing more than a disappointed audience. With surgeons, lives are at stake. And given the tens of thousands of patients believed to die due to medical errors every year, it seems many could use such guidance.

There's also a fine point for hospital finance executives to take home: Gawande noted that each medical error costs an average of $14,000 to correct. Employing a few coaches--essentially performing an interactive and real-time version of peer review--could potentially save a single institution millions of dollars a year.

The coach Gawande used, a retired surgeon named Robert Osteen, had helped train him during his residency. Osteen pointed out that although Gawande optimally draped the patient and positioned himself, he did so without consulting what would work best for the surgical technician and other allied healthcare professionals in the operating room. Upon following Osteen's advice, Gawande's complication rate began to drop once again.

"I can't say that every surgeon needs a coach to do his or her best work, but I've discovered that I do," he admitted.

However, Gawande's issue is one that bedevils many people: a failure to observe their immediate surroundings. Any report on a surgical mishap has essentially the same root: miscommunication between those in the operating room and their individual failure after the fact to take responsibility. Moreover, physicians especially tend to insulate themselves with entourages of nurses and secretaries; getting one on the telephone can be a days-long ordeal. Telling them that they could use a coach is not likely to be an easy sell.

But then again, it might be easier to live with than the wholesale rate of medical errors as a current fact of life. Hospital executives could serve themselves--and their bottom lines--well by sharing Gawande's article with their medical staffs. - Ron (@FierceHealth)

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