Features  |   April 2016
Interdisciplinary Teamwork and Bureaucracy Flattening: The Keys to Optimal Perioperative Care
Author Affiliations
  • David C. Mackey, M.D.
    Committee on Future Models of Anesthesia Practice
Article Information
Critical Care / Gastrointestinal and Hepatic Systems / Infectious Disease / Pain Medicine / Patient Safety / Practice Management / Quality Improvement / Features
Features   |   April 2016
Interdisciplinary Teamwork and Bureaucracy Flattening: The Keys to Optimal Perioperative Care
ASA Monitor 04 2016, Vol.80, 28-31.
ASA Monitor 04 2016, Vol.80, 28-31.
Our Biggest Problem Is Linear Management in a Non-Linear World
Surgical care providers across the U.S. are rapidly embracing the fundamental tenets of the Perioperative Surgical Home (PSH) model of care: coordinated global care of the surgical patient and standardized, evidence-based, interdisciplinary care pathways. Unfortunately, instead of seeing their expectations logically borne out as performance improvement success stories, advocates of surgical care improvement are often frustrated by unrelenting bureaucracy, persistently unfocused care coordination and suboptimal outcomes. This situation might be considered paradoxical, but in reality it is entirely predictable. Highly hierarchical organizations with centralized command-and-control are well-suited to structured, static environments and to centralized decision-making that produces predictable outcomes. Mathematicians, physicists and engineers use the adjective linear in describing such environments: linear equations, linear systems, linear thinking. However, frontline health care providers work in complex non-linear systems in which patients and disease processes are often highly variable, working conditions are not always optimal and outcomes are often not precisely predictable. Those multilayered bureaucracies and departmental silos that may effectively manage linear environments and systems with linear thinking are counter-productive in our world of greater uncertainty and often semi-chaos – and the result is often suboptimal outcomes, workplace inefficiency and worker frustration.
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