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"The first case of the day is very, very important. It's your best
chance to start on time," he says. "Anything after that that isn't on time
introduces complexity. So having subsequent cases lined up, ready
with all the appropriate information, is critical, because as the sched-
ules start to slide, then other people come in, patients or instruments
aren't in the room, and so on. All of those things are risk factors."
The key, he says, is to "work backwards from the time that you're
trying to begin the procedure." What do you need to have in place so
that you can have as few distractions as possible and focus absolutely
and totally on the task at hand?
But resisting time pressures doesn't mean sacrificing efficiency, as
Dr. Ring explains: "Quality, safety and efficiency go hand in hand. I
work in both an ambulatory center and a large academic hospital.
And I feel much, much safer in the highly efficient ambulatory surgi-
cal center. When you're in the zone and humming in an efficient oper-
ation, you can stay focused on the job. You're there to take care of
patients and that's pretty much it. It's when you have an inefficient
setting, that people get bored or upset or distracted."
That hurry-then-wait-then-hurry-again atmosphere was at least par-
tially responsible for the albatross he carries. "When I did my wrong
procedure [at Massachusetts General Hospital], it was inefficiency
that helped lead to the mistake in my mind as to what procedure I
was supposed to be doing. And it was inefficiency that kept us from
using safety systems that might have caught my mistake. The entire
unit was behind because of inefficiency, so there was pressure that
created a distracting, more nervous environment.
"You don't have to slow things down to be safe. You just want to feel
like you're doing everything in order, appropriately and fully, and get-
ting right on to the next thing — nothing more and nothing less. True
efficiency feels relaxing."
P R E - O P S A F E T Y
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