Improving Surgery By Talking To Each Other | Olle Ljungqvist | TEDxBeaconStreet

so I’ve been a surgeon for more than 30

so I’ve been a surgeon for more than 30 years now it’s just wondering if there’s

years now it’s just wondering if there’s

years now it’s just wondering if there’s anybody in the room who knows somebody

anybody in the room who knows somebody

anybody in the room who knows somebody who’s had an operation or perhaps you’ve

who’s had an operation or perhaps you’ve

who’s had an operation or perhaps you’ve had one yourself

had one yourself

had one yourself can I see a race of hands oh wow

can I see a race of hands oh wow

can I see a race of hands oh wow but you know so did I I was a surgeon’s

but you know so did I I was a surgeon’s

but you know so did I I was a surgeon’s patient also and you know it took that

patient also and you know it took that

patient also and you know it took that patient experience for me to understand

patient experience for me to understand

patient experience for me to understand what it’s like to go to the hospital and

what it’s like to go to the hospital and

what it’s like to go to the hospital and for once feel small and vulnerable to

for once feel small and vulnerable to

for once feel small and vulnerable to lie in that hospital bed after the

lie in that hospital bed after the

lie in that hospital bed after the operation and see medical practitioners

operation and see medical practitioners

operation and see medical practitioners come by one after another checking out

come by one after another checking out

come by one after another checking out their Shores throughout the day picking

their Shores throughout the day picking

their Shores throughout the day picking their own particular part of the process

their own particular part of the process

their own particular part of the process that they wanted to check I also know

that they wanted to check I also know

that they wanted to check I also know what it’s like to lie there in bed and

what it’s like to lie there in bed and

what it’s like to lie there in bed and just want to recover quickly without

just want to recover quickly without

just want to recover quickly without complications and go home

complications and go home

complications and go home but you know as a surgeon I know that

but you know as a surgeon I know that

but you know as a surgeon I know that surgery can be dangerous despite all the

surgery can be dangerous despite all the

surgery can be dangerous despite all the technical and medical advances that we

technical and medical advances that we

technical and medical advances that we made over the years people are still

made over the years people are still

made over the years people are still gonna suffer severe complications now

gonna suffer severe complications now

gonna suffer severe complications now picture yourself and three close ones

picture yourself and three close ones

picture yourself and three close ones having an operation one of you is gonna

having an operation one of you is gonna

having an operation one of you is gonna have a complication and no matter what

have a complication and no matter what

have a complication and no matter what some people still die after what we

some people still die after what we

some people still die after what we would regard as standard procedures but

would regard as standard procedures but

would regard as standard procedures but there’s a huge difference between some

there’s a huge difference between some

there’s a huge difference between some hospitals and others and there are

hospitals and others and there are

hospitals and others and there are studies from Europe that would say that

studies from Europe that would say that

studies from Europe that would say that you know the risk of dying after a major

you know the risk of dying after a major

you know the risk of dying after a major operation may be 10 to 15 fold greater

operation may be 10 to 15 fold greater

operation may be 10 to 15 fold greater in one country over another and believe

in one country over another and believe

in one country over another and believe it or not but for the same operation you

it or not but for the same operation you

it or not but for the same operation you may have to stay in the hospital three

may have to stay in the hospital three

may have to stay in the hospital three weeks to recover in one hospital while

weeks to recover in one hospital while

weeks to recover in one hospital while in another one it will take you three

in another one it will take you three

in another one it will take you three days to be perfectly fine and go home

days to be perfectly fine and go home

days to be perfectly fine and go home so you see if I’m gonna have another

so you see if I’m gonna have another

so you see if I’m gonna have another surgery I would choose my hospital very

surgery I would choose my hospital very

surgery I would choose my hospital very carefully now what may surprise you a

carefully now what may surprise you a

carefully now what may surprise you a little bit is how I make that choice

little bit is how I make that choice

little bit is how I make that choice you see I wouldn’t necessarily go to the

you see I wouldn’t necessarily go to the

you see I wouldn’t necessarily go to the most modern hospital with the fanciest

most modern hospital with the fanciest

most modern hospital with the fanciest machines and equipment and what have you

machines and equipment and what have you

machines and equipment and what have you no there’s something else that I’m

no there’s something else that I’m

no there’s something else that I’m looking for so what is it then with most

looking for so what is it then with most

looking for so what is it then with most hospitals that makes some so much better

hospitals that makes some so much better

hospitals that makes some so much better than others and how can we deal with

than others and how can we deal with

than others and how can we deal with that problem and why is it that the idea

that problem and why is it that the idea

that problem and why is it that the idea that I’m gonna tell you about today is

that I’m gonna tell you about today is

that I’m gonna tell you about today is about to cause a revolution in surgery

about to cause a revolution in surgery

about to cause a revolution in surgery so let’s start with what is the problem

so let’s start with what is the problem

so let’s start with what is the problem let’s together move back a little bit

let’s together move back a little bit

let’s together move back a little bit and reflect on something I’m sure

and reflect on something I’m sure

and reflect on something I’m sure everybody knows that you’re not allowed

everybody knows that you’re not allowed

everybody knows that you’re not allowed to have anything to drink from midnight

to have anything to drink from midnight

to have anything to drink from midnight to the day of that operation right well

to the day of that operation right well

to the day of that operation right well if you just have as much as a sip of

if you just have as much as a sip of

if you just have as much as a sip of water perhaps while you’re brushing your

water perhaps while you’re brushing your

water perhaps while you’re brushing your teeth that morning you’re probably gonna

teeth that morning you’re probably gonna

teeth that morning you’re probably gonna die on that operating table right well

die on that operating table right well

die on that operating table right well it’s probably the best known medical

it’s probably the best known medical

it’s probably the best known medical rule in the world but you know what it’s

rule in the world but you know what it’s

rule in the world but you know what it’s nonsense it’s completely false it’s

nonsense it’s completely false it’s

nonsense it’s completely false it’s wrong and still this is being practiced

wrong and still this is being practiced

wrong and still this is being practiced in just about every hospital around the

in just about every hospital around the

in just about every hospital around the world you see old habits die hard the

world you see old habits die hard the

world you see old habits die hard the problem is that this is not the only one

problem is that this is not the only one

problem is that this is not the only one of these old traditional treatments that

of these old traditional treatments that

of these old traditional treatments that we impose on patients around the world

we impose on patients around the world

we impose on patients around the world today and why is that well let me take

today and why is that well let me take

today and why is that well let me take you back a little bit in history a long

you back a little bit in history a long

you back a little bit in history a long time ago as I’m sure you can see on the

time ago as I’m sure you can see on the

time ago as I’m sure you can see on the picture I met with a fine surgeon from

picture I met with a fine surgeon from

picture I met with a fine surgeon from Edinburgh Ken theorem and he and I had

Edinburgh Ken theorem and he and I had

Edinburgh Ken theorem and he and I had the idea that we would for the first

the idea that we would for the first

the idea that we would for the first time put together the ideal protocol for

time put together the ideal protocol for

time put together the ideal protocol for major surgery everything that we do

major surgery everything that we do

major surgery everything that we do around it we would put together best

around it we would put together best

around it we would put together best practice so we gathered a team of expert

practice so we gathered a team of expert

practice so we gathered a team of expert colleagues to join us in a project that

colleagues to join us in a project that

colleagues to join us in a project that we called enhanced recovery after

we called enhanced recovery after

we called enhanced recovery after surgery or short

surgery or short

surgery or short so together we scanned all the

so together we scanned all the

so together we scanned all the literature that we could find that had

literature that we could find that had

literature that we could find that had any bearing on the outcomes of patients

any bearing on the outcomes of patients

any bearing on the outcomes of patients undergoing surgery and put together that

undergoing surgery and put together that

undergoing surgery and put together that ideal protocol the guideline when we

ideal protocol the guideline when we

ideal protocol the guideline when we looked at it we realized none of us were

looked at it we realized none of us were

looked at it we realized none of us were doing it and we were all doing

doing it and we were all doing

doing it and we were all doing differently so we decided to do a survey

differently so we decided to do a survey

differently so we decided to do a survey in the five countries that we

in the five countries that we

in the five countries that we represented and found nobody was doing

represented and found nobody was doing

represented and found nobody was doing it why was that well then we realized we

it why was that well then we realized we

it why was that well then we realized we were up against something really big

were up against something really big

were up against something really big Hospital organization okay well you see

Hospital organization okay well you see

Hospital organization okay well you see we’ve developed hospital care in

we’ve developed hospital care in

we’ve developed hospital care in departments surgery anesthesia intensive

departments surgery anesthesia intensive

departments surgery anesthesia intensive care all moving more and more into

care all moving more and more into

care all moving more and more into specialization all getting more and more

specialization all getting more and more

specialization all getting more and more technically advanced which is fine and

technically advanced which is fine and

technically advanced which is fine and dandy because that is actually one of

dandy because that is actually one of

dandy because that is actually one of the reasons we have some of the better

the reasons we have some of the better

the reasons we have some of the better results today compared to what we had

results today compared to what we had

results today compared to what we had years ago but the problem is that the

years ago but the problem is that the

years ago but the problem is that the more advanced each one of them become

more advanced each one of them become

more advanced each one of them become the further apart they grow and

the further apart they grow and

the further apart they grow and communication between them is like

communication between them is like

communication between them is like communication between silos very poor

communication between silos very poor

communication between silos very poor you see you have surgeons

you see you have surgeons

you see you have surgeons anesthesiologist nurses physiotherapists

anesthesiologist nurses physiotherapists

anesthesiologist nurses physiotherapists focusing on their own little part of

focusing on their own little part of

focusing on their own little part of that patients journey not caring about

that patients journey not caring about

that patients journey not caring about anything else but that not seeing what

anything else but that not seeing what

anything else but that not seeing what might be good or bad for the patient

might be good or bad for the patient

might be good or bad for the patient later on let me give you an example we

later on let me give you an example we

later on let me give you an example we can often use fluids to manage blood

can often use fluids to manage blood

can often use fluids to manage blood pressure during during anesthesia and

pressure during during anesthesia and

pressure during during anesthesia and surgery now that may solve the problem

surgery now that may solve the problem

surgery now that may solve the problem for that particular period of time the

for that particular period of time the

for that particular period of time the problem is that very often the patient’s

problem is that very often the patient’s

problem is that very often the patient’s gets way too much fluids and it’s not

gets way too much fluids and it’s not

gets way too much fluids and it’s not uncommon that you would have a patient

uncommon that you would have a patient

uncommon that you would have a patient come off the operating table increasing

come off the operating table increasing

come off the operating table increasing their weight by 6 8 or even 10 pounds

their weight by 6 8 or even 10 pounds

their weight by 6 8 or even 10 pounds just water inside the body is very

just water inside the body is very

just water inside the body is very uncomfortable for the patient it

uncomfortable for the patient it

uncomfortable for the patient it certainly will delay recovery and it can

certainly will delay recovery and it can

certainly will delay recovery and it can cause some serious complications are you

cause some serious complications are you

cause some serious complications are you beginning to see the problem that we

beginning to see the problem that we

beginning to see the problem that we discovered you see

discovered you see

discovered you see nobody has the the overview of the

nobody has the the overview of the

nobody has the the overview of the entire patient’s journey nobody controls

entire patient’s journey nobody controls

entire patient’s journey nobody controls the different elements nobody sees the

the different elements nobody sees the

the different elements nobody sees the entire picture so despite all the best

entire picture so despite all the best

entire picture so despite all the best of intentions we have a huge problem

of intentions we have a huge problem

of intentions we have a huge problem right so the issue is now how could we

right so the issue is now how could we

right so the issue is now how could we deal with this and have best practice

deal with this and have best practice

deal with this and have best practice being introduced well traditionally Ken

being introduced well traditionally Ken

being introduced well traditionally Ken and I be insurgents we would look at

and I be insurgents we would look at

and I be insurgents we would look at these things from our own point of view

these things from our own point of view

these things from our own point of view the surgical view but this time we tried

the surgical view but this time we tried

the surgical view but this time we tried something completely different we took

something completely different we took

something completely different we took another view we took the patient’s view

another view we took the patient’s view

another view we took the patient’s view that’s the only one who actually does

that’s the only one who actually does

that’s the only one who actually does the entire journey and this is where we

the entire journey and this is where we

the entire journey and this is where we found the solution so this is what IRA’s

found the solution so this is what IRA’s

found the solution so this is what IRA’s is of today and it’s based on one of the

is of today and it’s based on one of the

is of today and it’s based on one of the oldest skills that we have communication

oldest skills that we have communication

oldest skills that we have communication between people so the way that we train

between people so the way that we train

between people so the way that we train people today is that we bring best

people today is that we bring best

people today is that we bring best practices to them using this new

practices to them using this new

practices to them using this new approach the patient’s view so we train

approach the patient’s view so we train

approach the patient’s view so we train hospitals to form an arrest team have

hospitals to form an arrest team have

hospitals to form an arrest team have them sit around the table making sure we

them sit around the table making sure we

them sit around the table making sure we cover every one of the silos that the

cover every one of the silos that the

cover every one of the silos that the patient is passing through

patient is passing through

patient is passing through we take them beyond the checklist we

we take them beyond the checklist we

we take them beyond the checklist we take them trained to communicate in a

take them trained to communicate in a

take them trained to communicate in a way that they never did before well you

way that they never did before well you

way that they never did before well you may think we’ve done this forever but

may think we’ve done this forever but

may think we’ve done this forever but it’s we haven’t actually not this way

it’s we haven’t actually not this way

it’s we haven’t actually not this way you see now we have the surgeons and the

you see now we have the surgeons and the

you see now we have the surgeons and the anesthesiologist who take the medical

anesthesiologist who take the medical

anesthesiologist who take the medical decisions making sure we move away the

decisions making sure we move away the

decisions making sure we move away the old outdated traditional care elements

old outdated traditional care elements

old outdated traditional care elements and put in the new updated ones but they

and put in the new updated ones but they

and put in the new updated ones but they don’t do it in isolation one on one on

don’t do it in isolation one on one on

don’t do it in isolation one on one on their own no this time they do it

their own no this time they do it

their own no this time they do it together to make sure that we harmonize

together to make sure that we harmonize

together to make sure that we harmonize the patient’s journey and the nurses

the patient’s journey and the nurses

the patient’s journey and the nurses around the table the ones that actually

around the table the ones that actually

around the table the ones that actually carry out the work that it has to be

carry out the work that it has to be

carry out the work that it has to be done they know what functions and what

done they know what functions and what

done they know what functions and what doesn’t and they bring that to the table

doesn’t and they bring that to the table

doesn’t and they bring that to the table together with the dietitians the

together with the dietitians the

together with the dietitians the physiotherapist and any other health

physiotherapist and any other health

physiotherapist and any other health practitioner out there they make sure to

practitioner out there they make sure to

practitioner out there they make sure to refine the entire protocol now the other

refine the entire protocol now the other

refine the entire protocol now the other thing they do is they gather information

thing they do is they gather information

thing they do is they gather information about every patient that goes through

about every patient that goes through

about every patient that goes through their service and they come together on

their service and they come together on

their service and they come together on a way

a way

a way limiting the entire team and audit what

limiting the entire team and audit what

limiting the entire team and audit what is going on they audit their data they

is going on they audit their data they

is going on they audit their data they see the outcomes but also the processes

see the outcomes but also the processes

see the outcomes but also the processes behind them this is how they target

behind them this is how they target

behind them this is how they target their improvements and make sure that

their improvements and make sure that

their improvements and make sure that those improvements are sustained they

those improvements are sustained they

those improvements are sustained they also communicate to the rest of the team

also communicate to the rest of the team

also communicate to the rest of the team out there what each and everyone’s role

out there what each and everyone’s role

out there what each and everyone’s role is in the bigger picture and at the core

is in the bigger picture and at the core

is in the bigger picture and at the core of it all the patient the patient is

of it all the patient the patient is

of it all the patient the patient is given full information of what to expect

given full information of what to expect

given full information of what to expect during the surgical journey this

during the surgical journey this

during the surgical journey this empowers patients to take an active part

empowers patients to take an active part

empowers patients to take an active part in their own recovery so

in their own recovery so

in their own recovery so IRA’s you could look at it as the human

IRA’s you could look at it as the human

IRA’s you could look at it as the human to human link that secures that

to human link that secures that

to human link that secures that technology is not pushing us apart now

technology is not pushing us apart now

technology is not pushing us apart now I’m happy to say that this revolution

I’m happy to say that this revolution

I’m happy to say that this revolution has already started we begun in 2010 to

has already started we begun in 2010 to

has already started we begun in 2010 to implement these programs and it’s now

implement these programs and it’s now

implement these programs and it’s now spreading across the world well you may

spreading across the world well you may

spreading across the world well you may say this is not rocket science and

say this is not rocket science and

say this is not rocket science and perhaps it isn’t them but it’s extremely

perhaps it isn’t them but it’s extremely

perhaps it isn’t them but it’s extremely powerful and you know why it’s moving so

powerful and you know why it’s moving so

powerful and you know why it’s moving so fast it’s because of the outcomes I’m

fast it’s because of the outcomes I’m

fast it’s because of the outcomes I’m gonna show you in just a moment but

gonna show you in just a moment but

gonna show you in just a moment but before I do just keep in the back of

before I do just keep in the back of

before I do just keep in the back of your mind if this was a new drug a pill

your mind if this was a new drug a pill

your mind if this was a new drug a pill that was produced by the pharmaceutical

that was produced by the pharmaceutical

that was produced by the pharmaceutical industry I think you will agree it would

industry I think you will agree it would

industry I think you will agree it would be a billion dollar seller in no time

be a billion dollar seller in no time

be a billion dollar seller in no time because look at this patients will

because look at this patients will

because look at this patients will recover with only half the complications

recover with only half the complications

recover with only half the complications they recover much quicker and much more

they recover much quicker and much more

they recover much quicker and much more comfortably this brings down the need of

comfortably this brings down the need of

comfortably this brings down the need of hospital stay from what used to be weeks

hospital stay from what used to be weeks

hospital stay from what used to be weeks to days and for the hospitals and other

to days and for the hospitals and other

to days and for the hospitals and other healthcare organizations costs are

healthcare organizations costs are

healthcare organizations costs are coming down sometimes dramatically and

coming down sometimes dramatically and

coming down sometimes dramatically and we just found in our own study that we

we just found in our own study that we

we just found in our own study that we just published that we may even improve

just published that we may even improve

just published that we may even improve survival after some cancer surgeries so

survival after some cancer surgeries so

survival after some cancer surgeries so quite amazing isn’t it so the w-h-o the

quite amazing isn’t it so the w-h-o the

quite amazing isn’t it so the w-h-o the World Health Organization is predicting

World Health Organization is predicting

World Health Organization is predicting that this year 320 million operations

that this year 320 million operations

that this year 320 million operations are going to be performed that would

are going to be performed that would

are going to be performed that would result in six

result in six

result in six 80 million complications now just

80 million complications now just

80 million complications now just imagine for a moment if we could have

imagine for a moment if we could have

imagine for a moment if we could have eras out there as a standard of care for

eras out there as a standard of care for

eras out there as a standard of care for everyone my vision is that we would be

everyone my vision is that we would be

everyone my vision is that we would be able to reduce complications for maybe

able to reduce complications for maybe

able to reduce complications for maybe 10 20 or even 30 million people you see

10 20 or even 30 million people you see

10 20 or even 30 million people you see the next revolution in surgery is going

the next revolution in surgery is going

the next revolution in surgery is going to be based on something that has been

to be based on something that has been

to be based on something that has been with us all the time talking to each

with us all the time talking to each

with us all the time talking to each other so the next time or if you is for

other so the next time or if you is for

other so the next time or if you is for you it’s the first time you go for a

you it’s the first time you go for a

you it’s the first time you go for a surgery I think you should do what I

surgery I think you should do what I

surgery I think you should do what I would do

would do

would do look your surgeon straight in the eye

look your surgeon straight in the eye

look your surgeon straight in the eye and ask him do you have the era’s

and ask him do you have the era’s

and ask him do you have the era’s protocol in place in your practice thank

protocol in place in your practice thank

protocol in place in your practice thank you for listening

you for listening

you for listening [Applause]