Anesthesia Culture and the Future of Anesthesiology 1 Definition of "Culture" and "Human Factors"

Overview

     The technological changes that have occurred in the last 25 years in delivery of Anesthetics have been paralleled by vast improvements in Education and Culture. The Society for Airway Management , created by Andranik Ovassapian and his friends, is a manifestation of these changes. This Society and all of the other changes have joined to create many improvements in patient safety. The safety of practice improvements have been reflected in some countries , like Canada, by stabilization of growth of Medical Malpractice insurance rates and claims. 

Technological change has been unrelenting and has provided challenges for those learning and teaching management of these changes.

     With these changes we have seen the evolution of a class of caregivers CRNAs who have energetically learned to work in the space , for the most part as  trusted partners of the anesthesiologist. The new technology has increased the ease and safety of using the new class of providers in an Anesthesiology Environment. These new providers are now part of an evolving  new culture. The culture of change developing  is the subject of this series of posts.

Culture Definition:  Merriam Webster Dictionary

• The integrated pattern of human knowledge , belief, and behavior that depends upon the capacity for learning and transmitting knowledge to succeeding generations.
• The customary beliefs , social forms, and material traits of a racial, religious, or social group.
• The set of shared attitudes, values, goals, and practices that characterizes an institution or organization.
•  The set of Values , conventions, or social practices associated with a particular field, activity, or social characteristic.

Human Factors Engineering Definition:  Britannica

• Human factors Engineering, also called Ergonomics, or Human Engineering Science is application of information on physical and psychological characteristics  to the design of devices and systems for human use. Think aviation culture.
• As a body of knowledge human factors is a collection of data and principles about human characteristics , capabilities, and limitations in relation to machines , jobs, and environments.
• As a profession , human factors engineering includes a range of scientists and engineers from several disciplines that are concerned with individuals and small groups at work.

     The culture we now have in Anesthesiology is amazing in its power and reflects the enormous  output of the University systems and Industry output.  There is a complex intertwining of private medicine with new Government Care funding and all of this has a large bureaucracy attached.

What would be the feature set of a new culture  created to provide a path to the future:

• The new culture must have a strong central theme benefiting from "Enlightened Management ".
• The new culture must not be centrally micromanaged but must allow "islands of change that are locally inspired and controlled". Think of the hospital group , ICU level or the stand alone OR as examples of scale of the agents of change.
• The culture of change should weld into its DNA the benefits of Telemedicine that enables shared Electronic Medical Record , practice guidelines, inter hospital and inter service coordination while remaining decentralized in many ways.
• The culture of change should be viewed as a continuous process that engages all players.
• The culture of change should embrace the science of change management and the disciplines of Human Factors Engineering.

The Medical Professional of the future should be educated and enabled to be able to lead in local change initiatives in a role change that exploits the intellect and history of our profession.

To do this refocussing the training and preparation for change must be embraced and incorporated in Medical Training as a sub specialty. Medical schools should spend valuable teaching time serving this need.

Anesthesiologists can become the visionaries and agents of change in developing this new culture by reinventing them selves and learning to create " a new Personal Brand " as a change agent. 

The great technical development we have experienced now makes us the weak link in the " quality of care" equation. The way we behave leaves great opportunity for us to measure and improve our contributions to the great " Hippocratic Tradition".

Post Operative Continuous Positive Airway Pressure : ( New Book Reference)

The critical Postoperative period is different for those with risk of hypoventilation , subsequent respiratory failure, atelectasis, pneumonia, acute illness factors, and exacerbation of underlying lung disease or OSA than for those with short surgery with no risk factors.
         As an aside that corresponds with my intense interest in Nasal Tse Pap:
The provision of CPAP (preferably from the nasal route a la Rutgers Professor Dr. James Tse "Nasal Tse Pap" ) is a superior way of managing those at risk. The benefits , arguably ,  should be provided more liberally as opposed to the current practice where use is indicated " as required for problem solving".  This is an evolving topic which parallels a similar discussion around the 2013 ASA minimal requirement for "pre oxygenation" during intubation .  Nasal CPAP can provide extra preop benefits (next post). Dr Tse has received numerous awards from ASA Patient safety poster competitions for creative demonstrations of Nasal CPAP applications at Rutger's University Medical School.

Noninvasive Mechanical Ventilation and Difficult Weaning in Critical Care

Springer
Editor  : Antonio M. Esquinas
ISBN  978-3-319-04258-9 Print
           978-3-319-04259-6 Online