Professionalism in support of pediatric cardio-thoracic surgery: A case of a bright young surgeon

摘要

Effective teamwork is critical to successful outcomes in pediatric cardiac surgery. Unfortunately, lapses in professional performance and conduct by those who treat pediatric cardiac patients pose threats to quality and safety. One hallmark of a profession is self regulation. Therefore, healthcare leaders need specific means for identifying and addressing those lapses and indicators of unsafe systems or individuals. This article describes an initial "near miss" event involving a pediatric cardiac surgeon. While fictional, the case represents a composite of events involving several pediatric cardiac surgeons who practice at different medical centers throughout the U.S. Research shows that patient complaints are significantly associated with physicians' risk management activity and lawsuits. Research also demonstrates that a small subset of physicians and surgeons in various areas of practice are associated with disproportionate shares of patient complaints. Coded and aggregated patient complaint data therefore offer a metric for identifying and promoting behavior change. Analysis of the distribution of patient complaints associated with 41 pediatric cardiac surgeons is presented as a means for helping leaders show one surgeon how her/his risk status compares with peers'. The paper describes a specific plan and reliable process by which medical group/center colleagues and leaders may: 1) address lapses in professionalism and performance; 2) follow-up to promote professionalism, professional accountability, quality, and a safety culture; and 3) reduce risk.