Humans, Machines, and Operating Rooms
August 19, 2012 § 1 Comment
Cardiac Surgery: Studying its Participants and Practices in Flux
In the past few decades, American medical workers in cardiac surgery have witnessed significant technical and social changes in their work. Over the past year, I have grappled with the professional implications of those changes, specifically as they affect communication in coronary artery bypass graft (CABG) operations. In CABG cases, technical advances have improved the quality of grafts, the protection of the heart during cardioplegia, and the sterility of the operating room (OR). These were all major limitations to the success of CABG surgeries in the past. As a result, patients are leaving ORs after thoracic surgery with better blood flow, superior “squeeze,” lower chances of infection, and less damage to the heart during bypass. These changes have transformed cardiac surgery. Today, in 2012, performing a CABG is a routine activity in hospitals around the country. However, parallel improvements in cardiology — that address heart disorders through drugs and other non-surgical approaches — have meant that only the sickest patients make it to the operating table. The typical CABG case is now more complex than it has ever been.
Alongside technical changes, organizational and cultural shifts in the administration of medical work are taking place. Cardiac surgeries are increasingly regulated and systematized by checklists, timeouts, and data logging. Such changes have profound implications for relationships among surgeons, techs, nurses, anesthesiologists, perfusionists, and an array of other transitory workers in the OR. Old disciplinary hierarchies, abusive communication practices, and unproductive ways of assigning blame are facing new policy reforms. New standards of OR behavior, often pitched as “patient safety initiatives” are meant to create a more progressive, efficient, and even liberated culture in the OR. But these initiatives can also create new tensions or simply more work.
The new culture of the standardized cardiac OR is still emerging in everyday interactions among people, technologies, and policies. This research attempts to understand the cardiac OR’s most persistent values as well as its new challenges, with particular attention to practices of information exchange. My aim is to engage medical workers in reflecting on the evolving social and technical environment of the cardiac OR and to identify opportunities for improved communication and more equitable ways of handling errors and conflicts.
This research has been undertaken with David Mindell and the MIT Laboratory for Automation, Robotics, and Society.