Embracing Failures Serves as a Catalyst to Success

Drawing from both the profession and the sport that he loves, 2017-2018 STS President Richard L. Prager, MD encouraged attendees of his Presidential Address on Monday to “see their realities” and to “make seeing and knowledge continuous with each other.”

Richard L. Prager, MD highlighted the importance of performance measurement.

“Professional innovation is our responsibility, and recognizing we are a creative specialty, I would offer that we—as surgeons—and our professional societies must be the leaders in accountability and transparency. To do so, we must embrace and advance performance measurement and analytics, performance feedback, and performance improvement,” he said.

Dr. Prager’s work with quality improvement initiatives is his professional equivalent of a grand slam, according to Keith S. Naunheim, MD, who introduced Dr. Prager. It was therefore fitting that the focus of Dr. Prager’s address was the vital role of performance measurement and feedback in achieving success.

Dr. Prager took attendees on a journey of quality improvement initiatives in cardiovascular surgery, highlighting the STS National Database and the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, the latter of which he now directs.

As one example of the power of the Quality Collaborative in improving outcomes, Dr. Prager described an initiative to increase use of the internal mammary artery in coronary bypass surgery. The success was the result of identifying rates of use at various sites, offering educational sessions, creating an exclusion form for operating surgeons who chose not to use the internal mammary artery, and providing feedback.

Subsequent Quality Collaborative initiatives were successful in reducing ventilator time, decreasing unnecessary blood transfusions, and identifying when the critical or sentinel thought process or care process occurred leading to a patient’s death.

“Cardiac and thoracic surgeons have a unique opportunity with the data we have from our registries in the United States and worldwide to explore our outcomes and comparative performances, and—with understanding and feedback, discussion, and resetting of approaches and goals—create improvements, knowledge, and benefit for patients and our national health care systems,” he said.

Dr. Prager then reinforced the integral role of performance analysis and feedback for success in the sport he loves: tennis. Through short video clips of interviews with players and coaches, attendees heard how performance measurement, performance feedback style and timing, and personal qualities lead to improvement and success.

Dr. Prager captured the essence of the interviews by noting that cardiothoracic surgeons must embrace their failures, as that is the path to greatness, and should always think about getting better—not winning, but getting better—in order to be successful.

“The commitment of [tennis] players is unwavering and the recognition that performance feedback is essential is understood by every player at every level. Perhaps we can learn from their commitment and approaches,” said Dr. Prager.

He added, “Accepting performance feedback and looking at our outcomes is as much about our character as our talent or ability as surgeons, and as our future tennis stars recognize, there always are ways to improve.

“For all of us, while this may seem to be an aspirational narrative, the mastery of the approach, whether it is a hospital network, an individual hospital, or an individual surgeon, our professional innovation, our seeing, will create success,” he said.