Emily Harris is the Business Manager for the Heart and Vascular Program at Unity Health Toronto – St. Michael’s Hospital
Healthcare is a varied and multidisciplinary world. From clinical medicine to social work to data collection, expertise from many diverse specialties is required to ensure that hospitals run successfully and that patients receive the very best care.
The value of a collaborative environment in healthcare is simple to understand – we all know that it’s beneficial to learn from others and share skillsets – but making this a reality can be difficult to implement in practice. How can we move collaboration from a conceptual buzzword to a lived experience for our varied hospital teams?
As the Business Manager for the Heart and Vascular Program in a Toronto hospital, my work is focused on the medical periphery; I blend the clinical with the fiscal by analyzing trends in medical data and supporting the successful funding and operations of my department. Since I began this work, I understood the impact of procedures like a coronary artery bypass graft (CABG) in terms of its funded provincial rate, the volume that our hospital completes each fiscal year, and the resources and supplies used to perform the procedure and to care for the patient. Yet I had never understood a CABG through its visceral elements. I hadn’t seen the look on a patient’s face just before their first open-heart surgery, or heard the cacophony of sounds made by the monitors to measure vital signs, or felt the impact of busied yet coordinated preparations made by the team in the operating room.
This is a familiar situation for many of us who work in healthcare outside the clinical realm. We can face a disconnect between clinical and non-clinical work which may lead to a lack of understanding at least, and miscommunications or mistakes at most. In my case, and as a result of the support from an insightful, forward-thinking director and an open, generous surgeon, I was able to make a step towards crossing the collaborative divide and observe my first cardiac procedure.
It was an experience I will never forget and a privilege for which I will always be grateful. The patient underwent an aortic valve sparing root repair and double CABG, which is uncommon and highly specialized. From the moment I arrived in the OR, I developed a stronger appreciation for my clinical colleagues. The early starts to the (long) day, the challenges in ensuring all the equipment was sterilized, prepared, and easily accessible, and the positioning of each piece of machinery made an impact. Even the greeting to the patient affected the day (whereas the patient said “Good morning” to one of the team members, they smiled and corrected him: “Great morning”, they said. And with that, reassurance was given and received). The procedure lasted nearly five hours and I was enthralled throughout the process. I witnessed the way a chest is opened, the mechanisms to stop and restart a heart rhythm, and the anatomy of the heart from angles that I had never imagined I would see. Every moment shaped my understanding and appreciation for our hospital’s ability to provide lifesaving care to our patients.
Since my time in the OR, I have felt the true impact of the work that I do and the work of my colleagues as well. I have an appreciation for both the cost and the clinical impact of each instrument within a case costing analysis, I feel a stronger reaction when analyzing the results from a patient experience survey and the troubling effect of long wait times for surgeries, and I value any opportunity to advocate for increased funding for highly specialized cardiac procedures.
Many elements came together in order for this experience to be possible for me. First and foremost, I am grateful to the patient. Not everyone is comfortable with observers during their procedure and so it is vital to respect patient privacy and honour the wishes of patients and their families. Part of this privilege as an observer also means taking care to respect the space that is occupied and follow directions regarding behavioural guidelines. In addition, my supportive and collaborative team was instrumental in creating this opportunity for me. To name a few: my director, the surgical team, administrative staff, technologists, nurses, and anesthesiologists all played a role and I am deeply appreciative of their hard work and effort.
Importantly, the concept of clinical and non-clinical collaboration is reciprocal. I am thankful for any opportunities to present back to my clinical colleagues about the funding and business management of the program. I hope to cultivate even greater interest and foster open conversations about the ways that quality, funding, efficiency, and patient experience are all part of our larger, mutual goal. This is work that I am honoured to undertake.
In closing, if an opportunity to take part in a clinical procedure or other clinically-focused activity is available to you as a non-clinician, or if you are a clinician and you have the chance to join in on a non-clinical activity, I implore you to take it. Learning from your colleagues will help to guide your perspective and might inspire you to uncover the best of both worlds in your hospital.
Thank you, Emily, for sharing your thrill and exhilaration at your first cardiac OR experience. I understand and appreciate your epiphany, as it were, and vicariously experienced your excitement. Thanks again for taking the time to write. A retired GP-anesthetist.