During the fall 2018 in-person meeting of AAOS’ Patient Safety Committee (PSC), members addressed methods for creating a culture of safety and enjoyment in orthopaedic surgery. David C. Ring, MD, PhD, chair; committee members Michael R. Marks, MD, MBA; Nina R. Lightdale-Miric, MD; and former PSC member

Dr. Ring: How do you create a good team? What about the idea of hiring for values? You can teach most technical skills, but it’s harder to instill good values and find people who are genuinely emphatic and compassionate. I think we can teach the rest of it.

I’ve noticed that when we think about people we would rather replace, it’s usually about values. It can be difficult to discern values from an application or interview. There is an art to interviewing in a way that addresses those core values. I’m not very good at that yet.

Dr. Marks: We have a real problem in health care; studies have shown that the first-year medical student demonstrates more empathy than a fourth-year medical student. A first-year resident shows more empathy than a fifth-year resident. What are we doing during all this training that is dehumanizing medical students? It goes along with the burnout aspect that can happen when you get so beaten down on the job that you feel like, “I don’t hear you. I don’t see you. I don’t understand what you’re going for.”

Dr. Ring: We need ways to get clinicians’ attention and make them feel like learning effective communications strategies, self-awareness, and balance is important.

Dr. Marks: Data show that being happy with yourself, your environment, and whatever is going on is directly correlated with what’s going to happen with respect to malpractice suits. It’s why the malpractice companies are getting involved in improving personal skills and enjoyment of work.

Dr. Pinzur: When medical students are choosing a residency program, I say, “Just step back and see which culture you think you’re going to be the most comfortable in. Which environment is most like you?”

When looking for a job, I ask, “Which environment looks like it is going to be the easiest for you to succeed in?” A position may give you fewer resources than the next, but it might have something else that’s right.

Dr. Lightdale-Miric: One example is that our colleagues whose manners and attitudes make work less fun need to be aware of their impact and either evolve or move on. AAOS can set the standard on this type of culture.

Dr. Ring: When there are reckless people, they should be identified and taken care of as immediately as possible, so it doesn’t ruin the culture. What’s more common is that we allow people to drift into bad behavior. Some people—given every opportunity and support to improve—might become your culture, quality, or communication skills advocate. They might be the ones to say, “I know how this will work because I know what wasn’t working for me.”

Dr. Pinzur: In the book “Why Hospitals Should Fly: The Ultimate Flight Plan to Patient Safety and Quality Care,” John J. Nance said one of the key things that sometimes helps is addition by subtraction. There are some people who just aren’t team players. Anybody who creates a negative environment hurts the whole environment. You may be better off without them.

Dr. Marks: It’s the teamwork that may allow you to have the time off to get to your kid’s softball game, so that you are not enveloped in a 24/7 thought of, “I’m the only one who can take care of this.”

For a lot of people, teamwork is about being able to actually cede some of that control and stepping back to say, “I don’t need to micromanage.” We may feel like good managers when we micromanage, but we have not learned how to become good leaders.

Dr. Pinzur: Leadership can work differently with different generations. It’s helpful to adapt to each individual and each generation’s needs. We have to adapt to people if we want people to adapt to us.

Dr. Ring: The idea of making an effort to work with people of different backgrounds and learning and styles supports diversity. If you think differently from me, that’s an opportunity. Differences in generation, ethnicity, race, gender, culture, language, and traditions offer perspectives that can enhance the work we are doing. You might learn from me and change a little bit, and I might learn from you and change a little bit. That’s a culture that is supportive of success.

Conclusion

Creating an effective work culture must be intentional and takes work. There is also a knowledge base and expertise that must be tapped into. To build a culture of safety and feedback, we need to plan and nurture it.

David C. Ring, MD, PhD, is chair of the AAOS PSC.