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Letters to Editor

Learning as we grow, growing as we learn

Gangakhedkar, Gauri Raman

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Journal of Anaesthesiology Clinical Pharmacology: Apr–Jun 2021 - Volume 37 - Issue 2 - p 297-298
doi: 10.4103/joacp.JOACP_378_19
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Dear Editor,

The excellent and well-worded review titled, “Beyond the borders: Lessons from various industries adopted in anesthesiology,“ made wonderful read. One can only imagine the extensive research and pain-staking efforts that went into its creation. The review reminds us that in implementing what we learn from other industries, anesthesia has led the way in creating widespread acceptance of the patient safety culture.

As the authors have rightly quoted, “Aircraft and flying are more predictable than patients and their responses to treatment.“[1] The dynamics of an anesthesia team thus necessitate adaptive leadership, where team members are required to interchange roles and responsibilities, unlike the fixed roles that can be followed in aviation. Aviation has led the way in discerning the role of human factors in errors. Studies undertaken in medicine led to a similar observation with human factors contributing to as many as 79% of the incidents.[2]

One of the most important lessons that we learn from high-reliability organizations (HRO) is to report failures. In medicine, it translates to publishing data which suggests failure or difficulty or even negative outcome. Any evidence that helps the fraternity prevent recurrences, must be made public.

In adopting Lean Systems at work, entrusting anesthesiologists or surgeons as Operating Room Directors (ORD) may prove to be advantageous given the unique vantage point that their training provides them. This thought finds evidence in a review and survey by Boggs et al., where 94% of the participants believed that anesthesiologists possess the skills to be ORD.[3]

The implementation of the hospitality industry “menu culture“ could be better utilized if the patients were provided “menu card“ choices with regards to anesthesia from their first visit to the surgeons, in the form of written brochures. The available literature proves beyond a doubt, that increasing the level of patient involvement in decision making, results in patient satisfaction in as many as 93% of the patients, with around 70% of them wanting to adopt at least a collaborative role, regarding the choice of anesthesia.[4]

In speaking about achieving professional excellence, Dr. Atul Gawande discusses the role of coaches in the operating room.[5] In allowing peers or seniors to critique our style of functioning, we are likely to gain new insights with regards to lacunae and room for improvement which may not be evident to us. In conjunction with Innovisits, self-invited coaching/critique tours would be valuable tools to improve patient outcomes.

The amalgamation of the various lessons we learn from other industries into our daily practice establishes that the progress of our discipline has stemmed from the core belief that safe anesthetic and perioperative outcomes must be provided for each patient receiving anesthetic care. While anesthesia as science appears to be well on its way to improve safety standards, we yet to achieve the ideal state. To quote Robert Frost,

“The woods are lovely dark and deep,

But I have promises to keep,

And miles to go before I sleep,

And miles to go before I sleep.“

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Conflicts of interest

There are no conflicts of interest.

1. Mahankali SS, Nair P. Beyond the borders: Lessons from various industries adopted in anesthesiology J Anaesthesiol Clin Pharmacol. 2019;35:295–301
2. Heideveld-Chevalking AJ, Calsbeek H, Damen J, Gooszen H, Wolff AP. The impact of a standardized incident reporting system in the perioperative setting: A single center experience on 2,563 'near-misses' and adverse events? Patient Saf Surg. 2014;8:46 doi: 10.1186/s13037-014-0046-1
3. Boggs S, Frost E, Feinleib J. Anesthesiologists as operating room directors: Results of a survey Int J Anesthetic Anesthesiol. 2016;3:041
4. Hwang SM, Lee JJ, Jang JS, Gim GH, Kim MC, Lim SY. Patient preference and satisfaction with their involvement in the selection of an anesthetic method for surgery J Korean Med Sci. 2014;29:287–91
5. Gawande A. Personal best: Top athletes and singers have coaches—Should you? New Yorker. 2011Last accessed on 2019 Nov 04 Available from:
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