​Better Use of Operating Rooms: think outside the New Brunswick Box

For years New Brunswick has had this public policy tug of war at the expense of patients who suffer from issues requiring sometimes even minor surgical correction.  The tug of war is:  lots of Operating Room Space and getting much better with new construction, specialist surgeons who could and would love to do more work but cannot get surgical hours in the Operating Room.

In the middle of the pack is the patient whose gynecological issue really needed repair or the acutely painful joints that could be fixed in a flash or the vascular challenges that would benefit from repair in a few days not a few weeks.  In tugs of war, it is always the patient in the middle in health care and, for them, not only is it not pleasant but it is often unnecessary.

For decades in New Brunswick, the typical discussion of surgical wait times and access to operating room time has degenerated into “shortage or nurses and shortage of anaesthetists.”  That theme was carried again in Andrew Waugh’s article on November 29, 2023 dealing with Hip, Knee Surgical push…

If the same themes keep re-appearing, who, pray tell, is saying: “we heard this song before, many times; it is now time for new music!”

Nursing issues have been discussed in public over and over for years with the union, government, health authorities, the association, the academic institutions that train them, and PETL who fund training all stating their piece.  Little common themes seeming to arise from the themes except that all know there are issues.

I took some Lean Six Sigma training years ago and was taught Root Cause Analysis; not much of what appears in press seems to have been subjected to that discipline.  Lots and lots of positions expressed but no real solutions because of limited agreement on root causes.  And it is not simple; the nursing issues are not helped by sound bytes.

But the posturing, the rhetoric, the defensive positioning all need to be halted and policy makers forced to get to the real issues and lead to solutions.  This is not best done a year out from election or in the midst of other political crises.

In 1964 I was a college student in Western New York; either through athletics of other activity, I experienced an inguinal hernia which, for a 19-year-old kid, was painful.  So off to the regional hospital I was referred, prepped for surgery, taken into the Operating Room and was greeted by a very kind Nurse Anaesthetist who announced that she would be putting me to sleep so the surgeon could repair my problem.

An hour later I was in recovery and a few minutes later in hospital bed where I remained for a few days (now would go home the same day).  In the years since, and after becoming familiar with the significant contributions of Nurse Anaesthetists in the United States, I have often wondered why Nurse Anaesthesia has not been developed in Canada.

In major centres in the US, the Nurse Anaesthetists tend to function as part of a team that has Board Certified Anaesthetists working in the same Operating Room Suite and not only performing anaesthetic procedures but overseeing the work of Nurse Anaesthetists and there for intervention as required.

In New Brunswick, the regional hospitals have relied on Royal College Certified Anaesthesiologists.  In smaller hospitals, normally a local family physician who has interest will go to a larger centre to receive training, then returning to the small hospital as the doctor assigned and now qualified to perform anaesthetic procedures.  This training is not 5 years post-MD as is the case of the certified anaesthesiologists but is much shorter.  This standard of practice has been the savior of local small hospitals where highly complex procedures are not performed but the procedures that are performed are normally urgent and sometimes life-sustaining.

In the evolution of health care in New Brunswick, we have seen the acceptance, after many years, of Nurse Practitioners as part of the Primary Care System.  The system has been slow and reluctant to accept mid-wives, and the acceptance of Physician Assistants has finally been approved after a 12-year pilot program as well as widespread acceptance for decades in the United States.

I recall when working at a hospital in northern Canada, a family doctor with supplementary training in anaesthesiology enabled the hospital to perform a variety of procedures which otherwise would have required a 7-hour drive or two-hour flight to a regional hospital.  It worked very well and created great public satisfaction.

In health care, with the changing demographics and the changing profiles in the practice of various specialities in medicine, solutions for the now and the future need to acknowledge history, learn from it, but not be bound by it.

My anaesthetic given in 1964 was every bit as good as any other anaesthetic I have ever had at the hands of incredibly kind and skilled anaesthetists.  And my family living in the US would recite the same themes from their experiences which have been many.  Better to get the essential surgical procedure in a week than wait for months, they would say.

Another planning tool that I learned was Force Field Analysis which simply helps you to line up the forces of support and forces of opposition for any proposed initiative and figure out how to get some consensus.  Any serious discussion of this topic that involves all the required voices will see strong opposition to any change with the theme of just recruit more anaesthetists.  Then there will be the voices of those who are enduring the long waits for procedures that can relieve pain, improve lifestyle, and, in some cases, increase life expectancy.  The voices that I have heard would at least want the discussion to engage in honest exploration of the issues and alternatives.

If the only option is to remain with the Royal College Certified Anaesthesiologist as the standard of practice, then public policy makers must get to the issue of how to train more, retain more, and do a better job of planning so that the predictable increases in surgical volumes are not continually compromised with “shortage of anaesthesiologists”.  These are important issues of public service that demand some new, bold thinking in order to ensure public service excellence.
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Ken McGeorge,BS,DHA,CHE is a retired career health care CEO, part time consultant, and columnist with Brunswick News; he is the author of Health Care Reform in New Brunswick and may be reached at [email protected] or www.kenmcgeorge.com