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Disruption…more than just a buzzword?

Innovation comes in all different shapes and sizes. Sometimes it’s about technology. Other times, it’s about shaking up status quo processes. This story is proof that disruption can help improve patient outcomes and innovation in hospitals.

On this episode of Boldly, Tamara Mason from Joule interviews Dr. Duncan Rozario, Chief of Surgery at Oakville Trafalgar Memorial Hospital.

At a young age, Dr. Rozario realized access to health care, or lack thereof, can have a significant impact on our lives as human beings. At worst, it can prevent us from living up to our greatest potential. Paired with his passion for science and problem-solving, this is what drove him to pursue a career as a physician. And later, becoming a surgeon.

Working collaboratively across disciplines, Dr. Rozario is driving change at Oakville Trafalgar Memorial Hospital to positively impact patient outcomes. Listen to learn how disrupting a process for day surgeries has helped better manage his patients’ pain and reduce opioid prescribing.

tweetable: “I realized from a very early age how access to health care or a lack of access to health care can prevent us from living to our greatest potential.” - Dr. Rozario

Key takeaways

What inspired Dr. Rozario to become a physician?

  • A family trip to India at the age of 5 helped him realize that access to health care can help us realize our greatest potential;
  • An interest in science led him to study medicine;
  • It was his drive to solve problems that led him to surgery.
tweetable: “When we look at the challenges that face us in health care―whether there are challenges of capacity, funding, or leadership―they will not be addressed by doing the same thing and expecting a different outcome.”

Why is disrupting the health care system important?

  • There are many different challenges in health care, but these challenges will not be addressed by doing the same thing and expecting different results;
  • Tolerating risk is key to evoking change, especially in health care;
  • Canadian health care has room to grow and the resources to do so.
tweetable: “Unless we're willing to tolerate risk, unless we're willing to try something new…we will not get out of the historic patterns that we have been in.”

How did he apply this principle to postoperative pain management?

  • Identify a problem: They shifted primarily to day surgeries, but pain management didn’t shift along with that change. It started as a way to manage pain for patients who had day surgery.
  • Collaborate: As Chief of Surgery, it was important to collaborate with the Chief of Anesthesia on this initiative.
  • Seek solutions: A study led by Dr. Sanjho Srikandarajah at North York General Hospital affirmed it is possible to reduce the use of narcotics in day surgeries.
  • Try it and test results: A specific protocol they introduced has helped 80% of patients having day surgery use zero narcotics.
tweetable: “Only by trying new things and trying things that the mainstream may consider disruptive will we really be able to improve access and the health status of our population”

Can this solution be scaled across Canada or other hospitals in Ontario?

  • Yes. Dr. Rozario believes this solution could even be scaled internationally.
  • Other hospitals in Ontario, some of which have led the research in this field, have already adopted this protocol.
  • Aside from general surgeons, it can also be implemented across different departments and with different patient populations.
  • This could significantly reduce opioid overprescribing.
tweetable: “What if patients now have a clear understanding that for most day surgery procedures―opioids will not be required that the objective is not to eliminate pain―but to maintain what we describe as functional status.”

How did collaboration help move this initiative forward?

  • Change is a team sport;
  • Bringing the patient’s entire care team into the fold is critical to success;
  • Family physicians are brought into the loop as well so they can familiarize themselves and their patients with these approaches;
  • System change will only happen and last if there is a collaborative approach.
tweetable: “Sometimes the only way you know whether something works is if you try it out.” 

How can physicians be more involved in the decision-making process?

  • When we collaborate, we won’t always agree―but having a voice, and having your opinion heard is important;
  • Empathy, listening with compassion and having an open mind are key to advancing any idea;
  • Remember everyone is working towards the same goal and same objective, they might just approach it differently.
tweetable: “Change is a team sport―there's not one individual who can introduce a system change.” - Dr. Duncan Rozario


Recommended Resources

Thinking about multimodal pain control, a Canadian Healthcare Network article by Dr. Duncan Rozario

Opioids for pain after day surgery, a patient handout by the Institute for Safe Medication Practices Canada

NYGH Reduces Opioid Prescriptions To Help Curb Misuse, a news piece by North York General Hospital

From one doctor to another: here’s what you can do about burnout, a Boldly article by Dr. Duncan Rozario

Burnout, resilience and moral injury: How the wicked problems of health care defy solutions, yet require innovative strategies in the modern era, a Canadian Journal of Surgery article by Dr. Duncan Rozario

A guide for surgeons on burnout, a Canadian Healthcare Network article by Dr. Duncan Rozario

The importance of the patient experience, a Boldly article by Lindee David about a conversation she had with Dr. Duncan Rozario

Optimization of communication in the surgical program via instant messaging, Web-based surveys, newsletters, websites, smartphones and telemedicine: the experience of Oakville Trafalgar Memorial Hospital, a Canadian Journal of Surgery article by Dr. Duncan Rozario



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The opinions stated by podcast participants are made in a personal capacity and do not reflect those of the Canadian Medical Association and its subsidiaries, including Joule. Joule does not endorse any views, product, service, association, company or industry mentioned in this podcast.