How “Surgery as Unusual” is Like Business as Unusual
By Cal Beyer; VP; Workforce Risk & Worker Wellbeing, ACAP Health Works
When a change agent assumes leadership of a struggling team, unit, division or company, these leaders frequently throw the gauntlet down. They’ll say we are embarking on a change management initiative. They’ll make bold statements that this will not look, feel, or sound like business as usual. They boldy exclaim “It’s going be ‘business as unusual’”.
The first time I remember hearing the term was in 2001. A book of that title was published by Anita Roddick, the founder of The Body Shop retail store. Roddick was addressing the need for business to continually evolve.
I’ve used the expression myself working in startups and turnarounds. I also used it when I became director of risk management for a large construction company. It set the tone for transforming the company’s risk and safety culture. I used it again when I was calling workplace mental health and suicide prevention the next frontier in safety almost 15 years ago.
The expression business as unusual fosters openness to innovation and change – it allows the leader to share their vision for change and helping team members to thoughtfully consider areas of necessary change. It provides a pathway for team members to be part of the solution and not part of the problem. It demonstrates a commitment to calculated risk taking by moving outside the confines of the status quo.
Greek philosopher Heraclitus is credited with the expression “the only constant is change”. So, if change is not new, then what is new about change? The pace of innovation is what is new. There is a need for speed in adapting to a changing world through innovation. On the one hand, I marvel at the innovations available in modern health care. On the other hand, the implementation of changes in health care are not uniformly accepted, adopted, or implemented for various reasons.
One example appears to be surgery. The more I’ve learned about surgery, the more I recognize there is a dichotomy: “surgery as usual” vs. “surgery as unusual”. What is the difference?
A major difference is if the procedure will be performed following standard surgical procedures or using Enhanced Recovery After Surgery (ERAS) protocols. In short, ERAS represents a better way of surgery. Yet only approximately 5% of surgeries in the US are performed under ERAS protocols vs. 95% under standard operating procedures. Why is this the case?
The aforementioned consistent lack of adoption of change is the major explanation.
The innovative ERAS protocols originated in Europe approximately 15 years ago. An abundance of over 5,000 peer-reviewed articles highlights evidence-based research demonstrating the efficacy of improved surgical outcomes achieved with ERAS. There are two professional societies that govern the continuous evolution and advancement of ERAS. The ERAS Society of the USA website provides sample standardized guidelines (protocols) for at least 21 distinct types of surgery.
The table below provides a summary of traditional surgery as usual vs. surgery as unusual using ERAS protocols.
| Factor | “Surgery as Usual” | “Surgery as Unusual” |
| Pre-surgical education | Standard call from surgeon’s office with reminders of when to arrive | Intensive pre-surgical education with focus on being physically and emotionally prepared for surgery |
| Pre-surgical preparation | No food or drink by mouth after midnight | Clear carbohydrate drink up to 2 hours before surgery |
| Site of surgery | Generally, inpatient at hospital | Outpatient, ambulatory surgical care center |
| Type of surgery | Open with larger incisions | Laparoscopic and robotic assisted resulting in smaller incisions |
| Pain management | Opioids prescribed as standard pain relief with take home prescription expected upon discharge | Opioid-sparing, including non-opioid medication and perioperative multimodal pain management with significant less likelihood of a take home prescription |
| Post-Surgical Advocacy | Standard discharge instructions to follow-up with surgeon in “x” number of weeks | An assigned Surgical Nurse Navigator continues to provide post-surgical education and advocacy with focus on return to life and work |
| Overall healing time | Standard recovery as per practice guidelines is normal | Accelerated recovery and quicker return to life and work is possible. As per the Validation Institute, recovery is faster than 31.8 days on average with lower readmission rates and other complications associated with surgery. |
What qualifies me to make this opinion?
- Personal Experience – I had my first of several knee operations when I was 11 years old and three by the time I was 15. I have personal lived experience with long-term post-surgical opioid prescription medications – including experiencing misuse resulting in persistent opioid use.
- Family experience — I am a spouse, father, son, grandson, and sibling of family members who have had surgeries. Almost three years ago our family had two of our five grown children scheduled for major surgery less than two weeks apart. This was the first time any of our children required surgery. Our children were treated at the same major university health system. However, the two surgical practices in two different medical-surgical disciplines had differing protocols for pre-operative preparation, patient and caregiver education, and pain management.
- Risk Management experience – I am a risk management professional with a predilection for assessing risk, identifying alternatives, selecting the best decision, and monitoring results. This is based on making informed decisions through research and analysis, including evidence-based practices.
- Early adopter as a proponent and leader of workplace mental health. I serve on the Executive Committee for the National Action Alliance for Suicide Prevention, and have partnered with public health, private sector, and nonprofit organizations focused on mental health, substance misuse, suicide prevention, and opioid risk reduction.
- Professional networking and collaborative thought leadership with Goldfinch Health – I’ve coauthored three articles and co-presented numerous webinars and presentations with the Co-Founders of Goldfinch Health. In our collaborations, I’ve gained razor sharp insights about innovation in surgery and pain management.
Please read the article below to gain these same insights to help protect your workforce and families. This article is featured on the website of the International Foundation for Employee Benefit Plans (IFEBP). It is titled Optimizing Outcomes and Containing the Costs of Surgery:
Learn how surgery as unusual can reduce healing time by 32 days with a return on investment of $7.7- to every $1 invested in optimizing surgery outcomes. In case you’re skeptical of these benefits, ask Goldfinch Health to share the performance guarantee offered by the Validation Institute attesting to these performance metrics. That is further proof of the benefits available from surgery as unusual.