Hippo - Dr. Alexander LangermanDr. Alexander Langerman is an otolaryngology surgeon at the University of Chicago Hospital. He directs the Operative Performance Research Institute, a think tank studying operating room efficiency and safety through collaborations with The Booth School of Business, the Computation Institute, and the Illinois Institute of Technology’s Institute of Design. He is also a faculty member of The MacLean Center for Medical Ethics and researches the ethics of surgery and data recording in the operating room.

What initially drew you to academia (and your field specifically)?

I love to pursue interesting questions. Finding the right questions takes patience, but I enjoy the process. I know I’ve found a worthwhile question when I spend hours thinking about it, without noticing the time. Intriguing questions stick; I’ll continue to think about them when I leave the hospital, and new thoughts will strike me while I’m in the shower or out for a run. It’s a privilege to explore compelling questions and propose viable solutions.

There are many opportunities for innovation in surgery, and academic medical centers encourage the exploration of these innovations. It’s wonderful to share ideas with colleagues, and combine our experiences to create new ways of treating disease. Academic medical centers are stimulating environments; they are where breakthroughs happen.

I also enjoy being a part of other peoples’ learning and discovery—in the lab, clinic, and operating room (OR). Watching surgical trainees first appreciate an anatomical relationship or see a tissue plane is a monumental experience, and it’s fun to play a role in creating that moment. Training future surgeons to be safe, careful clinicians who respect tissue and physically heal people is both a burden and an honor.

What is your favorite academic work in your discipline and why? How would it be useful for those outside your discipline to read this work?

Forgive and Remember by Charles Bosk is my favorite academic work about surgery for several reasons. First, someone without medical experience followed a team of surgeons for months at a time, trying to understand how they thought and worked through the lens of sociology. This is in keeping with the work I do in the Operative Performance Research Institute (OPRI), trying to improve the OR by drawing upon other disciplines of thought. Second, the surgical culture Bosk described in 1979 isn’t that much different from the culture we have now. Some characteristics of surgery that Bosk noticed are intrinsic to the profession; these will continue to endure in the years ahead. But many of the constructs he described aren’t so fundamental and have persisted without being questioned. As they are questioned, we will see opportunities for improvement. Lastly, the book provides readers with an understanding of the history of surgeons, forming a bridge between the surgical world of the past and present.

What do you see as the particular challenges in your discipline and how can these be addressed?

Surgery has developed tremendous innovations in its history, and the majority have been developed from within surgical specialties. Other industries have been influenced by thinkers in expert performance, business, organizational behavior, and design. Many of the innovations that have been successfully implemented elsewhere are relevant to surgery, but we’ve been slow to adopt them. Part of this is the culture, part is the sequestered and sterile environment that is hard for people to observe and participate in. With OPRI, we are opening the OR to other thinkers, allowing them to help us create solutions to operating challenges.

What do you wish more people knew or understood about the work and research you’re doing? Are there any misconceptions you’d like to clear up?

I want people to know that surgery is a team activity and is nothing like what’s shown on TV: it’s usually not nearly as dramatic, it’s human, and it’s a routine day at work for the people involved. That being said, the surgeon and patient have an intimate connection. The surgeon has the patient’s values and hopes in their hearts as they operate, and they are responsible for conveying the patient’s wishes to the rest of the OR staff.

It is important for people to understand that surgery is approachable, and innovations from people without a surgical background are needed. There are examples of non-medical engineers or designers proposing novel instruments and technical solutions for the OR.

The future of surgery, and the surgical treatment of disease, is dependent on generating more of these ideas—we should be welcoming them.

What do you see as the current pressing issues in your field?

The most pressing issue in surgery is the most pressing issue in medicine: the appropriate expectation of delivering higher quality care at a lower cost. The trick is how to accomplish this. There are plenty of workflow solutions that could be introduced, but they can’t just be transposed from an assembly line. Surgery is a human act performed on a human body; there’s inherent variability. Therefore, we have to create standardization that is also adaptive and nimble to the particulars of an individual patient.

What is your dream project or research undertaking? (i.e. if you had an unlimited budget what would you do with it?)

I would connect every surgical team in the world, learn who is doing what best, and share those ideas with all surgical practitioners. Surgery is isolated and the proclivities of an individual practitioner dictate how the surgery is performed. We need to be sharing ideas more rapidly. I want to introduce a Darwinistic pressure, such that only the best surgical techniques “survive.” That would take the development of a new science for understanding the flow of surgical cases and their performance, which is something we’re presently working on. Based on that foundation, we could then create methods for surgeons to share and replicate ideas.

What are you working on right now?

OPRI has several projects going at the moment. Our main project currently is the creation of ExplORer, a playbook for the operating room that helps every team member coordinate to the specific task at hand. ExplORer offers surgeons an opportunity to share their knowledge of the patient and procedure with the whole team and, in doing so, help the OR run more efficiently and safely. It also serves as a platform for surgeons to share innovations and ideas.

Dr. Langerman’s Recommended Reads:

  • Nudge: Improving Decisions about Health, Wealth, and Happiness, a popular book by Richard H. Thaler, has a lot to say about how to influence change in people.
  • I also recently read Social Physics by Alex Pentland, about the science of idea sharing and development. It wasn’t designed to relate to surgery, but it certainly could. It’s also a wonderful chronicle of the high-impact career of someone who clearly enjoyed figuring things out.
  • In general, I read books on design and business, and I watch TED Talks. I seek out ideas outside my fields because that’s where I think disruptive ideas lie.

Image credit: Drew Bates via flickr