Managing theatre issues in private facilities

• Taking steps to avoid theatre issues from occurring is the best course of action, which includes preparation, strong team relationships and time management.
• Responding appropriately to theatre issues can help avoid risks to your surgical performance and patient safety, or of disciplinary action.
• If an issue arises, you can raise concerns in the hospital’s risk register or, if appropriate, by writing to the hospital administration, providing objective information about patient safety or other risks.

Being credentialled to operate at a private health facility is a significant milestone in a new consultant’s career. Having your own private practice and operating lists allows certain freedoms and benefits. However, like any workplace, there can be challenges.

These challenges can add unnecessary distractions, stress and time pressure to your day. At times, frustration and emotion can build and lead to unprofessional or inappropriate conduct, such as yelling at a staff member. This conduct may result in a complaint and subsequent disciplinary process.

More critically, these challenges can have consequences for your surgical performance and patient outcomes.

As with healthcare in general, prevention is better than cure. Here are some tips to prevent issues from happening in the first place.

Be prepared 

While having everything and everyone you need in the theatre is ideal, the reality is this doesn’t always happen.

To increase your chances of having what you need ready for you, make sure your requests are reasonable (e.g. not too expensive) and that you communicate why you need the resource to do your job. It’s especially important to let the facility know if a request is urgent, so they know to prioritise it.

It could also help you access the resources you need if they serve the needs of multiple doctors. Talk to your colleagues to see where your needs overlap and where you can make a request as a group.

Along with your other professional obligations, it’s vital to familiarise yourself and comply with the policies and procedures of a facility. If you don’t agree with them or have concerns, you can raise them with an appropriate supervisor, such as the director of medical services.

Prepare for when things go wrong and know where you can get help. Find out if the facility has an ICU, or if you would need to transfer a patient to another facility by ambulance. If you have a colleague operating in an adjacent theatre, check if they could help if necessary.

Build strong team relationships

You cannot overstate the importance of having a strong working relationship with your surgical team.

The bedrock of strong relationships is communication. Ensure that your surgical team understands your expectations and preferences and their roles. Organise a brief discussion with all staff before each list or procedure to convey this information. Then, during the procedure, clearly verbalise requests rather than assuming the team will anticipate your needs.

Similarly, it’s important you understand how your surgical team members work. Many experienced surgeons have a consistent surgical team (e.g. anaesthetist, surgical assistant and instrument nurse) to reduce variability and improve efficiency and patient safety.

If you’re starting out in private practice, begin by finding an anaesthetist and surgical assistant you had a good relationship with at medical school or someone you worked well with as a registrar. They’re most likely at the same stage of their career as you and looking to build their private practice.

Discuss with the anaesthetist pre‑operative review of complex patients, post-operative care, and preferred anaesthetic techniques to make sure your expectations align. Also, discuss fees to ensure they match your patients’ and your expectations.

Establish a solid professional relationship with an instrument nurse you like working with. If the nurse enjoys being part of your surgical team, they may request to be regularly allocated to your list, which will help build a consistent, supportive team.

Having a good rapport with the nurse unit manager in the facility’s perioperative services can also be beneficial. Let them know your preference is to work with a regular team of operating room nurses and provide positive feedback on the nurses you work well with. Bear in mind that there will likely be new or junior staff who are learning on the job too.

Manage your time

There may be a high demand for your skills but avoid the temptation to overschedule operating theatre lists.

If you leave sufficient time in your list, you will have more time before the next patient arrives to review the operating theatre and request any desired changes.

Allowing sufficient time can also mean you avoid having patients anaesthetised until you’re sure all necessary equipment is available and ready. Leaving some time after the procedure may also allow you to speak to the patient (when they have capacity) and their next of kin or support person (with consent).

For the benefit of the nursing staff and to help build a positive relationship with them, try to schedule your list so they can finish work at the end of their rostered shift. Ensure long operating lists allow adequate breaks for everyone.

Encourage your practice manager to build good working relationships with hospital schedulers so issues can be resolved when they arise. They should also feel empowered to escalate concerns to hospital administrators (such as the Executive Director of Medical Services) if they do not receive a satisfactory response.

Ensure you leave enough time at the end of your list to attend to matters such as completing documentation before you leave the hospital, providing clear post-operative instructions to staff, speaking with patients/family members if necessary and advising staff how and when to contact you.

If an issue needs immediate resolution, you could escalate it to the nurse unit manager or another appropriate supervisor. Remain objective and calm in your discussions regardless of how frustrated you feel. Your focus should be remedying the immediate issue so your theatre list can proceed.

If you feel upset or stressed while in theatre, consider leaving to calm down if it is safe to do so. If it’s not possible to leave, liaise with the anaesthetist or another person on the team to see if they can assist you in dealing with the issue.

At the end of your list, or if you still feel upset, the next day, consider whether to escalate the issue further. This might be appropriate if there is a systemic issue or if there has been a risk to patient safety.

Most private health facilities have a risk register where you can raise concerns about patient safety issues. Any entry into the risk register should be objective and factual and focused on the patient safety issue rather than a complaint about the conduct of one of your colleagues.

If you wish to make a complaint about a colleague or a serious issue, consider raising your concerns in writing to the appropriate hospital administrator. Writing to them might help resolve the issue and can assist in protecting you if there is a medico‑legal issue down the track. You also need to consider whether you have an obligation to make a notification to the Medical Board.

If appropriate, discuss what to do with the head of department or a senior colleague, before you take any further action.

If you decide to write to a hospital administrator, your correspondence should:

1. Explain the issue, focusing on patient safety or other risks that arose (rather than simply complaining).

2. Explain the solution or outcome you’re seeking.

3. Indicate that you’re happy to be part of the solution (as appropriate).

To remove any emotion from the complaint, draft your correspondence and put it aside for a few hours before reviewing it again. It can also be helpful to ask someone to review what you’ve written before submitting it such as your practice manager, a colleague or Avant.

If the issue is not addressed to your satisfaction, you can call Avant for advice.

For medico-legal advice, please contact us here, or call 1800 128 268, 24/7 in emergencies.