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Mark Your Calendar

Surgery Grand Rounds

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Grand Rounds

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Educational Schedule

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Educational Calendar - January 2015 (PDF)

Surgery Scheduling

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To See Ourselves as Others See Us

By Harry C. Sax, MD
Professor and Executive Vice Chair, Department of Surgery

"That's the news from Lake Wobegon, where all the women are strong, all the men are good looking, and all the children are above average." — "A Prairie Home Companion"

Each of us has risen to our present positions because, over the years, we have excelled at standardized tests, passed various certification exams, hit our productivity targets for the quarter and received accolades for how good we are. To get on the medical staff at Cedars-Sinai, all the evaluations must be above average, or additional follow-up and adjudication is required. As we do performance reviews for those we supervise, the vast majority of boxes checked are "exceeds expectations."

But are we really as good as we think? And are we measuring "the right stuff"?

From the outside, Cedars-Sinai has a reputation for excellent care, but at high cost. This has led to the exclusion of the institution, and many medical staff members, from participation in new contracts and patient groups. Even for simple procedures such as appendectomy or cholecystectomy, the range in costs of the equipment chosen varies by thousands of dollars, depending on the physician.

As leaders, we have received results from anonymous employee engagement surveys that we are not providing enough support, guidance and feedback to those we supervise. And our own evaluations tend to come from those above us, rather than those we mentor and for whom we are responsible.

Cedars-Sinai is addressing these challenges in several ways. One is active feedback to the medical staff on performance measures that are being examined by outside agencies and are used in deciding whether you can participate in various products.

The first will be length of stay index (LOSI). This is the ratio of how long your inpatients stay in the hospital versus how long they would be expected to stay based on co-morbidities and the severity of the index illness. Multiple factors can affect this, including variability in coordination of care, excessive consultant use and inadequate documentation of how ill our patients really are.

We've made great progress on LOSI with the Physician Advocate Program, and we want you to see your own results over time. In addition, we are providing access to the Crimson physician performance profile for you to review your own data in greater depth 24/7. This will soon include actual cost data, as opposed to charges, so you can examine and optimize your own practice.

On a broader scale, as an institution, we are increasing the use of the 360 evaluation. As implied by its title, this tool seeks feedback from colleagues, supervisors and direct reports. It provides a more realistic view of your performance in multiple dimensions. It can be quite eye opening and sometimes disconcerting. We are all colored in our own perceptions of our abilities; it is vital that we see how we are truly perceived. As a department, we are examining how this tool can help us each identify opportunities for self-improvement.

Being measured by others is always a bit uncomfortable, is open to subjectivity and can be seen as unfair. Yet as Socrates said, "The unexamined life is not worth living, and the unlived life is not worth examining." If Socrates was your supervisor today, he likely would be offering you these tools.