Planning makes perfect, says Dr Leigh Spielberg

I couldn’t believe it. An elderly patient who I had seen in the clinic an hour or two earlier was walking into my operating room, a relieved smile on his face. This patient, who I knew to suffer from vascular dementia that led to extreme agitation when he was confronted with stressful situations, was the picture of calm, despite his very recent diagnosis of endophthalmitis. Here he was, about to receive a vitreous tap and intravitreal antibiotics under local anesthesia, and there was nothing about his demeanor to suggest that anything had progressed anything less than perfectly since I had planned his surgery. We had worked long & hard for this moment. What caught me by surprise when I started working as a full-time university staff ophthalmologist is the amount time and energy that needs to be devoted to coordinating logistical processes. As a resident and fellow in another institution, I took the organisational aspect of the whole process for granted. That’s the way I’ve always known it, so it must have always been that way. And anyway, I had other things to worry about, like learning how to be an ophthalmologist and a retinal surgeon. But once I graduated from training, started working elsewhere and inherited another system, I started looking critically at the organization in which I work. Identifying and eliminating inefficiencies became a top priority of mine. This is in part because a more efficient system is a safer system. Streamlining a process eliminates the confusion involved with extraneous tasks and concerns so that the focus can be placed on what’s important. But also because it’s more pleasant for everyone involved.

A more efficient system is a safer system

I have been concentrating on what happens from the moment I plan a surgical procedure to the moment the patient leaves the operating room. A clear, concise, 1-page surgical planning document has, I think, helped everyone involved know what’s going on (What’s the diagnosis? What’s our plan? What do we need to carry it out? Vision blue? ILM blue? Membrane blue?) and how we’re going to achieve it. My colleagues in the planning department have received clarified instructions on how to plan procedures, with unambiguous documents and materials lists for each specific operation. The nurses in the operating room greatly appreciate this simplification. Everything moves more quickly, despite less effort being expended. I’ve had a lot of help. My colleague, Thierry Derveaux, returned from his phaco fellowship full of insight into how a well-run and highly professional clinic works, along with the energy and motivation to make it happen. The resident currently rotating through the operating room, Geraldine Accou, is highly organised, well-prepared. As we say in NY, she gets the job done. No procrastination, no forgetting, no nonsense. Ever since I spent many of my first days in the university hospital working until 7pm, either supervising the clinic or operating, two of my (many) goals have been the following: first, to finish the workday earlier. Second, to see more patients every day. My goals have seemed to many to be mutually exclusive. I disagree. Dr Leigh Spielberg is a vitreoretinal and cataract surgeon at Ghent University Hospital in Belgium