Thursday, December 06, 2012

Advancing Hernia Solutions

Hernia surgeries are often considered to be prosaic.  At academic medical centers, for example, they are rarely discussed, compared to the attention paid to higher level tertiary and quaternary cases like transplants and Whipples.  But they are important procedures for the patients who need them.  They are also rife with complications, both short-term and long-term.

Bruce Ramshaw, at Advanced Hernia Solutions in Daytona Beach, FL, believes there are two reasons for this.  First, these procedures often fail to receive the kind of rigorous analysis and review that others do.  For example, there are dozens of kinds of mesh that can be used, but there is no clear evidence as to which type of mesh works best for which kind of patient.  Some varieties of mesh have been in use for decades without ever having to demonstrate clinical efficacy, in that they were grandfathered from approval by the FDA.

Second, there has been little effort to apply the use of effective teams to deliver person-centered care in this arena.  He notes:

Person-centered care is embodied by care teams, with the person who is the patient and family at the center, and with the care team all working for the best interest of the patient, learning and improving to provide value for the patient and for the overall system.

It is this model that Bruce and his colleagues have constructed at their clinic.  In addition to surgeons, the team includes patient care managers--who get to know the patients and families intimately and are on call to assist them 24x7.  Here you see Brandie Forman, director of patient care management, who arrived to work with Bruce in the medical world years ago after being a flight attendant.  There she learned and developed keen skills of personal interaction and service delivery.

The team also includes an engineer, Joe Johnson (left), who evaluates the systems issues around the delivery of care as well as technical issues that arise from the equipment being employed.  Joe arrived with no medical background, but with a sound foundation in systems design and process analysis.  There is also a materials scientist on call.  That person concentrates on the issues surrounding the durability and effectiveness of different types of mesh.

Bruce and his colleagues take seriously the idea of patient and family input, and they have created an advisory panel with whom they review their plans, their educational materials, and other aspects of the clinical pathways.  As demonstrated in a meeting I attended today, the participants are out-spoken, thoughtful, and extremely experienced in other fields that they are keen to apply to the "boring" world of hernia surgeries.

These patients and spouses know, of course, that the issues surrounding hernia repairs are not boring at all.  They have experienced such surgeries--sometimes successfully and sometimes not--and they are prepared to offer advice and assistance to Bruce's group as it develops and expands its program.

As we come to the end of the year and look forward to the inevitable lists of "great medical advances of 2012"--the usual assortment of still-in-the-clouds technological innovations--it is good to remember that the real medical advances are those occurring on the ground.  It is by the kind of thoughtful hard work and planning demonstrated by Bruce and his colleagues--and by his patient and family partners--that the quality of life is being enhanced and that lives are being saved today.  Let's rank them and similar groups among the greatest medical advances of the year!


Anonymous said...

I have forgotten the term that Clayton Christensen used for such services in 'The Innovator's Prescription', which concentrate on doing one thing exceptionally well, but as I recall he mentions a practice specifically concentrated on hernia repair - perhaps this very practice.
Coupled with a research article that I just read on why gout is frequently mismanaged (it is not glamorous and there have been no new expensive drugs until recently), your post identifies yet another inequity in medicine - many, many nooks and crannies of disease which escape notice and research, even though they cause as much suffering as the ones which garner recognition and acclaim for their practitioners. Kudos.


Paul Levy said...

This was topic Clayton covered, and he mentioned hernia "focused factories" as an example. Unlike the Daytona setting, though, most of the hernia focused factories that have been set up are not prepared to handle patients with complex conditions. Indeed, Advanced Hernia Solutions gets referrals from those places, as they are prepared to serve those complex patients as well simple ones. Accordingly, their catchment area extends far beyond the local Florida geography.

Paul Levy said...

A little more detail: Bruce ran an earlier version of this program when he was located at the University of Missouri, and it served patients from 46 states and outside the US within 5 years of its formation.

Pam said...

As a patient with permanent complications from 2 hernia surgeries, this is something I stress to surgeons whenever I can. It's not "just" a hernia. It's surgery with unrecognized adverse events.