Of the sixteen cardiac surgery departments my colleagues and I studied, only seven stuck with the new technology. The other nine departments tried it out for a handful of operations, then abandoned it. The most important difference in the groups that succeeded was surgeon leadershipânot surgeon skill, experience level, or seniority. When we started the study, we expected that the more elite academic medical centers would be more likely to succeed than the less well-known community hospitals. But we were wrong. Hospital type and status made no difference at all. The challenge all these teams faced was more interpersonal than technical. The innovation challenged the traditionally hierarchical structure of operating rooms, where the surgeon typically issued orders that others carried out. Surgeons practicing the new technique were newly dependent on the rest of the operating-room team to coordinate aspects of the procedure and keep a âballoon clampâ in place inside the patientâs artery as a way of restricting blood flow to the heart. The balloonâs tendency to shift meant that the team had to monitor its location through ultrasound imagery to make adjustments. But unless people felt psychologically safe enough to speak up, these activities were hard to carry out. For instance, asking the surgeon to pause while the balloon was
repositioned was both new and difficult for most nurses. Surgeons had to listen to other members of the team more often, and more intensely, than in traditional surgeries, where they had done most of the talking. The successful innovators in our study recognized that they needed to lead differently. They had to make sure that everyone in the operating room could talk openly and immediately about what was needed from one another to make the procedure work. When my colleagues and I analyzed the teams that persisted in mastering the new approach, we found that all of them engaged in a few special activities that reflect core practices in the science of failing well.