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Adoption of minimally invasive mitral valve surgery in the NHS. A blend of science and psychology.
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  • Megan Joffe,
  • Steven Hunter,
  • Roberto Casula,
  • Inderpaul Birdi,
  • Ranjit Deshpande,
  • Toufan Bahrami,
  • Paul Modi,
  • Ishtiaq Ahmed,
  • Hunaid Vohra,
  • Narain Moorjani,
  • Joseph Zacharias
Megan Joffe
Edgecumbe Consulting Group Ltd
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Steven Hunter
Sheffield Teaching Hospitals NHS Foundation Trust Cardiothoracic Centre
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Roberto Casula
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Inderpaul Birdi
Nottingham University Hospitals NHS Trust
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Ranjit Deshpande
King's College Hospital
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Toufan Bahrami
Harefield Hospital
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Paul Modi
Liverpool Heart and Chest Hospital NHS Foundation Trust
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Ishtiaq Ahmed
Brighton and Sussex University Hospitals NHS Trust
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Hunaid Vohra
University Hospitals Bristol NHS Foundation Trust
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Narain Moorjani
Royal Papworth Hospital
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Joseph Zacharias
Lancashire Cardiac Centre
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Abstract

OBJECTIVES The objectives of this study were to understand the challenges faced by early adopters of MIS mitral surgery in the national health system in the United Kingdom. It was to (i) capture the significance of the scrutiny introduced by reporting surgeon specific results during the introduction of surgical innovation, (ii) understand how individual personality and behaviour helped these surgeons succeed despite, in many cases, little wider support, (iii) to help more surgeons adopt these patient-centred techniques. SETTING AND PARTICIPANTS The study is based on a qualitative exploration of the reported experiences of all ten early adopters of MIS cardiac surgery in the NHS between 2006-2016. Interviewees were recruited by invitation through their professional society (BISMICS). All interviewees consented to the process; ethical permission was not deemed necessary. RESULTS The experience of introducing surgical innovation into the NHS was unanimously noted to be difficult with few incentives and many systemic and institutional obstacles. Despite this there was a general belief in pushing forward with these patient centred procedures while accumulating the evidence to support it. CONCLUSIONS Individual determination, confidence, mental agility and self-reflection were seen as characteristics of those who were successful. All surgeons agreed that the reporting of surgeon specific results were not conducive to adoption of innovation in teams. Starting a new program as two surgeons appeared to help reduce perceived pressures. Surgical innovation and its early adoption are always likely to be difficult and needs to be recognised as such, within the NHS