My son recently lent me Gawande’s popular book on errors in medicine. Gawande’s work has in fact been very influential within the NHS and led to the introduction of a routine pre-operative surgical and anaesthetic checklist. One chapter in particular in his book rang true – The Computer and the Hernia Factory – which deals with the beneficial effects of systematization on surgical outcome. So just how safe is facelift surgery? His initial observation is that the Shouldice Hospital in Toronto (which only performs hernia repairs and in very large numbers) both efficiency and surgical outcome are excellent, as you might expect. Gawande refers to Shouldice as a ‘focused factory’ and describes the benefits of this model of health care delivery. In many ways, this is the way in which we carry out our facelift surgery.
- all facelifts are performed by the same surgeon and anaesthetist
- we specialize in the Advanced Mini Facelift and full facelift and do not do anything else (e.g. breast implants etc)
- we do hundreds of these operations each year
- the same operating theatre is used each time
- the core team members have worked together for several years so everyone knows exactly what they are doing
- everything is standardized and as far as possible simplified
- there are written protocols for almost every aspect of the care pathway
What is the upshot of all of this? Repeated processes are ideal for continuous improvement and there is no doubt that we have refined the Advanced Mini Facelift concept almost beyond recognition over the years. In particular, we have reduced the incidence of post-operative bleeding effectively to zero. That is not to say that we do not have complications and you need to be fully aware of these before deciding to have a facelift. We are working on a complex biological system that can still be unpredictable and deliver surprises, which is where our clinical expertise comes in. We also have a maxim ‘You never lie awake worrying about people you have not operated on’ and indeed we see patient selection as being a fundamental part of the care pathway.
Is it boring for us? After all, both the surgeon and anaesthetist are massively experienced clinicians used to dealing with a vast scope of surgical, anaesthetic and critical care scenarios. I think the answer is that ‘boring is good’ – or rather, ‘no stress is good’. The operating theatre is not the place for excitement or stress – that is what extreme sports are for! All this experience has also made us experts (and I use the term advisedly) and we are now writing what we hope will become the authoritative consumer guide to facelift surgery, of which more in a later blog post.