Virtually every day, Dr. Bryce Taylor has a meeting at 7 a.m. with his surgeons. "Surgeons have to get to the operating rooms by eight," says Taylor. "Any meeting that has a finite point is more efficient. After that, it's just chaos." But that unpredictability is exactly why he loves his job. Taylor is responsible for University Health Network's surgical program, one of the largest in Canada, with surgical teams performing more than 25,000 surgeries a year in 29 staffed operating rooms at their three teaching hospitals: Toronto General, Toronto Western and Princess Margaret. Taylor was also an initiator of the University of Toronto Liver Transplant Program and remains active in training residents and fellows in general surgery. He still performs surgery once a week, specializing in hepatobiliary and pancreatic surgery.
"When you're in surgery, you have to be caught up in the moment," says Taylor. "But the minute you get out of the operating room, you have to be a big picture person again and not get diverted from your objectives. And in healthcare, it's easy to get diverted."
As a hospital administrator with over 10 years in his current job, Taylor says his most vexing issue is leading individuals who are also independent medical practitioners. That's a very different challenge than leaders in most other industries have because the doctors - the physicians, surgeons and anesthesiologists - who work in any hospital are not employees of the hospital, but have what's called 'privileges' which allow them to go into the public purse to use hospital and public resources to treat patients. They have to follow the rules for standard operating procedures of the organization, but are still independent practitioners. "To lead that group of people, you have a whole new set of challenges," says Taylor, whose strategy is to try and blur that apparent dichotomy between management and the practitioner.
"If you have independent practitioners vying for resources in a hospital, and those resources are controlled by a number of administrators or 'suits', then you set up a potentially confrontational relationship," says Taylor. "What we've done is to bring the doctors, nurses and directors 'into the tent' on a daily basis. Then, when we're faced with difficult decisions, it's not a 'we' or 'they' situation. It's an 'us'."
One of Taylor's recent challenges was getting those independent practitioners to embrace the surgical checklist, a World Health Organization (WHO) study that Toronto General took part in from October 2007 to September 2008. Taylor decided at the start to be careful about his approach with the team, who "like ourselves, aren't particularly joyous when confronted by change." First, he got the surgeons, nurses and anesthesiologists together to make it their own, altering the original WHO template into something more complex. Then, right in the middle of the study, he invited an Air Canada pilot in to speak to them about the kind of safety checklist pilots use before takeoff.
"Everyone got it," says Taylor. "That was much more valuable than if you were to deliver it like an edict."
*Data from the study showed a significant drop in the death rate and major complications following surgery. It is now done for all surgeries at UHN.