Surgeons as researchers – the path to better patient care

Melbourne’s western region is now one of Australia’s fastest growing, most culturally diverse areas. Its population has doubled to more than 800,000 since the early 1990s. The hospital’s focus on medical research has grown too, responding to the region’s unprecedented population growth and its high rates of cancer, heart disease, stroke, diabetes and other illnesses.

More of its surgeons and surgical registrars are becoming involved in investigating the diseases that afflict their patients. Under the leadership of Professor Steven Chan, the hospital’s Professor of Surgery, a registrars research program was established about eight years ago. Surgical trainees in the program investigate a clinical problem and conduct research to try to solve it.

Registrars are expected to write a research paper and then present their findings at the hospital’s annual research week. The program has become increasingly popular among trainees.

The Kendall Francis Prize, named in honour of Kendall Francis, one of the hospital’s longest serving and most highly regarded surgeons, is awarded to the trainee who presents the best research paper.

Dr Arlene Wake, Western Health’s Director of Community Integration and Service Planning, was involved in naming the Kendall Francis prize. She said the award and the rising number of trainees and surgeons involved in research had enhanced the academic profile of surgery within and beyond the hospital.

“Research is something that you might think physicians spend more of their time dwelling on than surgeons, so the prize has added another element to the depth of surgery and the way it’s considered at the hospital,” she said.

“Getting good patient outcomes is a bit like having a three-legged stool. You need research and evaluation, the training leg and the leg that involves delivery of care to patients. It’s hard to have delivery of care to patients without the other two legs of the stool. Patient care is so much stronger if you can have all three of these elements in your own organisation.”

The orthopaedics unit is one of the surgical specialties increasing its research capacity. In 2015 its surgeons and medical staff were involved in more than 30 research projects. The unit has three research staff, compared with none five years ago.

At a national orthopaedics conference in 2014, the unit’s medical staff presented 14 research papers at the conference podium – an unprecedented number for Western Health.

“To go from a hospital that hardly did any research and wasn’t known for its academia, to one that’s now known for its academia and medical research has required a group effort,” said Mr Phong Tran, head of the hospital’s orthopaedic unit.

“Chris Haw, as the former head of our unit, created the foundation for what we’ve achieved with great consultants on staff. We’ve built on that, with more of an academic and research base and more quality assurance for patients.”

The unit’s emphasis on research and evaluation has led to impressive patient results recorded in the National Joint Registry, an internationally-renowned data base that monitors the lifetime outcomes of patient hip and knee replacement operations performed in Australia’s hospitals. The registry records the results of individual surgeons and hospitals.

Tracking surgical results

Despite Western Health dealing with some of the highest percentages of overweight, unhealthy patients in Victoria, the registry data shows that Western Health’s results are better than the national average in every criteria of patient outcomes measured in the data base, including complications from surgery or whether a joint replacement fails and needs to be redone.

“The results show that we have excellent patient care. At the same time we’re well known for our training,” Mr Tran said. “We don’t let our training and research capacity compromise our patient care – they all work together to make sure the patient has better care.

“If you’re able to attract the best registrars and all your patients are being recruited into studies – where we monitor their progress – it can lead to better patient outcomes. That’s what we’re seeing.”

Another sign of the hospital’s rising national reputation as a centre of excellence for orthopaedics occurred in 2014. Mr Tran was awarded the prestigious American British Canadian Fellowship, becoming the first Victorian surgeon in 18 years to receive the prize. The Fellowship is awarded for exceptional performance in leadership, patient care and research.

Mr Tran said the Fellowship reflected the unit’s collective expertise rather than his individual efforts.

“It’s a sign of the collaborative atmosphere created at the Western. We’ve got a bit of a slack hierarchical structure here. Even though I’m the head of the unit I don’t decide anything of importance – we decide via a vote.”

The unit has a monthly business meeting and holds a weekly meeting to discuss clinical issues, with unit members voting on issues that require decisions.

“In our meetings everyone can see that our decisions are made as a group,” Mr Tran said. “It makes people feel that their opinion is valued so more people participate in decision-making. It’s a key reason why our unit is doing well because everyone chips in and heads toward the same goal.

“All this couldn’t have happened without the senior colleagues in the unit who’ve set the culture of the unit – where the junior consultants are allowed to blossom and make a difference rather than being told what to do. They’re empowered to make decisions as a group and as an equal.

“That doesn’t happen in all orthopaedic units, especially when a unit is often dominated by the most senior person or head of unit or professor.”

Building an academic hub

Associate Professor Alex Cockram, Western Health’s Chief Executive, said the hospital had many leaders aged in their 30s and 40s, including heads of departments, who had won national and international recognition for their research work. “They’re men and women who’ve been given opportunities and professional development training at Western Health that their peers in other large health institutions often find hard to come by or have to wait longer to achieve,” Associate Professor Cockram said.

The hospital’s purpose-built academic hub, the Western Centre for Health Research and Education, has played a key role in Western Health’s rising prominence in medical training and research. The $51 million Centre was established at Sunshine Hospital in 2011.

Surgeons and other medical staff use its teaching and research facilities, which include simulation centres, a 200-seat auditorium, a lecture theatre, library and seminar rooms. It houses Melbourne University’s Western Clinical School for Medicine and Allied Health as well as researchers, academics and educators from Western Health, Victoria University and Melbourne University.

Western Health recently created its own annual grant program to support promising research done by staff, especially multidisciplinary research in chronic diseases. The annual grant program, known as the Western Health Research Grant, is funded by contributions from staff specialists and other sources.

Associate Professor Cockram said results from the research projects carried out at the Centre and Western Health’s other campuses were leading to better treatment options for patients.

“Our research is always relevant to our clinical practice and the health needs of the patients we care for,” she said. “It is locally responsive to the communities, characteristics and disease patterns within our region, while also being globally connected, because we participate in collaborative research with our Victorian, national and international partners.”