Todd Schlosser: Hello, and welcome to this episode of Scrubbing In, a podcast powered by Specialty Care. I am Todd Schlosser, and today my guest is Mauricio Garrido, Clinical Director for cardiac surgery at Abington Hospital, Jefferson Health. In this conversation, Dr. Garrido and I discuss what led him into the health care field, the importance of building a strong operating room team, and how to build team morale even in the most challenging of situations. Enjoy the conversation.

Thank you for listening to Scrubbing In. I’m Todd Schlosser, and joining me today is Mauricio Garrido, and he is the Clinical Director for cardiac surgery at Abington Hospital, Jefferson Health. The reason I brought you here today is I’d love to talk to you a little bit about your general upbringing through the medical field and sort of what led you to where you are today. But I’d like to start out with what got you into the field of medicine in general?

Dr Mauricio Garrido: Well, thank you very much. I’ve been now out of training for about 11 years, and I really didn’t think I was going to go into medicine up until pretty late, right before starting college. My training is in engineering, in chemical engineering. My degree is in that. But right before starting college, I had been through a period of time where my dad ended up having a coronary artery bypass, and I didn’t know anything about medicine at the time. But my dad had been sick. At that point, I was entering college. My dad was diagnosed with coronary disease at age eight, my age eight, and he had diabetes, coronary disease, and I saw him kind of deteriorate over time … had multiple heart attacks. I can see what effect that can have on a family.

Then when he had the coronary bypass, I saw the gravity of the operation, but I also saw how well he was able to recover. Over the long run, I could see that he could go back to work, he had no angina, it allowed him a new lease on life, and I thought that was wonderful. That kind of planted a seed, just recognizing the ability that we have as caretakers, as perfusionists, OR teams, and nurses, to be able to change people’s lives and affect families. These are pinnacle events that happen to patients and in their families’ lives, in the patients’ lives. It was a big event for me.
I looked at medicine very early on in college and was able to proceed and get a degree in chemical engineering, specifically focusing on fluid mechanics, which has been perfect for my field, so that I’m very, in a unique position in that the chemical engineering background gave me a broad science background, and they kind of meld well, so that’s one of the things I like about what I do.

Todd Schlosser: Now, when you got the sort of engineering focus, was that at Cornell?

Dr Mauricio Garrido: Yeah, that’s right.

Todd Schlosser: I did stalk you a little bit on LinkedIn before this.

Dr Mauricio Garrido: Gotcha.

Todd Schlosser: I like to do my research.

Dr Mauricio Garrido: Sure, sure.

Todd Schlosser: And then you went to Yale for medicine, correct?

Dr Mauricio Garrido: That’s right.

Todd Schlosser: Is that right? And that was … And you, I guess finished it about 11 years ago. You say you’ve been practicing for 11 years, or did you do the residency after that [crosstalk]?

Dr Mauricio Garrido: The sequence is four years of college, five years of medical school, just because I did a thesis in the meantime as part of the program there, and then it’s about six years of general surgery training, including a research year. After that you became a general surgeon, but then you can go on, which I did, for a cardiac surgery fellowship, which is two years.

In addition after that, it’s six months of specifically LVAD Training, so mechanical cardiac assist training. And that’s when I started working. And something … when you go into surgery, and you go into cardiac surgery, by the time you hang up your first shingle, your first job, many people have had the first part of their career already done. So it’s a little bit different for us.

Todd Schlosser: So let me ask, and not to touch on too sensitive of a subject, but with your dad and his health issues, and that leading you into that, did that give you a different outlook than most people coming in?

Dr Mauricio Garrido: Yeah.

Todd Schlosser: Because you’re focused on, not only … I mean, you saw how it impacted your father, but also your family, so it’s not just the one person who’s having sort of their worst week ever. It’s their family that’s also struggling with that.

Dr Mauricio Garrido: Yeah, there’s a couple things I remember specifically from that time. I mean, I was young, granted, in high school, but I remember the … how difficult it is to be waiting during the operation. I also know that during that whole period of time from age eight until 18, my dad was in and out of hospitals and the emergency room, and I remember that many people would come in, that they were attendings or what have you, I had no idea at the time, and they’d speak with a lot of confidence and just kind of say to my dad, “You’ll be fine. We’ll get you through this.” And then they went on their way.

And in reality, the people that I felt most comfortable with were probably, I’m assuming either a fellow or resident that would come in and have a look of concern. And in that, it helped, because it gave me some solace that this person’s coming in realizes this is a serious thing, whether they think it’s fine or not, it shouldn’t matter. What’s important is that they’re concerned, and I really am grateful for that ’cause it helps me to keep that in mind from the patient’s perspective.

We see patients every day, and we operate on them every day, operate five or six times a week, and the truth is that all those patients are very concerned, and it’s our responsibility to approach it with the same level of concern, but on a foundation of experience and expertise and teamwork. So that’s important.

Todd Schlosser: I think, and this has not been my experience in dealing with surgeons or things like that, and my father too has had some health problems and I’ve had to be at the hospital with him, and so I’ve been on that side of it. And the sort of pop culture thinking of a doctor is sort of cold, especially a surgeon, sort of cold and dispassionate in their bedside manner, if that’s even an appropriate term anymore for that.

Dr Mauricio Garrido: Sure.

Todd Schlosser: Is sort of, very business, if that makes sense. Not dispassionate, but business.

Dr Mauricio Garrido: Sure.

Todd Schlosser: And I would imagine that having been through what you’ve been through and seeing it from that side, it allows you to have a different sort of outlook on it.

Dr Mauricio Garrido: Yeah, if I didn’t have that experience I had with my dad, it probably may have changed my temperament, so I’m very grateful for it. There is a public’s view of what cardiac surgeons should be about, but I’m here to let you know that there’s the whole gamut. Yes, there are people that are very businesslike and abrupt and so forth, but on the other spectrum are the people that take a lot of care to do the right thing. Not just for the patients, but for the people that they work with.

Todd Schlosser: And I was listening to the Specialty Care CEO talk … I think it was last week, about how everyone who’s in surgery with you … not only you and your chief perfusionist and your anesthesiologist, but also the nurses, and if you’re using anyone from [inaudible] monitoring, that sort of stuff. They are all touching not only that patient’s life but that patient’s family and their community, and ultimately you’re touching this large group of people anytime you’re in there operating on anybody.

So that, I think, viewpoint helps us, and helped me to understand, not only just the stakes, but you know, the impact that one person in surgery, not necessarily just the surgeon, but one person can have in that.

Dr Mauricio Garrido: Yeah. It’s very important.

Todd Schlosser: And I wanted to talk a little bit about-

Dr Mauricio Garrido: I recognize that.

Todd Schlosser: I wanted to talk a little bit about the importance of the team that you build. I’d imagine, as the cardiovascular surgeon, you are seen as the leader of that team. I’ve heard it often compared to sort of leading a symphony, being the conductor of a symphony, because you have to trust everyone to do the job they’re there to do.

Dr Mauricio Garrido: Yeah.

Todd Schlosser: But you still are sort of in charge of making sure they do it. So can you talk to the importance of building a professional and strong team, and experienced, is the word I’m looking for.

Dr Mauricio Garrido: Sure. Sure. I can tell you that it’s not uncommon for me to round on the service, or see patients when they come back to the office three weeks afterwards, and they’ll say, “Oh Doctor, you saved my life. I’m so grateful for what you did.” And if they’re an elderly patient, lady, I often joke a little bit and I tell them, “Well you know, it’s really about thirty people that are involved intimately in your care, and each one of them have contributed to you getting to where you are now.”

And I tell them I’m just the good looking spokesperson for the group. And they get a kick out of that, but there’s some truth, there’s a lot of truth in that. It’s common for patients to associate the surgeon as being the primary vehicle in the whole thing, but the truth is that it’s a team. We work together. I depend on them as much as they depend on me.
Ultimately I take leadership, I get to take responsibility for the outcomes that happen, both good and bad, but at the same time I recognize that each member of that team, it’s not a big team, but it’s a cohesive team that I’ve worked with my whole time that I’ve been there, 11 years. I’m dependent on them on addressing the issues and catching the issues not only under their responsibility, but other people’s responsibility, so we work together and help each other to get the patient safely through their …

I think that the idea of having one leader that orchestrates from the top, and everybody just follows orders, that’s [inaudible], that’s not, it’s almost an anachronism, because there’s too much data going on, and there’s the complexity of cases is high. And we need to be able to allow independent thought and independent leadership to be able to deal with issues as they happen.
Sometimes the surgeon is not the leader. Sometimes there are scenarios where I have to defer the expertise to my anesthesiologist for something that she’s strong with, or he’s strong with. I have to get expertise from the perfusionist. Ultimately, as a surgeon I’m responsible, but you allow people the ability to move with independence. That’s very important.

Todd Schlosser: That is very important. It’s actually a good quality of a leader is to trust those that need to move, as you say, or think and act quickly, allow them the space to be able to do that.

Dr Mauricio Garrido: Yeah, it’s an important factor.

Todd Schlosser: Let me ask, when building a team, the things I think about are, you know, when building a strong team, are things like communication, and I wanted to talk to you a little bit about that side of it. Fear, a lot of times, can come across as anger.

Dr Mauricio Garrido: Sure.

Todd Schlosser: And I’d imagine there’s almost no higher stakes situation than when you have a patient’s heart stopped on the table.

Dr Mauricio Garrido: Sure.

Todd Schlosser: And you’re doing the work that needs to be done to get to where they need to be. So in that situation where there’s a lot of, could be perceived, a lot of fear, does that ever come across as anger, and how do you deal with the emotion that comes with that.

Dr Mauricio Garrido: Yeah. It’s tricky. The issue of having concern at a different point in time, surgeons like to use the word ‘concern’ instead of ‘fear’, just to look cool-

Todd Schlosser: It’s probably also a better way of framing-

Dr Mauricio Garrido: Yeah, but the truth is that there are things that happen that are unexpected in the operating room or outside, and your inner dialogue during that is pretty intense. You have a lot of things you’re considering. What could be the cause of this? How can I reverse it? And my belief is that, at least with the group that I work with, that you can lead the tenor of what’s happening. Your aspect and disposition.

Todd Schlosser: Sort of set the tone.

Dr Mauricio Garrido: Yeah, and that’s important because, if you maintain your calmness and allow things to be clear, and decisions or ideas to be thrown into the mix with order, that can save a patient’s life. I’ve seen it go both directions. I’ve seen it when the energy level starts heightening, and there’s a lot of yelling and excitement and so forth, and then people make mistakes and there’s bad outcomes that happen from that. I’ve also seen it where someone wants to show grace under pressure, but so much grace that there’s no movement.

You have to strike a balance. It just turns out with the team that I’ve worked with, we resonate really well, and like I said, we’ve been very consistent over the 11 years I’ve been there. We’ve learned a lot over time, how we deal in adverse situations. So it doesn’t come as unfamiliar, and that helps. We tend to be maintained pretty calm during emergency situations.

Todd Schlosser: I’d imagine calm is where you want it to be.

Dr Mauricio Garrido: Yeah. You want people to be able to be at their best. There are scenarios where, and teams where I’ve been in that in the past, not here, where in order to get people to be their best you have to be loud or abrasive and so forth. It just happens that the way we’ve grown together as a group, we’ve realized that that’s not helpful. It’s just not my temperament either, so it ends up being for the better with my group.

Todd Schlosser: You’ve been with your current team, and I’d imagine some team members come, so team members go, in this 11 years that you’ve been with them, but during that time I’d imagine there’s a comfortability that develops between you and your chief perfusionist, who we also had the benefit of interviewing.

Dr Mauricio Garrido: Sure.

Todd Schlosser: Or your anesthesiologist or your physiologist if you’re dealing with them.

Dr Mauricio Garrido: Sure sure sure.

Todd Schlosser: So are there benefits of having a team that you work with a lot, and I guess the only thing that comes to mind right now, although I’m open to you having other benefits, but sort of the non-verbal communication. Them sort of being able to anticipate your needs and yours theirs. Does that sort of self-develop over time?

Dr Mauricio Garrido: Yeah, it does. I think the best way to lead that is to take the first step in acknowledging where your shortcomings are.

Todd Schlosser: Sure.

Dr Mauricio Garrido: I’ll give you an example. If you look at aerodynamics with human factors in the operation room or elsewhere, a common way that distraction can cause problems is if you have a series of steps you’re supposed to take: A, B, C, D, E … and you go through A, and then you go to B, and then there’s some unexpected distractor. An event happens, someone’s … something distracts your attention for a moment, then you come back. I have a tendency of moving onto D instead of C.

So I’m very clear with my staff and the people that I work with that that’s where my cognitive overload can happen, when I’m managing what’s happening and something unexpected happens, I’m dealing with it. So they’re very quick to know, to make sure that I’m there and I stay on point with it.

Same thing can happen with a perfusionist, or the perfusionist has a scenario where they’re taxed, and they’re working with a student, working to get them through the teaching and so forth, or there’s a very quick change in what’s happening. My perfusion team is phenomenal. It can deal with quick changes well, but I recognize that when that’s happening and they’re in a teaching state there are multiple things going on, so I’m recognizing of that. I recognize that, and we learn to support each other. So you have extra eyes on the situation.

And that goes across the board between nursing, anethesia, perfusion, perfusionist and first assistant, and cardiac surgeon.

Todd Schlosser: That brings up another question that I have. You as a surgeon, maybe more than anyone else in the operating room, your job is to focus on the patient and get the patient working, but that one focus is impacted by everyone else who’s in the room. How important is it that everyone be working at the same … in unison? Not to go back to the symphony motif, but to be working in unison so that you can do the job that they want to do. Also that would help, you know, you can impact what the perfusionist does, so how important is that?

Dr Mauricio Garrido: It’s very important because, you know, you’re taking on, if you’re gonna operate, and operate effectively and efficiently, you need to be able to focus on the task at hand, and coordinate the four hands that are working together between the surgeon and the first assistant. The benefit of the position I’m in is that I’ve developed a rapport and a working relationship with all the people that I work with, that’s been tried in the fire at times.

And because of that, trust builds. And with the trust, you know that they will address issues as they happen. They’d let you know of things are coming that are outlier, that stand out early, outliers. It allows me to really focus on what I’m doing. But when I first started, fresh out of training, I could … you know, a lot of my thinking was distracted by sometimes doing someone else’s job [crosstalk].

And over time you develop that trust. It doesn’t mean that you’re forgetting of it, or you just focused on what you’re doing, it allows you the opportunity to, you know, have people be ready to tell you what’s happening in real-time fashion. That’s one of the benefits of Specialty Care. The team that I have is phenomenal, and they bring in the latest, most up-to-date ways of taking very complex data in real-time that’s relevant and synthesizing an analysis of what’s happening physiologically with a patient, and bringing it to me. Either through the Connect System, which is a very great system that allows us to really get real-time data with oxygen utilization during the pump run, CO2 uptake and so forth.

All these things allow us to not dumb down the [inaudible] circuit, not dumb down the physiology when it happens, but at the same time, not be overwhelmed by too much data. That can be very distracting.

Todd Schlosser: The most difficult part of that, I think, would be to not overload you, but to give you every bit of information you need to be able to do what you need to do effectively.

Dr Mauricio Garrido: Not just me, but to the anethesiologist, to the nurses, to each other, for the perfusionist. I mean, there’s one set of information moving around. We communicate it, everybody hears it.

Todd Schlosser: If it’s okay I’d like to close with just one question, and that would be around morale when it comes to teams. Building team morale. ‘Cause when you have good days, those days have to be great, because you’re dealing with the extremes. You save someone’s life and, you know, you have the best outcome. The other side of that is sort of a negative outcome that’s, you know, that would be very, I’d imagine, very demoralizing.

Dr Mauricio Garrido: Yeah.

Todd Schlosser: So how do you celebrate the successes? And how do you help your team bounce back from those rough outcomes?

Dr Mauricio Garrido: Good point. What I recognized early on was that the people that work in the operating room, and particularly the perfusionist, the first assistants, the circulating nurse and the scrub nurse, they are integral to what happens, but they almost never, if ever, get a chance to really see how these patients are at three weeks, four weeks out when they come up for the post-op visit, and they’re grateful. So we have a process of bringing them up to see the patients there. I think it’s important to them to see that.

At our hospital, you know, the Jefferson Health, in terms of its values and mission and vision, innovation is a huge part of it, and thinking differently is a big part of it. For example, in our operating room when we’re beginning to close, and there’s still, you know, probably about 30 to 40 minutes in the operating room before we go up and see the family, we set up a HIPPA-compliant video link to the waiting room.

Todd Schlosser: Oh, yeah.

Dr Mauricio Garrido: We realize that the last 45 minutes, almost exponential growth of stress for patients, for families when they’re waiting. I knew that when I was waiting for my dad. So, we make a video link through HIPPA compliance to an iPad that’s in the waiting room that’s actually in the patient’s room where it’s private for the family. And for about 30 seconds, to 45 seconds, they get to see my staff, me, nothing gory, so from the chest up.

I tell them, “We replaced the valve, we made the two connections, I’m very happy with the way things are going. He’s still in critical condition, but I’ll be up in about forty-five minutes.”
You can visibly see family members relax-

Todd Schlosser: Oh, I’m sure. Just relax, yeah.

Dr Mauricio Garrido: The secondary, it’s got a lot of press, a lot of people like it. I’ve had a lot of hospitals across the U.S. calling me about that same program. But the real nice thing is that the staff actually get to see the family members, and how appreciative they are. And the family members get to see them. So I think it’s very good.

As far as morale, during different times, you really really prove who you are as a leader and as a surgeon in how you handle the difficult times. You can, you know, be … push blame other places. You can be quiet and avoid the discussion. Or you can have a real discussion about it.

In the situations where, unfortunately, a patient would die in the operating room, we have an agreement that we’ll meet the next day in the same operating room with everybody involved to go over the issues, see what we could’ve done better. But also for the ability of people to debrief. These events affect all of us, and part of the process of building morale is to help each other during that. That’s important.

Todd Schlosser: I mean, I’d imagine it’s, maybe not the same as for you, but you’re dealing with what happened, and it was a big event, even if you didn’t really personally know the person who was on that table. It’s a big event, but it’s … you’ve gotta work through in order to get back on the horse, if you will, and get back into it.

Dr Mauricio Garrido: Yeah, I recognize very well what it’s like to make a decision, or do an action, that results ultimately in the death of a patient. Part of our training through general surgery, cardiac surgery is to be able to see that squarely and be able to make decisions, so you can make it, and you can help the aggregate number of people you’re gonna treat in the rest of your career.

I also recognize that for members of my team, there’s a lot of responsibility I put on them, and so when something goes wrong or goes poorly, part of that is protecting them, in the sense of, you know, this is communal, we decided on this as a community to do this, or as a group to do this treatment and do what we did. We’ll learn about it as a group, but no one individually is held as a primary source of that problem. And we talk about actions, and less so, individual ad hominem, you know, tax on people. That’s not gonna work.

Todd Schlosser: Yeah. You gotta focus on what is beneficial in the situation we’re in now.

Dr Mauricio Garrido: Correct.

Todd Schlosser: And get rid of the things that aren’t.

Dr Mauricio Garrido: That’s exactly right.

Todd Schlosser: Well, thank you so much for doing this. I can’t think of a better way to end this. But Dr. Garrida, I appreciate it very much. Thank you so much for joining us on Scrubbing In.

Dr Mauricio Garrido: Hey thanks, that was great.

Todd Schlosser: Thanks.

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