Jarrod Shapiro, DPM
Operationalization: A Big Word With Tiny Parts
Part 2

Sometimes it's nice to discover a new word that characterizes something we previously did. It helps us to frame complex ideas, even though the idea of operationalization sounds complex on the surface. Last week we discussed this concept and showed an example of its use in residency training. Today, we'll discuss a way to apply this idea to problem solving and show how you can take this big word and apply it to any problem. So let's get into it...

When we operationalize a process, we are reverse engineering it.

So this is all well and good. Scientists use operationalization. Academicians use it to evaluate their trainees. How can you use this in everyday life? That's up to your creativity. Here are a couple of quick examples.

How to Operationalize Tasks of Daily Life

First, breaking a chore into smaller parts is a known method to decrease stress and accomplish goals. Additionally, this is a method that segues easily into team situations. If your team is able to break a job into manageable parts, then those parts can be assigned to the members and completed with a successful overall result. This is essentially what Atul Gawande, MD discusses in his excellent book The Checklist Manifesto. Checklists allow us to break complex activities – like surgical procedures – into manageable parts that allow us to stop and make sure things are safe and appropriate.

Second, this concept is a beautiful way to solve problems. Pick a problem, any problem! Break that problem into parts and then address each part individually.

Tonight's Premier Lecture is
Regenerative Medicine: The Unlimited Potential of Stem Cells in Foot and Ankle Surgery
Steven A. Bernstein, DPM

Here's an example of a problem solving method that utilizes an operationalized approach.

Identify the problem.
Determine the nature of the problem.
Consider what's missing (ie, missing knowledge or resources).
Break the problem into manageable parts.
Make a plan to acquire what's missing.
Execute the plan.
Test the result.

Let's take an example to demonstrate. Let's say I have a resident who takes too long to suture during surgical cases (No, this is not one of my residents!). This person keeps regripping the needle, drops the needle in the field occasionally, and wastes a lot of motion. The simple way would be to tell the resident to practice more. But that won't solve the problem (unless the resident can figure it out for themself and then practice). Let's operationalize my fictional scenario by having the resident demonstrate their technique outside the OR on a pig's foot.

Identify the problem. You've already done this since you've observed the resident suture poorly.
Determine the nature of the problem. You notice during the demonstration that your resident clamps the needle too far forward with the needle driver. Additionally, the resident grips the needle with the pick-ups as it comes out of the near side of the incision, requiring him or her to reclamp the needle and waste time.
Consider what's missing. After a short discussion, your resident admits to not practicing a lot because he lost his spare instruments.
Break the problem into manageable parts. You realize that this problem has more than one etiology and decide to approach the following issues: resident behavior, clamping the needle properly, and using instruments to throw the needle efficiently.
Make a plan to acquire what's missing (in this case instruments and professionalism). The resident is given a new set of instruments with which to practice, and you discuss the need to practice this skill at home and the importance of professionalism.
Execute the plan. Next, you have the resident demonstrate clamping the needle, showing him/her the correct location in which to clamp. The resident practices this skill in isolation multiple times while you occasionally correct errors. You next demonstrate the proper suture throw method, holding the tissue with the pick-ups, letting go with the driver, and reclamping with the driver without letting go of the tissue with the pick-ups. The resident practices this while you again correct errors. The two of you come up with a plan, that the resident practices suturing for at least 30 minutes nightly on a regular basis with a plan to demonstrate improvement in two days.
Test the result. Two days later, before your next procedure, the resident quickly demonstrates improvement on felt. You feel comfortable allowing the resident to proceed to suturing the patient. He/she demonstrates the improved skill.

At first view, this looks like a laborious process, but keep in mind that the verbal explanation is much slower than the physical one. And, like all skills, this process becomes faster as it is used more often. The basic concept of this, though, is to break the thing you're doing into its important parts and use that information to analyze your process and make changes. Try this out the next time you're about to tackle a new problem or have a complicated task to complete. Operationalize your task to decrease stress and make your problems more manageable. Good luck with your next task.

Best wishes,

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]