Machine learning might be the new frontier in the operating theatre but it is unlikely to replace the human touch that is crucial to effective healthcare and healing. (Getty Images)
Isabella “Pippie” Kruger was just a toddler at the time of her accident. At a family braai, a bottle of gel fire lighter exploded while her father was lighting the fire, burning Pippie so badly that 80% of her body surface area was affected and giving her a mere 3% chance of survival.
Despite full-thickness burns, inhalation injuries and damage to her lungs and physiology, the three-year-old clung to life while a multidisciplinary surgical team rallied, not only to save her life, but to consider its future quality.
Plastic and reconstructive surgeon Dr Ridwan Mia — at the time a junior in his field of specialisation — and his team were tasked with finding a way to cover Pippie’s body.
Mia turned to ground-breaking stem-cell technology, a process called “cultured keratinocytes” to grow sheets of Pippie’s own skin and graft them onto her body.
Biopsies of the child’s skin were sent to a laboratory in the US, where they were cloned to create new sheets of skin. These were flown back to South Africa and grafted onto her body in a pioneering surgery for which Mia received South Africa’s national Order of the Baobab — an award bestowed on citizens for distinguished service in the fields of business and the economy, science and medicine, as well as for technological innovation and community service.
Overcoming resistance to the new
Not everyone in the medical fraternity was impressed with Mia’s innovation, however. A number of burn surgeons perceived the new technology as a threat to existing protocols for large-surface burns. Some published journal articles in outright opposition.
Others argued that many other patients could have been treated with the funds set aside to treat a single patient, despite the fact that private donors and organisations had funded the research and technology, which had not depleted medical aid or state funds.
“It was the first time I had encountered the fiercely competitive side of my profession and the wall of resistance young surgeons have to contend with from established professionals when proposing new and innovative techniques,” Mia recalls.
“When I looked back on the achievements of my predecessors, I discovered that many of them had been instrumental in developing advanced techniques that were of enormous benefit to patients. Had they been prevented from driving new developments, or restricted to only using current techniques, then the world of reconstructive medicine would have been extremely limited.”
Balancing innovation with the personal touch
These critical dilemmas are captured in a new teaching case study published by Henley Business School Africa, which explores Mia’s role as a surgical leader and his drive to incorporate technology in medicine. Medicine’s new frontier is undoubtedly AI, and for a surgeon such as Mia, who prides himself on testing limits and innovating wherever possible, embracing these new technologies is the only way forward.
Machine learning has already proved valuable to patients and surgeons alike. It offers clinicians the opportunity to delegate tasks and process large amounts of data more quickly, leading to better patient care. A massive benefit is that it frees surgeons to focus on managing their teams under stressful conditions, such as in the operating theatre.
But — and it’s a big but — AI has its limits. Notably, it cannot mimic the emotional connection a good surgeon must forge, not only with their patients, but also with their team members — or the personal touch. Getting the balance right in high-pressure situations could be the magic elixir for surgical success in the future.
In the case of Pippie’s groundbreaking surgery, AI might have had a hand in creating her new skin but it was the rapport between Mia, his surgical team, and the Kruger family, that played the greatest role in achieving a successful outcome. According to the UK’s Royal College of Surgeons, integrity, consistency and honesty, as well as accessibility and the ability to make decisions quickly and effectively, are key to successful medical outcomes.
The hallmarks of good surgical leadership
The Henley case study demonstrates that this rapport does not come out of nowhere, it is meticulously crafted by good leaders such as Mia — someone who has self-awareness, an understanding of the impact they have on both their patients and their teams, and the ability to manage their own stress and that of others.
Good leaders not only encourage their teams to provide input and raise questions, they also provide teams with the skills and resources they need to perform effectively. All these factors need to be underpinned by the understanding that the patient is at the heart of everything they do.
“All decisions and actions taken in the operating theatre — both in Pippie’s case and beyond — need to put that patient first,” says Mia who, from experience, understands that taking a moment to confer can help prevent miscommunication in the theatre.
“It’s critical to make every team member feel empowered, since everyone is an integral part of the procedure, regardless of the level they are at, or the role they pay.”
While surgeons often get a bad rap for reinforcing hierarchies and stifling team participation, there is no hierarchy in Mia’s surgical ward. “A surgical nurse was never considered inferior to a surgeon, and the same applied to a scrub technician, who was never considered inferior to a surgical nurse.”
Each team member is encouraged to provide feedback and share ideas for improvement. This resonates with the concept of “black box thinking”, which Mia learned early in his career from a medical trauma professor who said that even in the direst resuscitation in the trauma unit, it was essential to never discount information or advice, regardless of who gave it.
“Ambitious standards are achieved by providing support and praise when working under pressure — and there’s little to top the pressure of being in an operating theatre with a patient’s life in your collective hands.”
Zara Cupido is the research manager at Henley Business School and author of the case study Surgical Leadership: Disrupting the Status Quo.