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About Sickkids
About SickKids

January 26, 2011

A vision for paediatric surgery

Dr. James Wright, SickKids Surgeon-in-Chief, is named head of national group

Dr. James Wright, Chief of Perioperative Services and Surgeon-in-Chief, was recently named head of Pediatric Surgical Chiefs of Canada. 

Wright, a native of Halifax, joined SickKids in 1991. He received his surgical training at the University of Toronto, followed by a clinical fellowship in Melbourne, Australia, and graduate work in clinical epidemiology and a fellowship in the Robert Wood Johnson Clinical Scholars Program at Yale University.  He has served in his current role for six years.

Senior Scientist in the Child Health Evaluative Sciences Program at SickKids Research Institute, Wright studies the characteristics of health and disease and outcomes of treatment modalities in children. He holds the Robert B. Salter Chair of Paediatric Surgical Research and won the SickKids Robert B. Salter Excellence in Orthopaedic Education Award in May in 1997.

Q: What are your goals as head of Pediatric Surgical Chiefs of Canada?

All of the chiefs share a goal of improving care for Canadian children. For example, our organization has developed targets for access to surgery for more than 800 diagnoses in 11 surgical disciplines and measured the wait for surgery among more than 200,000 Canadian children. The group allows us to share learning on how to best address our respective clinical and academic missions, and epitomizes the camaraderie typical of children’s hospitals. 

Our work on surgical wait times will continue. We are also sharing learning on development and implementation of check lists across the country to increase safety in the operating room. Efficiency is another issue. We are working on uniform definitions for efficiency measures so we can speak the same language when we talk to funders, who naturally want to know we are using their resources effectively. The driving aim is that if you use resources effectively, you can deliver more care.

We are also beginning to talk about health human resources planning – how many service sub-specialities are needed and what is required to recruit and retain these individuals. There are probably fewer than 300 paediatric surgeons in the 16 Canadian academic paediatric hospitals. We are trying to understand how many are needed to meet the demand. Furthermore, we want to ensure the resources are available when people are hired.

These issues are all complementary to what I do as surgeon-in-chief at SickKids. Shared learning is always helpful, and SickKids will benefit from the national discussion among surgeons.

Q: What is special about the camaraderie in children’s hospitals?

Children’s hospitals are devoid of cynicism. People who work in children’s hospitals believe they are working towards a higher mission. This mission creates a sense of camaraderie that’s unique for children’s hospitals.

Residents and fellows comment on how much nicer everyone is at a children’s hospital. Without cynicism, people are more respectful and easy-going. Children’s hospitals also tend to be less formal, which creates a wonderful working atmosphere.

Q: Since 2005, when you became Surgeon-in-Chief, what has gradually become easier about your job and what is proving more challenging?

We have developed strong relationships and trust that makes working in teams easier. The challenging part is trying to do everything that needs to be done with the available time and resources.  We do 11,000 surgical procedures a year in 25,000 hours of surgery. We don’t have all the time we’d like to accomplish other things such as changing the system, processes, improving quality, safety, efficiency etc.

Q: How have you developed strong relationships and trust in surgery?

If you invest in the health of children and believe in the value of the staff, these priorities will guide everything you do.

I have three rules that govern our activity and, I believe, pervade our perioperative services: One, our decisions are based on what’s best for the children; two, the process by which we affect change is collegiality and teamwork; and three, we judge our success by accomplishing what we say we will do. 

For example, as part of our focus on safety in the operating room, we are breaking down barriers between disciplines. Five years ago, I asked that people use each other’s first names in the operating room. If you can get people to use first names, you are much more likely to have them treat each other as a person and address safety concerns together.

We keep making changes. Some haven’t worked, but in large part we’re doing well, which is reflected in our engagement scores and other parameters that suggest we’ve achieved a lot in terms of trust.

Q: Why did you choose medicine?

It’s probably a common reason: out of a desire to help others. As time went on, I chose orthopaedics because it was very demonstrable that what you did had a direct impact on someone’s life: A broken bone, and you fixed it; a crooked bone, and you straightened it. I was very attracted to the tangible nature of orthopaedics and also to the accountability. Either you did it right or you didn’t.

Once I got into a children’s hospital it became clear to me that this was where I wanted to work. SickKids is where I had my best residency experience. There are only two things I seriously wanted in my life in terms of my job: one was to work at SickKids and, two, to become surgeon-in-chief.

Q:  What’s the best way to motivate people?

To give them a noble cause, and a vision, and to help them understand how they can make a difference.

Q: Is innovation an important part of being a good surgeon?

Innovation is absolutely essential in surgery. You have to achieve success when you perform an operation. So as part of their training, surgeons learn to think fast to get from A to B. The task of using your hands grounds you in that experience and makes you wish you could do things faster, easier, and with fewer complications.

Not to say that other physicians aren’t innovative, but I don’t think that skill is tested as frequently as it is for surgeons.  When you go into the operating room, there will inevitably be cases that require you to re-think how you are going to accomplish your goal. That’s why surgeons are innovative.

Q: What’s the future of surgery?

I think that in next 10-20 years, we will see a major shift in how surgery is performed. The introduction of general anaesthesia more than 100 years ago was a huge step. Since the 1960s laparoscopic or minimally invasive surgery has been available, removing hands from the surgical area. Nevertheless, surgery is still done with hands and knives, essentially the same as 50 or 80 years ago, although with much better equipment and less invasion.

The next big shift will be technological, maybe with robots, maybe with imaging and surgery at the same time. I think surgery will fundamentally change. In 30-40 years the idea of a surgeon using a knife may be antiquated.

Q: What is your biggest wish for SickKids?
Every child cured and every staff member successful.