Marty Makary: How to Be a Disruptive Innovator

Nurses hold the key to restoring the public’s trust in a healthcare system dogged by a lack of communication and coordinated care, and plagued by “money games” such as a lack of price transparency and predatory billing practices, according to surgical oncologist and gastrointestinal surgeon Marty Makary, MD, MPH.

Makary is well known as a New York Times bestselling author, health policy expert and driver to improve health care.

To write his latest book, The Price We Pay, Makary travelled the US and spoke with providers and administrators to understand the best and the worst of healthcare delivery. He recalls strides in transparency seen at a surgical center in Oklahoma where a menu of prices is shared with patients. He talks about moves toward lower costs in surgical care by a surgeon in India who can provide $500 CABG surgeries with high quality through improved team coordination and empowering patients and families to optimize home care.

He also can’t forget the struggles he witnessed patients facing, such as a woman in Tennessee being sued by her community hospital because she couldn’t pay for excessive and unnecessary care.

Perioperative Nurse Leader as Disruptive Innovator

Despite witnessing healthcare at it’s worst, Makary says he continues to be inspired every day by the disruptive innovators, including nurses, who are transforming healthcare back to its comforting and charitable roots.

“No one is more on the front line of patient care than American nurses,” he says. “I’m convinced as a surgeon that it’s nurses who have the ideas and the understanding of care delivery to redesign healthcare with a focus on effective communication and coordinated care that puts the patient first again.”

Here are four ways Makary believes nurse leaders can drive this movement back toward patient-centric care:

1. Drive a civil, speak-up culture on the front line—Nine times out of ten, we know someone in the OR had a concern they didn’t share or that wasn’t heard just prior to an adverse surgical event, Makary notes. “Nurse leaders have the power to inspire nurses, surgeons and other perioperative care providers to be on a first-name basis, to feel comfortable speaking up, and to know they will be heard without retribution or retaliation.”


2. Share data with outliers—He says nurse leaders must speak up themselves when the data they collect show surgeon activity beyond general practice guidelines, such as excessive and unnecessary surgeries. Makary currently leads such a data-sharing initiative called Improving Wisely to measure appropriateness in medicine using a physician-led, consensus process. “Civil conversation and honest data sharing from peers can go a long way to help outliers autocorrect.”


3. Talk about price transparency and cost-saving solutions—No one would go to a restaurant where the menu is different based on your employer and the person next to you could pay half the cost for the same meal, so why do we expect our patients to accept this with their healthcare costs?, he asks. “Perioperative nurse leaders and the front line nurses they lead have the perfect vantage point to successfully implement a new approach to healthcare costs, such as direct contracting pay models”—a practice currently being piloted in several US hospitals to shift from fee-for-service to a global fee model.


4. Support clinician time with patients—Nursing care provides an approach to caring for the patient and their family members at a deeper level, and nurses on the front line need the time to be able to connect with patients on this level, Makary suggests. “Every person in the delivery of care is important, but it’s the nurses I work with who clue me in to the blind spots, whether it’s some important piece of information the patient didn’t share with me or just a deeper understanding of the patient.”

Learn more about Improving Wisely, order your copy of The Price We Pay, and watch this video to understand why Makary wrote the book.

AORN Leader Membership

Designed for perioperative nurse leaders who need solutions beyond clinical challenges, like staffing and budgeting, while also supporting their professional passion. Benefit highlights include:

• Free and discounted leadership events
• Free online leadership courses
• ORNurseLink online community leader-only group

Learn more