Bring us more cases, but not those orthopedic Medicare cases. Start your cases on time. And here, try these new gloves - we switched and you must have missed the memo.

Nag, nag, nag.

Mark the surgical site. Be efficient. Fill your block schedule. And here, try these new safety scalpels - they're light, but they're dull.

Nudge, nudge, nudge.

Are your surgeons buying what you're selling? Probably not, if you're seen as someone who's full of demands, orders and yourself. So how do you win over surgeons who are wired to resist and resent being told what to do?

"If I had a dime for every time somebody asked me how to get surgeons to do something differently, I'd be rich," says Martin Makary, MD, MPH, an assistant professor of surgery and public health at the Johns Hopkins University School of Medicine's surgery department. "Surgeons speak the language of data: graphs, charts and statistics. When you have good data to support the need to improve a problem, they believe it. Right now, there's very poor science behind the study of teamwork, safety and culture in the OR."

This issue is filled with articles about getting surgeons to do lots of somethings differently, namely starting cases on time (see "Align the Incentives in Your ORs" on page 20), using safety sharps (see "Getting Your Surgeons Excited About Safety Sharps" on page 34) and investing in smoke evacuation devices (see "If You're Thinking of Buying ..." on page 63).

"Surgeons don't like to be told how to run operating rooms," says Dr. Makary. "There is a captain-of-the-ship mentality deeply impressed upon us during training."

In his book Going South, an insider's look at what went wrong at HealthSouth, ENT surgeon William Cast, MD, tells why his group of Indiana surgeons really wanted out of its short-lived joint venture with HealthSouth. Take a guess.
a. Their surgical center's revenues and their own salaries began to drop steeply.
b. Communications were abysmal.
c. Without warning, new supplies and equipment were shipped to their surgical suites.
d. They were tired of being told what to do, from what artwork they could hang in their waiting room to what type of sodas and snacks they could offer and consume on the premises.

Oddly, the tipping point involved a directive that Coca-Cola would be the official beverage of HealthSouth. "And with the intrusive demand from Birmingham," writes Dr. Cast, "our willingness to remain loyal subjects in the HealthSouth land of Oz ended."