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The strategic advantage of sex-diversity in the operating room 

Authors: Julie Hallet 1 2 3, MD MSc; Alana Flexman 4, MD; Gianni Lorello 5 6 7, MD PhD

1. Department of Surgery, University of Toronto, Toronto, Ontario, Canada;
2. Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada;
3. ICES, Toronto, Ontario, Canada;
4. Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada; Department of Anesthesiology, St. Paul’s Hospital/Providence Health Care, Vancouver, BC, Canada
5. Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada;
6. Department of Anesthesiology and The Wilson Centre, University Health Network, Ontario, Canada.
7. Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
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The conversation around diversity has recently expanded from equity and social justice to performance and quality in various sectors, such as business, sales, technology and education; team diversity is recognized as a strategic resource that enhances performance and results.1–6 With our recent study published in BJS, we turn the spotlight to surgical teams.  

Previous works in healthcare have suggested that female physicians achieve better patient outcomes than their male counterparts.7–10 However, our perspective was that the true advantage of diversity does not reside merely in the success of a female physician over a male one, or one being better than the other. Rather, it lies in diverse teams of both males and females combining a multiplicity of experiences and viewpoints. This “diversity bonus” has been described by Scott E. Page, Professor at the University of Michigan, who showed the power of differences in how people think and work in enhancing performance.11  

Our study examined over 700,000 major inpatient operations in Ontario, Canada, and found that care in hospitals with more than 35% of their anaesthetist-surgeon team being female was independently associated with lower odds of 90-day major morbidity. Despite growing sex-diversity in medical school and residency programmes, our field still faces challenges in hiring and promoting female physicians.12–15 Our results support the need for greater diversity, as it can improve patient care.  

The efficacy of care can be increased much more by improving the fidelity of how standard of care is delivered than by developing new and often costly treatments.16 Team organization is the cornerstone to the reliability and quality of surgical care delivery. For instance, our previous research has shown that an anaesthetist’s clinical volume and the familiarity of anaesthetist-surgeon pairing can positively influence patient outcomes.17–20 Now, team sex-diversity appears as another key component of high-performing operative teams.  

While changes in operative teams are cheaper than the millions necessary to purchase new equipment or develop new treatments, implementing workflow and culture changes is daunting, possibly more so than introducing new technology. Such changes require alterations in individual work patterns and can be perceived as threatening or disruptive.  

Multifaceted solutions and policies are needed to enhance operative team’s performance through sex-diversity. Our results suggest that realizing the benefits of diversity depends on achieving a critical mass. Minority team members may withhold their perspectives until minimum representation is achieved, such that diverse perspectives are not fully leveraged.1,2,21,22 Sufficient representation is needed to avoid “tokenism”. Furthermore, diversity is not a cure-all. A supportive environment and systematic policies are essential for recruiting, developing, promoting, and retaining female physicians, are critical. Finally, monitoring and reporting on operative teams’ sex-diversity could hold healthcare organizations accountable, similar to other quality and performance metrics that are already tracked (such as surgeon and hospital volumes, surgery wait times, or surgical site infection rates). 

The push for sex-diversity in operative teams is not just ethically sound – it’s a strategic move. In other words, it’s not only the right thing to do, it’s the smart thing to do. Healthcare systems and organizations should consider operative team sex-diversity as a mean to optimize care for the ultimate benefit of those we serve – our patients.

Media coverage of this piece can be found on: The Guardian; NBC online; CBC online; CityNews radio


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