The development of a new procedure in a hospital : a case study of how cardiologists and cardiac surgeons respond to the introduction of the new transcatheter aortic valve implanation (TAVI) procedure

Abstract

Background: Medicine has a strong focus on evidence-based practices. Although, even when evidence helps ease the introduction of new technology, it also creates challenges for medical professionals who are used to traditionally established practices. My study is a case study describing the development of the new transcatheter aortic valve implantation (TAVI). Here, the challenge that has developed is a ‘turf battle’ related to how cardiologist and cardiac surgeons perceive their future role in TAVI. This level of competitiveness is interesting in many ways for it helps illustrate some of the pathways professionals take when undergoing change in their field.

Methods: The motivation for this study is to investigate how the TAVI project, a procedure combining cardiac surgery and cardiology, has the potential to mature into a treatment for aortic stenosis. The two main research questions asked were; what kinds of challenges these professionals face with the new minimal invasive procedure and how they are reacting to the uncertainty over ownership in the future. Methods used are interviews with experts in cardiology and cardiac surgery, alongside observations and literature reviews. Here, I will use the theoretical framework of change management with contributions from Kurt Lewin, John Kotter, and W. Warner Burke & George Litwin.

Results: The results were the TAVI project is a new, non-inferior alternative to the current standard of care for aortic disease, but this creates apprehension within cardiac surgeons over the possible loss of patients and ownership over the procedure. Nonetheless, experience shows both professions are aware changes in treatment strategies are always underway. The implications are both cardiologists and cardiac surgeons are progressing through a paradigm of change as this new procedure is accepted in the medical community.

Conclusion: Indications from informants in this case study have shown that there is a conflict between cardiac surgeons and cardiologists in dealing with who will own the procedure in the future, but the TAVI project is not sufficient enough in size to negatively affect the professional position of cardiologists or cardiac surgeons. On the contrary, the idea of TAVI has expanded the notion of what kind of treatments are available for patients with aortic stenosis and that there is a possibility of a new sub-speciality arising involving new minimal invasive methods.