“There is a whole system that comes together for every patient:” Professor Raj Bhattacharya on his surgical career
Professor Rajarshi Bhattacharya is a consultant orthopaedic surgeon and previous clinical director for trauma, and current divisional director of surgery and cancer at Imperial College Healthcare NHS Trust. He features in the latest series of Channel 4’s Emergency documentary, leading a surgical team as they operate on a patient who was involved in a car crash and suffered a serious leg injury. Find out why he calls himself a “rational perfectionist” and how he manages his portfolio career.
Tell us about your role in the major trauma centre and your current role as divisional director of surgery and cancer.
In summer 2022, when Emergency was filmed, I was clinical director of orthopaedics, plastics and major trauma. I performed elective surgery – like planned knee operations – as well as emergency surgery and run outpatient elective and fracture clinics. In addition to my surgical role, I was responsible for ensuring our trauma directorate was functioning efficiently.
Since I became divisional director of surgery and cancer in 2023, I am now responsible for the majority of the surgical specialties as well as our cancer service, so I have taken the difficult decision of giving up my trauma work. I joined the trauma team at St Mary’s Hospital when the Major Trauma Centre was first established in 2010, so I do miss trauma surgery, but I also enjoy my current management role.
Tell us about your role as the director of surgery and cancer.
I love working one-on-one with patients and seeing the impact I can have on individual patients and their families. But by moving into management, I wanted to have the chance to improve systems and processes so I could help a wider group of people. That’s why in addition to my surgical training, I went to business school to help prepare for a role in management – I wanted to be able to make an impact in an even bigger way.
Right now, every day is different. I try to protect my clinical time, so I have days where I spend most of my time in operating theatres or in my outpatient clinic working directly with patients. I spend the rest of the week in management looking at how to provide a good working experience for our teams, as well as the best possible care for as many of our patients as possible.
Can you give us an overview of the project to improve productivity in our theatres?
Operating theatres are one of the costliest resources in a hospital. There are so many components to surgical work, from planning our lists to our pre-surgery appointments to cleaning the theatres and ordering equipment and so on. This project unites clinical staff and service managers to look at all the metrics we use to measure our success and find ways we can improve across the pathway.
When we started in 2023, we were towards the bottom of the Shelford Group of hospitals (a collaboration between ten of the largest teaching and research NHS hospital trusts in England) in terms of theatre efficiency. But I'm pleased to say that we turned this around and, in January 2024, we had the most efficient theatres in the group. This means we're treating more patients, which is ultimately helping us bring down waiting times.
It’s taken a collaborative, one-team approach uniting clinicians and managers and more to make that happen – we are all very proud of what we’ve achieved so far.
In the documentary series Emergency on Channel 4, we see you and your team carry out emergency surgery to fix a complex break in Jeymi’s leg. Why is it important to be a ‘perfectionist,’ as you say in the documentary?
Surgeons are craftspeople, and we are meticulous about our craft – I call myself a ‘rational perfectionist.’ I always tell surgeons in training to aim for perfection. If you aspire for perfection, you will end up with the best possible result. If you don’t, you can quickly settle to a mediocre level, and that’s just not good enough for our patients.
We take x-rays throughout each operation, so we check our work at every stage of surgery to ensure we’re getting it right. In Jeymi’s case, we were nearing the end of her operation when an x-ray showed that something wasn’t quite right. We went back and re-did that part of the surgery over to ensure the best possible result.
Professor Rajarshi Bhattacharya"There is a whole system that comes together for every patient"
Can you give us a sense of the scale of the teams and disciplines involved in caring for someone like Jeymi?
There is a whole system that comes together for every patient from the moment someone rings 999. There are the paramedics at the scene, emergency department staff who receive the patient, lab staff and imaging teams investigating the patient’s injury, cleaning staff preparing the theatre, porters moving the patient through hospital, surgical teams performing the operation, ward staff who care for the patient around the clock while therapies teams support the patient’s recovery, community teams who support the patient at home... this is all for a physical injury. There is also extensive mental health support required for patients who have experienced trauma. It can take years to recover from traumatic injuries and there are countless professionals involved in the care of each patient.
What do you love most about your work in trauma and surgery?
There are so many good things about trauma surgery. The adrenaline rush, the challenge, the fact that every day is different. Trauma is unplanned and unpredictable. You are trying to make a change for people who have lost their lives as they know them, to bring those people as close as possible to where they were before their trauma. It is a big challenge and there is so much at stake, but it is inspiring and fulfilling to watch people who have suffered a major trauma leave hospital and return to their lives, even if they have changed.
Of course, the intensity of the work can take its toll at times, which is one of the reasons why we always need new people joining the trauma specialty. The beauty of this discipline and of the major trauma system is that we have so many people who pitch in and do their part to help every single patient.
Find out how to join Imperial College Healthcare NHS Trust.
Watch Emergency series 3 on Channel 4 in August 2024.
