In Search of Surgical Excellence: A Work Systems Approach

Surgical excellence is marked by the ability to manage errors and unexpected events during an operation (de Leval et al., 2000; Wiegmann et al., 2007). However, even experienced surgical teams can be negatively impacted by minor problems that disrupt the œow of a surgical procedure. Specifically, as the number of minor events increases, the ability of a surgical team to cope with major problems decreases significantly (Reason, 2001). The accumulation of minor events appears to diminish the compensatory resources of the surgical team, increasing their vulnerability and susceptibility to committing errors (Carthey et al., 2003). Unfortunately, little is known about the nature and frequency of surgical œow disruptions that impact surgical performance. As a result, developing interventions that improve patient safety is onerous, and errors with serious rami-fications continue to occur at high rates in many surgical specialties, including cardiac surgery, vascular surgery, and neurosurgery (Kohn et al., 1999; Gawande et al., 2003).