Leading the Way to Safer Surgery

What does safe surgical care mean to you?
Eliminating avoidable adverse events by developing and maintaining competent teams who deliver best practices, learn from their mistakes and aim to constantly improve. Surgery has become much safer decade by decade. The farther we go down the path of safety, the gaps that remain are those that relate to performance as individuals, teams and systems of care. 

As the director of Ariadne Labs’ Safe Surgery/Safe Systems program, what is the program’s mission?
Ariadne Labs is a joint center for health systems innovation at Brigham & Women’s Hospital and the Harvard T.H. Chan School of Public Health. The program aims to reduce surgical complications and associated mortality, and improve patient outcomes worldwide. We collaborate with facilities around the world to implement, evaluate and adapt our solutions to equitably reduce surgical complications and improve health systems. 

How are you helping expand the WHO Surgical Safety Checklist?
The checklist was designed to be a living tool capable of evolution. It can do more than what it is currently accomplishing in most settings. Our international team is piloting a toolkit that will help centers get the most out of their checklist by modifying it to their needs, and train them to use it in an efficient and effective way. For instance, during the pandemic, pieces of communication must be shared, such as a review of COVID-19 status and PPE, airway management discussions and agreeing on patient disposition. These can easily be integrated into the briefing, time out and debriefing sections of an updated checklist to ensure the safety of everyone involved in the operation.

How else can the checklist improve patient care?
It can play an even bigger role in complex cases. If I’m reconstructing the esophagus and trachea of a newborn, the anesthesiologist, nurses and I can use the checklist’s pause points to discuss how we want to manage the baby’s airway, what equipment we may need and what we must think about and do if difficulties arise during the case. 

What can leaders do to improve safety culture? 
They can role-model behaviors they want to see. Good leaders in surgical safety are a visible presence in the OR, constantly engaging with and responding to the teams they hope to influence. Although champions and frontline staff are critical, if there isn’t committed, meaningful investment from leaders, safety programs will often collapse or limp along without significant change. OSM