Guest Editor: Create a Culture of Safety

This special issue of Outpatient Surgery Magazine is dedicated to safety from both the patient and the staff perspectives. It’s a topic that is near and dear to me for many reasons. As a nurse with more 30 years’ experience working at a large academic medical center — 11 of which were spent as the executive director of perioperative services for two ambulatory surgery center service lines — I’ve dedicated my life to keeping my staff and patients safe. We constantly hear the phrase “culture of safety” used to describe the environment within the OR, but it bears repeating that high-reliability organizations with such a culture in place all share the following four key features:

• An acknowledgement of the high-risk nature of the organization’s activities and a commitment to consistently safe operations.

• A blame-free environment in which individuals can report errors or risks for harm without fear of repercussions.

• The encouragement of systemwide collaboration to resolve patient safety problems.

• A total dedication of organizational resources to address safety concerns.

It’s a culture every surgical leader strives to achieve. Unfortunately, however, rampant staffing shortages throughout the industry are conspiring against even the most diligent OR teams, increasing burnout and causing morale to plummet. Short-staffed facilities with sky-high burnout and low morale rates are hard-pressed to maintain the culture of safety needed to provide patients with the surgical experience they deserve. This is equally apparent in acute settings and in the ambulatory surgery realm, where high-volume production quotas are difficult to meet in the most ideal circumstances. Post-pandemic, we’re still seeing delayed and canceled cases that can impact surgical outcomes and, with postponed surgeries due to staffing shortages, difficult recoveries when they are finally rescheduled.

As troubling as this current staffing crisis is, it also presents an opportunity for forward-thinking facilities to adapt, change and thrive in this new era of care. Every ASC I’ve seen excel has formed fully collaborative partnerships between its surgeons and its nurses, partnerships in which the surgeons truly listen to their surgical teams. These facilities have created stronger teams by leaning into flexible scheduling, with tactics like creative block scheduling and shared hours. These are the facilities that pick up the phone and call recently retired nurses to fill in gaps during the busiest, most demanding times. 

Of course, these partnerships aren’t limited to surgeons and nurses. The nimble facilities successfully combatting the staffing crisis are doing so with input from everyone involved — owners, techs, surgeons, radiology, leadership, administrative staff and everyone in between. They are finding flexible, creative and, most importantly, collaborative ways to maintain the morale of everyone involved in the surgical process. They understand this core truth about surgery: When morale is high, staff functions at its best. When staff is functioning at its best, the safest possible care will always be delivered. What I’ve witnessed at the safest and most efficient, high-quality outpatient facilities is a family dynamic among staff. A surgical family finds a way to create an atmosphere where its staff can meet stringent production, quality and safety goals while also ensuring everyone has the time and bandwidth to focus on their own families when they’re not in the OR.

As you flip through the pages of this issue and read about the safety protocols and checklists on preventing everything from simple slip and trips to catastrophic sentinel events such as retained surgical items or wrong-site surgeries, keep in mind that the best facilities always find a way to prioritize patient safety without compromising the well-being of their staff — their own surgical family. OSM