HARD STOP David Ring, MD, PhD, leads a hard-stop time out. "Everyone is helping get things right," he says.

People still ask me to talk about my error. Talking about it respects the patient that was harmed. Talking about it helped me heal. Talking about it helps other patients, other surgeons and their teams embrace a safety culture, adopt checklists and encourage each other to speak up. Let's talk about my error.

My error
A 65-year-old woman came to the day surgery unit at Massachusetts General Hospital in Boston a few years ago for a trigger-finger release, a procedure I'd performed hundreds of times. Due to a confluence of events, I performed a carpal-tunnel release on this patient rather than a trigger-finger release.

About 15 minutes later, while I was in my office preparing to dictate the report, I realized that I had performed the wrong procedure. It's difficult to describe the feeling I had. Others have helped me try to put this into words. It's like the ground fell from beneath me. Like my breath was stolen. It was the typical layers of "Swiss cheese" that let my error cause harm:

• A backed-up schedule moved my patient to another OR and bumped the nurse who had performed the pre-operative assessment from the case.
• A time-out policy that did not require the entire team to stop and be involved. What's more, we performed the time out before we'd prepped and draped the patient.
• A site-marking policy whereby we marked the limb, but not the specific operative site. What's more, the site marking was wiped away by the alcohol in the prep and povidone-iodine.
• Then there was the language barrier. The circulating nurse thought that I would be doing the time out in Spanish — she was excluded from helping me because she did not speak Spanish.

After informing the patient of the error and apologizing, I offered to perform the correct procedure. She agreed. I reassembled the staff and performed a trigger-finger release, without complication. Other than an unnecessary incision on the palm, there was no lasting harm for my patient.

Even in my darkest hour, I knew that I had to talk about this error and learn from it so that other patients and other operative teams would be safe. An opportunity arose to share my story in the New England Journal of Medicine (tinyurl.com/2f4l4fw), and I was all for it On the eve of publication I wasn't sure how it would be received. Would patients avoid me and doctors stop referring to me? Would I lose the respect of my colleagues? Instead, my forthright discussion of the incident drew widespread praise; some surgeons called me courageous for risking my reputation for the sake of patient safety. Clearly many are ready for this change.

The real benefit of going on my "wrong procedure world tour" (the set of hospital and conference appearances that ensued) to talk about my error was to drive home the point that humans err and that by anticipating errors we can limit them and catch them before they cause harm. Here's more of what I learned.

1. Be accountable. When you make a mistake, turn the regret into action. Your respect for the patient and the team is clear when you work to figure out how such errors happen, do what you can to prevent them and build systems to catch the inevitable errors before they cause harm. Accountability starts with an appreciation that humans are imperfect. When you expect to err, you will help build, champion and implement effective safety systems, like the surgical safety checklist and hard time outs. You'll also help build a safety culture: a setting where people feel comfortable speaking up. My good fortune was that I work in a place that has worked steadily to move from the "blame-and-shame" culture of traditional medicine to the culture of safety successfully developed in aviation and manufacturing.

2. Safety protocols shouldn't be burdensome. Whatever systems you have at your facility to prevent errors, help to make them as little burden as possible and then champion them. To err is human. We're going to make mistakes. We need to catch the mistake before harm occurs. Planes crash because people make assumptions and don't speak up and don't use systems to catch their errors before they cause harm. Focus on the systems that help good healthcare providers catch their errors before they lead to harm.

3. Do a hard-stop time out. It's crucial that there be a systematic and consistent approach to identifying the correct patient, correct operation and correct site before each operation is started. Everyone must stop what they're doing and say, "Let's all put our heads together. Is this the right patient, the right surgery, the right site? Are we prepared?" Errors don't just happen to bad doctors or bad nurses. They happen to the best among us.

4. Encourage frank and open discussion. My message is, let's talk about it. When little things go wrong and the patient is unscathed, we shouldn't be complacent and happy that things worked out. We should say, "Hey, I bet we can learn from every single little thing that didn't go exactly as we wanted it to go." Anything in the surgery that doesn't feel like the best and safest surgery is a learning opportunity. That's a conversation you should be having. A lot of times when team members aren't happy, they keep it to themselves. They worry alone. There's a saying: Never worry alone. In aviation, nobody ever wonders why you're running a checklist. Nobody every wonders why somebody speaks up. It's part of the culture. Plus, they know that if the plane goes down, they go down with the plane.