Human reliability assessment in surgery--a new approach for improving surgical performance and clinical outcome.
Surgical operative performance is currently assessed by audit of morbidity, mortality and, especially in patients with cancer, in terms of long-term outcome. Its chief merit is the identification of problems and sub-optimal results by individual surgeons/centres. There is one aspect of audit that constitutes its intrinsic weakness, the verdict on performance it gives is always retrospective--the problem is identified because of the bad results thrown up by analysis of the data. As a result, there is a distinct possibility that surgeons might exclude patients with potentially curative conditions because of increased operative risk due to co-morbid disease from major surgery because of a fear, conscious or otherwise, of comparative under-performance. There is a methodology in established use by industry that is both prospective and prescriptive in ensuring optimal performance--human reliability assessment (HRA), which can be translated into clinical practice. This paper explains the nature of HRA and reports on its initial use in surgery.
Cuschieri
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Department of Surgery and Molecular Oncology, Ninewells Hospital and Medical School, University of Dundee, UK.
D002983:Clinical Competence; D006801:Humans; D008485:Medical Audit; D019300:Medical Errors; D017751:Safety Management / Q000379:methods; D013514:Surgical Procedures, Operative / Q000592:standards*; D013647:Task Performance and Analysis; D016896:Treatment Outcome