Systems approaches to surgical quality and safety: from concept to measurement.
OBJECTIVE
This approach provides the basis of our research program, which aims to expand operative assessment beyond patient factors and the technical skills of the surgeon; to extend assessment of surgical skills beyond bench models to the operating theater; to provide a basis for assessing interventions; and to provide a deeper understanding of surgical outcomes.


BACKGROUND
Research into surgical outcomes has primarily focused on the role of patient pathophysiological risk factors and on the skills of the individual surgeon. However, this approach neglects a wide range of factors that have been found to be of important in achieving safe, high-quality performance in other high-risk environments. The outcome of surgery is also dependent on the quality of care received throughout the patient's stay in hospital and the performance of a considerable number of health professionals, all of whom are influenced by the environment in which they work.


METHODS
Drawing on the wider literature on safety and quality in healthcare, and recent papers on surgery, this article argues for a much wider assessment of factors that may be relevant to surgical outcome. In particular, we suggest the development of an "operation profile" to capture all the salient features of a surgical operation, including such factors as equipment design and use, communication, team coordination, factors affecting individual performance, and the working environment. Methods of assessing such factors are outlined, and ethical issues and other potential concerns are discussed.
Vincent
Charles
C
Clinical Safety Research Unit, Imperial College of Science, Technology & Medicine, University of London, London, United Kingdom. c.vincent@imperial.ac.uk
Moorthy
Krishna
K
Sarker
Sudip K
SK
Chang
Avril
A
Darzi
Ara W
AW
D013502:General Surgery / Q000592:standards; D006801:Humans; D009873:Operating Rooms / Q000458:organization & administration / Q000592:standards*; D010043:Outcome and Process Assessment, Health Care / Q000379:methods* / Q000458:organization & administration; D010348:Patient Care Team / Q000592:standards; D019984:Quality Indicators, Health Care; D017751:Safety Management / Q000458:organization & administration / Q000592:standards*; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000592:standards; D013597:Systems Analysis; D013647:Task Performance and Analysis; D017749:Total Quality Management / Q000379:methods*