title: Safety in surgery: is selection the missing link?
abstract: Health care providers comprise an example of a "high risk organization." Safety failings within these organizations have the potential to cause significant public harm. Significant safety improvements in other high risk organizations such as the aviation industry have led to the concept of a high reliability organization (HRO)--a high risk organization that has enjoyed a prolonged safety record. A strong organizational culture is common to all successful HROs, encompassing powerful systems of selection and training. Aircrew selection processes provide a good example of this and are examined in detail in this article using the Royal Air Force process as an example. If the lessons of successful HROs are to be applied to health care organizations, candidate selection to specialties such as surgery must become more objective and robust. Other HROs can provide valuable lessons in how this may be approached.
authors.affiliation: Department of Biosurgery and Surgical Technology, St. Mary's Campus, Imperial College Healthcare NHS Trust, 10th Floor, Queen Elizabeth the Queen Mother Building, St. Mary's Hospital, Praed Street, London W2 1NY, UK. alistair_paice@hotmail.com
authors.forename: Alistair G
authors.initials: AG
authors.lastname: Paice
authors.forename: Rajesh
authors.initials: R
authors.lastname: Aggarwal
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
mesh_terms: D000337:Aerospace Medicine; D013502:General Surgery / Q000193:education* / Q000458:organization & administration; D006801:Humans; D019300:Medical Errors / Q000517:prevention & control; D015279:Organizational Culture; D010551:Personality; D010560:Personnel Selection / Q000458:organization & administration; D017751:Safety Management / Q000458:organization & administration; D006113:United Kingdom