Factors suggested to contribute to surgical errors Surgeon

* Factors suggested to contribute to surgical errors: • • • Surgeon inexperience Low hospital volume for surgery High workloads Fatigue Poor technology Poor supervision Poor hospital systems Ineffective communication Time of day Administrative failures Fatigue Over 50% of errors are said to be preventable.

* Workload Low hospital volume for operation Inexperience Surgical error Time of Day Fatigue Poor Communication Poor Supervision

* Looking at the literature: Sarker and Vincent (2005) defined surgical competency, noting mishaps are waiting to happen. Their definition states: “Surgical competency is a combination of technical skill, team performance and communication, and decision making. ” -Vincent, Taylor-Adams, and Stanhope (1998) claim surgical errors stem from “systemic features operating at different levels—the task, team, work environment, and organization. ”

* Human Systems Approach • Developed by Reason Goals: enhance performance, increase safety, and increase user satisfaction • Two types of error identified: Active failure Latent failure Active unsafe actions such as memory lapses, using the wrong equipment, and breaking surgical protocols or standards Latent poor decisions that lead to times of error or critical incident; shown to cause unfavorable events

* (Croskerry, Cosby, Schenkel, & Wears, 2009) This table demonstrates error rates in relation to the surrounding work environment. Compare!

* (Sarker & Vincent, 2005)

* (Sarker & Vincent, 2005)

* Should these factors/aspects be considered when looking at surgery from a public health perspective? YES. • Researchers have formulated models to explain the relationship between influencing factors in the work environment and surgical professionals. -many factors shown -identification to develop interventions

How does the literature and topic relate to theories we have discussed? Social-Ecological Model This model involves the interrelationship between personal and environmental factors. Social Cognitive Theory Personal, environmental, and behavioral factors influence each other. (Relationship between sleep, workload, admin support— “the system”) Theory of Reasoned Action Individuals actions can be affected by subjected norms, control, and attitudes. (Breaking protocols, pressures)