Subsequent to Dr. Britt’s address to the Association of Veterans Administration Surgeons (AVAS) in April 2016, Dr. Lipshy interviewed the ACS Past-President and Chair of the ACS Committee on Health
Care Disparities. Dr. Britt shared his views on the state
of patient safety. A summary of that interview follows.
You stated in your address to the AVAS that in
spite of our best efforts, relatively little progress has been made in the prevention of adverse
events in health care. With all of our technology
and awareness, why can’t we close the gap on
There is no system. There is no communication.
We have a dysfunctional system. We have too many
distractions. It is a ruse. In the time out, there is no
concentration on the actual tasks. I believe that we
are not systematic. You need to fix the system first.
We are a disparate federation consisting of insurance
providers, hospitals, nurses, and medical providers.
We are not integrated. To fix the problem, we need to
integrate the system. We need to all work together to
correct this problem.
Do you believe adverse events occur because we
are simply not smart enough to do what we are
supposed to do, or is there more to the story?
You are asking the wrong question. You need to ask,
“Why are surgeons not doing it right in the first place?”
At the end of the day, you need a system that corrects
itself for these types of issues. You wouldn’t work for
Vince Lombardi and keep making mistakes. If you
become an outlier, you get a chance to redeem your-
self. You get a chance for remediation. You relearn, or
you move out. You are no longer on our team. You
may find another place where you will fit in and func-
tion, but not with us. The true system should be able
to effectively address these adverse effects. You cannot
give the system a pass when it allows this to happen.
Is training in the effects of team dynamics, com-
munication, and human factors the answer, or are
they a portion of the equation?
The answer is both. These are all factors in the equation. Team training is only one component—a part of
the equation. Communication is clearly a key aspect.
You cannot fix this without improving communication.
But this should not be a top-down process. There must
be equal footing. We need a circular, cooperative communication process. We need to reconfigure the way we
communicate. If the Institute of Medicine reports that
adverse events have increased from 98,000 to 200,000,
then we have a problem. Why? It is likely that optimal
communication has not been achieved.
Are we making a mistake in trying to apply high-reliability organization (HRO) models, given that
health care delivery is more complicated and
dependent on human factors, or are we simply
applying those models incorrectly?
We may not be hitting a home run, but we need to
build upon these results. We need to embrace this and
move on. [Patient safety] requires a multidisciplinary
attack. Team training is just one of the components.
You cannot minimize these results.
I’ve said it before—aviation is not the same as
medicine. Medicine is much more complex. Aviation
typically has a relatively stable environment when
planes are operational. You get a weather report, and
it changes infrequently. In aviation you don’t have to
worry about comorbidities or typically worry about secondary changes. There is no parallel to what we have
in medicine. There are always unknowns in medicine.
We are just beating ourselves up too much over this.
with Dr. Britt