Editorial Comment—Symposium: Patient Safety: Collaboration, Communication, and Physician Leadership

This symposium, “Patient Safety: Collaboration, Communication, and Physician Leadership,” is a timely one. Quality of care, including the prevention of errors in our patients, is the major responsibility for all physicians, healthcare providers, and healthcare institutions. The topic is recognized by everyone in healthcare and, I suspect, most patients. It has been a focus in the United States since the Institute of Medicine’s report To Err is Human, published in 1999 [3]. The number of publications in peer-reviewed and nonpeer reviewed publications as well as books continue to increase rapidly. Problems have been identified, process improvements have been made, technology aids have been developed, but major issues remain, such as a lack of public reporting of outcomes of treatment by physicians and hospitals as advocated by Codman more than 100 years ago [2], and the fact that medical errors continue at too great a rate.

James H. Herndon MD.

Studies from medicine and surgery have dominated the reporting about patient safety and error prevention. Orthopaedics, although a leader in addressing the problem of wrong-site surgery [1], has not been a leader in the patient safety movement. The reasons are not obviously apparent, but in my conversations with orthopaedic surgeons, I find that many do not believe that there is a problem, often do not understand systems-based issues, remain overly concerned about transparency and reporting outcomes, and do not appreciate the problem of overuse. We also do not have national orthopaedic registries that would collect and report the necessary data on adverse events needed to educate orthopaedic surgeons and motivate their behavior to change.

This symposium focuses on some of the major issues that hopefully will direct the orthopaedic surgeon’s attention on methods to improve quality of care and reduce errors. The symposium’s lead article is what I think is a classic for orthopaedic surgeons, a must-read (DOI: 10.1007/s11999-014-3598-6). Speaking directly to orthopaedic surgeons, Dr. Leape gives a brief but excellent history of safety, emphasizing the importance of systems changes and a focused list of the barriers facing all of us when addressing the necessary culture changes in our hospitals and offices. He goes on to detail the position of autonomy most of us continue to protect, the acceptance of disruptive behavior by ourselves and colleagues, and the lack of using evidence and root cause analyses to improve our care. Interestingly, he also comments on the overuse of our services as a major barrier to achieving safe health care.

Other authors draw our attention to the importance of addressing these barriers regarding culture, effects of surgeons’ hazardous attitudes on patient safety, the use of data to evaluate a surgeon’s performance, and the use of a national database reporting outcomes of care that could be a powerful tool, if the orthopaedic community would partner with the American College of Surgeons. Some articles focus on unique orthopaedic surgery issues, such as surgical site infections in spine surgery and resident fatigue.

Important additional topics for future research include the challenge in understanding the safety culture differences between physicians, nurses and hospitals, specific orthopaedic data on wrong site surgery and retained surgical items, safety in clinical trials, value of national joint registries and the relationship of value and safety.

I want to personally thank all the contributors, as well at the editorial team and the peer reviewers who made this symposium possible.