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Featured Clinical Reviews

October 20, 2010

Improving Teamwork to Reduce Surgical Mortality

Author Affiliations

Author Affiliations: Departments of Anesthesiology and Critical Care Medicine (Dr Pronovost) and Surgery (Drs Pronovost and Freischlag), School of Medicine, and Department of Health Policy and Management, Bloomberg School of Public Health (Dr Pronovost), Johns Hopkins University, Baltimore, Maryland. Dr Freischlag is the editor of the Archives of Surgery.

JAMA. 2010;304(15):1721-1722. doi:10.1001/jama.2010.1542

Operating rooms are among the most complex political, social, and cultural structures that exist, full of ritual, drama, hierarchy, and too often conflict. For instance, in a surgical morbidity and mortality conference in which a roomful of surgeons were reviewing the delayed transport of a trauma patient from the emergency department to the operating room, the senior surgeon asked a junior surgeon what he would do differently next time. He replied, “I’m going to push harder, I’m going to transport them to the operating room faster.”1 This response highlights what is so great but also so myopic about medicine. Physicians strongly advocate for patients, believing they alone are responsible for patient outcomes. Yet pushing harder is an ineffective intervention and may result in conflict rather than better patient outcomes. Health care, and especially surgical care, is too often viewed as primarily a solo activity rather than as a team function.

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