the OR," says Dr. Haynes, a surgical oncologist with Massachusetts
General Hospital in Boston. "Once we conclude the time out, I always
say, 'At any point during the surgery, if anyone sees anything they
think is not right or if they're unclear about what we're doing, please
speak up.'"
And they do — every day. Usually it's the little things: "You might
want an extra drape here or there because it's not quite as covered as
we'd like" or "Someone's glove touched an unsterile part of the field."
In all too many ORs, though, potential red flags are noted but not
spoken aloud. Dr. Haynes ascribes this silence to entrenched behav-
iors rooted in the traditional surgeon-first hierarchy, or simply the fear
of being wrong and then chastised for interrupting the workflow. He's
been heartened by a shift away from this archaic OR culture, even
though it's happening more slowly than he would like.
"We should have an environment in the OR where it's not consid-
ered a courageous thing to say, 'I think you contaminated yourself,'"
he says. "As a surgeon, I would be mortified if someone felt they were
in any way not brave enough to say something like that. It's about
members of a team working together, not the surgeon who believes
others should speak only when spoken to. That's an absurd concept."
When, how to say it
A lack of courage has likely been a contributing factor in the crush of
wrong-site surgeries, infections and other medical errors that happen
in U.S. ORs every year. The result of not speaking up can bear a heavy
weight, according to researchers from the Johns Hopkins University
School of Medicine (osmag.net/D5ePMp). Their data shows that
medical errors now account for as many as 251,000 deaths per year —
nearly 700 per day — or about 9.5% of all deaths annually in the
United States.
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ERRORS
