High Reliability of Care in Orthopedic Surgery: Are We There Yet?

Building Cultures of High Reliability: Lessons from the High Reliability Organization Paradigm

Safety models from disciplines outside of health care have begun to diffuse into the health care safety arena. This article explores high reliability organizing (HRO) theory, which privileges culture as means to adaptively learn and reliably perform. A brief history of the HRO paradigm and factors that contribute to cultures of high reliability is provided, followed by review of existing research to discern which HRO ideas have diffused into research on anesthesiology and perioperative care. High reliability research is growing and concepts seem useful; but there is a long way to go before the benefits of HRO are fully realized.

Preoperative Site Marking in Dermatosurgery

Dermatosurgery is a growing subspeciality due to increasing numbers of skin cancer and aesthetic procedures. Patient safety is a major issue in dermatosurgery. Quality management, education, and organization are the backbone of patient safety. A simple measure to support patient’s safety and to avoid wrong site surgery is preoperative skin marking. Permanent skin markers offer a painless and cost-effective option. To ensure optimal results, the following problems need careful consideration: good viability after disinfection, sterility of the operation field, no sensitization, or toxic effects of the ink. These issues are discussed in detail to allow a safe and successful procedure.

Professional Formation of Physicians Focused on Improving Care: How Do We Get There?

As the Accreditation Council for Graduate Medical Education (ACGME) and National Academy of Medicine (NAM) increase emphasis on quality improvement (QI), continuing medical education must also adapt to meet these increasing demands. In fellowship programs and for attending physicians, QI initiatives exist but are more rare compared with initiatives during residency programs, and they are even more rare for orthopedic surgery residents, fellows, and attending physicians. A QI curriculum should be in place at all stages of continuing medical education, as they help meet the criteria of the ACGME and NAM and promote better clinical practice and minimize errors.

Gainsharing Strategies, Physician Champions, Getting Physician Buy In

As healthcare spending continues to outpace economic growth, legislators and healthcare economists have explored many processes aimed at improving efficiency and reducing waste. Gainsharing or the general concept that organizations and their employees can work together to continually improve outcomes at reduced expenditures in exchange for a portion of the savings has been shown to be effective within the healthcare system. Although gainsharing principles may be applicable to healthcare organizations and their physician partners, specific parameters should be followed when implementing these arrangements. This article will discuss 10 gainsharing strategies aimed at properly aligning healthcare organizations and physicians, which if followed will ensure the successful implementation of gainsharing initiatives.