Abstract
Background
Surgical crises, both clinical and executive, carry risk of harm to patients, staff,
and organizations. Once stabilized and contained, crisis recovery requires complex
decision-making and problem-solving to address primary failures (errors) and their
consequences. In contrast to other safety-critical professions, surgeons may lack
access to crisis recovery strategies and tools that go beyond the technical aspects
of clinical practice. This study aims to develop a framework for surgical crisis recovery
based on problem-solving interventions used by pilots in commercial aviation.
Methods
This study undertook observational fieldwork, semistructured interviews, and focus
groups with senior airline pilots and health care safety experts. Thematic analysis
using the framework method identified key interventions applicable to surgical crisis
recovery. Subsequently, expert group consensus adapted and content validated this
model for clinical use.
Results
Qualitative data from 22 aviation and health care safety experts informed surgical
crisis resolution. This consisted of 3 strategies: (1) building cognitive capacity
by improving situational awareness and workload management; (2) using checklists in
abnormal situations to implement emergency operating procedures; (3) undertaking structured
decision-making using analysis-based problem-solving cycles (eg, T-DODAR framework).
Twelve tools were validated and adapted to aid implementation of these strategies.
Conclusion
Once stabilized, surgical crises may be resolved using 3 sequential strategies derived
from commercial aviation.
Graphical abstract
Graphical Abstract
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Article info
Publication history
Published online: April 22, 2022
Accepted:
March 3,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
