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Surg Clin North Am. 2012 Feb;92(1):1-14. doi: 10.1016/j.suc.2011.12.005. Epub 2012 Jan 4.

High reliability organizations and surgical microsystems: re-engineering surgical care.

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  • 1Department of Surgery, Saint Mary's Hospital, 56 Franklin Street, Waterbury, CT 06706, USA. Juan.Sanchez@STMH.ORG


Error prevention and mitigation is the primary goal in high-risk health care, particularly in areas such as surgery. There is growing consensus that significant improvement is hard to come by as a result of the vast complexity and inefficient processes of the health care system. Recommendations and innovations that focus on individual processes do not address the larger and often intangible systemic and cultural factors that create vulnerabilities throughout the entire system. This article introduces basic concepts of complexity and systems theory that are useful in redesigning the surgical work environment to create safety, quality, and reliability in surgical care.

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