To Err is Human, to Get it Right Takes a Village

Even though the American Medical Association's code of ethics requires colleagues to report those they suspect are unable to practice medicine safely because of impairment or incompetence, we know that one in three physicians balks at reporting an incompetent or impaired colleague.

And for surgeons in rural hospitals, improving teamwork can be especially challenging. Surgeons at critical access or acute care facilities can be short-staffed and overworked, conditions not conducive to teambuilding drills and exercises, effective though they may be.

A 2009 study, Improved Operating Room Teamwork via SAFETY Prep: A Rural Community Hospital?s Experience, examinedteam-related competencies in a rural setting:

"From July 2006 to February 2007, a prospective evaluation of teamwork among the OR staff working with a single general surgeon in a rural community hospital in Alaska was undertaken before and after the implementation of a preoperative protocol briefing designed to foster team competencies and interactions."

It concludes that team-related competencies may improve OR efficiency and, as a result, could improve patient care and safety. JAMA's wider study, published Wednesday, concludes that participation in a Veterans Health Administration medical team training program is associated with lower surgical mortality.

While it may take a trained village of OR staffers to lower surgical mortality, let it be noted: The villagers need a strong leader.