[Maintaining safety management in the field of surgery]

Due to an increase in the number of medical accidents and medical conflicts, the administration of medical safety has recently introduced the following measures to cope with this situation; the process and the structure (reason) of error is analyzed based upon evidential facts, the origin of the errors is analyzed mainly in terms of teamwork and specialized medicine and structures rather than in terms of the ability of the individual, and the strategy against medical errors has been converted from aspects of management to prevention. The comprehensive strategy pursued now covers the field of social medical systems in addition to medical institutions. However, the judicial decisions in 90% of medical conflicts ruled that these were caused by the lack of knowledge and skills of the medical doctor, and a survey performed by the Japan Medical Association based on medical insurance research has reported incidences of repeated medical errors by the same physician. This has led to some criticism from the victim's viewpoint that insufficient administration of medical quality result in increased numbers of accidents which are due to repeated medical errors, under "legal" medical practice by "incompetent" doctors who should have been systematically reeducated or dismissed. In recent years, several societies and research groups of the Ministry of Health, Labour and Welfare have constructed medical guidelines based on evidence-based medicine techniques. The introduction of the clinical pathway offers the medical team access to information, directed to the appropriate roles, which may be helpful in performing constant safety checks. This medical check method that involves the patient's input will also contribute to the prevention of medical errors and promotion of safety.