Safety as a system: Event review, peer review, and professional practice evaluation

Surgical adverse events remain a source of patient harm despite increased focus on their prevention. High-reliability organizations reduce these events by fostering a just culture promoting transparency, shared accountability, and continuous improvement. This review article summarizes the systems and processes that promote safety in surgery, including incident reporting, root cause analyses, peer-review processes, and ongoing professional practice evaluations.

Systems employing a just culture encourage health care professionals to report adverse events through nonpunitive incident reporting systems to enable identification of trends and avenues for improvement. Root cause and apparent cause analyses are structured investigations that guide corrective actions rather than place individual blame. Ongoing professional practice evaluations and focused professional practice evaluations provide longitudinal assessment of provider performance, facilitating early identification of practice gaps. Collectively, these processes support continuous quality improvement and strengthen institutional shared accountability.

Safety in surgery depends on the integration of robust reporting systems, structured event analyses, and continuous improvement, all within a just culture framework. By emphasizing a system of shared accountability over individual blame, health care organizations can transform adverse events into opportunities for learning and promote safer surgical care.