Executive strategies for surgical quality and safety transformation

Surgical quality and safety transformation requires executive strategies that align multidisciplinary teamwork, standardized processes, data-driven oversight, and sustained cultural change across increasingly complex health systems. This article describes Atrium Health Wake Forest Baptist's approach to improving surgical safety across academic, community, ambulatory, and rural care settings through operational optimization, psychological safety, quality improvement infrastructure, education, unified governance, and integrated monitoring. Key initiatives include expansion of ambulatory surgical capacity, implementation of the Wake Wings procedural safety program, use of national surgical registries, interdisciplinary simulation-based training, system-wide peer review, and unified dashboards for real-time surveillance of hospital-acquired conditions, patient safety indicators, and surgical outcomes. These strategies have supported improvements in operating room capacity, staff engagement, speaking-up culture, protocol adherence, sentinel event reduction, and surgical site infection prevention. The Atrium Health Wake Forest Baptist experience demonstrates that executive leadership can advance surgical quality and safety by fostering psychological safety, standardizing practices across sites, integrating data systems, and sustaining interdisciplinary education. These principles provide a practical framework for health system leaders seeking to reduce surgical risk and promote high reliability across diverse care environments.