Surgery
Conversely, abandoning the aspiration risks weakening moral commitment. A balanced perspective recognises zero harm as a guiding vision rather than a literal prediction.4
As Stephen
Hawking noted, even those who believe in destiny still look both ways before crossing the street. This highlights the need for risk-based thinking: uncertainty demands careful anticipation and adaptation, not denial of responsibility.
Leadership, organisational design, and system alignment Frontline behaviour in operating theatres is shaped by organisational structures and leadership decisions. Workload pressures, staffing levels, scheduling demands, and performance metrics influence how clinicians prioritise tasks and manage risk. Organisations produce the outcomes they
are designed to create. If productivity targets conflict with safety practices, clinicians may prioritise efficiency over caution. Effective leadership aligns safety with operational goals and fosters psychological safety, allowing junior staff to raise concerns without fear.1 Robust incident reporting and feedback loops preserve organisational memory, ensuring that lessons from adverse events are captured and disseminated. Safety should not be viewed as a peripheral responsibility but should be integrated into strategic and operational planning.2
Conclusion
Managing the uncertainty of human error in surgery requires moving beyond simplistic binaries of competence versus incompetence.
Human fallibility is inevitable, but catastrophic harm is preventable. Integrating just culture principles, risk-based thinking, human factors design, non-technical skills training, and robust regulatory governance can significantly reduce the likelihood that human errors will result in patient harm.1,2,5 Safety in surgery is not merely the absence
of adverse events; it is the ongoing practice of anticipating, adapting, and responding to risk in complex, high-stakes environments. Embedding risk-based thinking and systems- oriented design within organisational culture ensures safety becomes central to the mission rather than an external requirement. Sustainable perioperative safety depends on humility, foresight, adaptability, and principled accountability. Recognising human variability as both vulnerability and strength allows surgical systems to transform uncertainty from a source of threat into a foundation for resilience.3
References 1. Dekker, S. (2017) Just culture: Restoring trust and accountability in your organisation. 3rd edn. Boca Raton: CRC Press.
2. Muschara, T. (2018) Risk-based thinking: Managing the uncertainty of human error in operations. London: Routledge.
3. Reason, J. (1991) Human error. Cambridge: Cambridge University Press.
4. Dekker, S. (2014) The field guide to understanding human error. 3rd edn. Farnham: Ashgate.
5. Flin, R., O’Connor, P. and Crichton, M. (2008) Safety at the sharp end: A guide to non- technical skills. Aldershot: Ashgate.
About the author CSJ
Mona Guckian Fisher LLM, BSc (Hons), RGN, OHND, Dip.HSWW, CMIOSH, Dip Periop Nursing, Dip Couns has over four decades of experience in perioperative nursing practice and leadership. She is a former President of the International Federation of Perioperative Nurses (IFPN) and the UK Association for Perioperative Practice (AfPP), and remains a committed advocate for the critical contribution of the global perioperative workforce. Mona is also one of a small number of registered safety practitioners working in healthcare, a qualified occupational health nurse, and a Chartered Member of the Institute of Occupational Safety and Health (CMIOSH). Her academic interests centre on medical law and ethics, particularly patient safety, standards of care, workforce staffing and competence, and human factors in healthcare.
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