Safety & quality resources: Overview

Abstract
Background: Junior anaesthesiologists often find it difficult to gain the trust of surgeons, possibly because of their limited experience and unfamiliarity with surgeons. Therefore, they can face pressure when navigating disagreements with senior surgeons. We investigated whether and how differences in anaesthesiologist-surgeon seniority might impact patient safety.

Methods: This was a sequential explanatory, mixed-methods evaluation conducted at a general hospital, comprising a retrospective case-control study followed by semi-structured interviews. In the quantitative phase, the case group included surgical patients who experienced anaesthesia-related adverse events. The control group was randomly selected from surgical patients without adverse events, matched to the case group by surgeon, surgery, and surgery year. The exposure was the differences in work experience between anaesthesiologists and surgeons. For the qualitative phase, participants were recruited from attending anaesthesiologists using a theoretical sampling strategy, and a grounded theory analysis was performed.

Results: The quantitative study included 390 patients in the case group and 1560 patients in the control group. After controlling for confounders, we did not find a significant association between differences in anaesthesiologist-surgeon seniority and odds of anaesthesia-related adverse events (adjusted odds ratio 1.00, 95% confidence interval 0.98-1.01, P=0.634). In cases of disagreements among surgeons, anaesthesiologists primarily based clinical decisions on the potential impact on patient safety. Junior anaesthesiologists faced challenges when rejecting surgeons. Nevertheless, they received robust support from anaesthesiology colleagues.

Conclusions: The capacity of anaesthesiologists to uphold patient safety was not significantly affected by their seniority levels relative to surgeons.

Abstract
The concept of ambidexterity as a strategic advantage has been discussed extensively in the business literature. While the specialty of anesthesiology has mastered exploitative/variance-reducing tactics as well as any specialty in health care, a new perspective of exploratory/variance-increasing strategies will be necessary to remain relevant in the perioperative space. We offer a framework of "idea flow" as a means for anesthesiology groups and departments to balance ongoing clinical mastery with innovative exploration.

Abstract
During the past 70 years, patient safety science has evolved through four organizational frameworks known as Safety-0, Safety -1, Safety-2, and Safety-3. Their evolution reflects the realization over time that blaming people, chasing errors, fixing one-offs, and regulation would not create the desired patient safety. In Safety-0, the oldest framework, harm events arise from clinician failure; event prevention relies on better staffing, education, and basic standards. In Safety-1, used by hospitals, harm events arise from individual and/or system failures. Safety is improved through analytics, workplace culture, high reliability principles, technology, and quality improvement. Safety-2 emphasizes clinicians' adaptability to prevent harm events in an everchanging environment, using resilience engineering principles. Safety-3, used by aviation, adds system design and control elements to Safety-1 and Safety-2, deploying human factors, design-thinking, and operational control or feedback to prevent and respond to harm events. Safety-3 represents a potential way for anesthesia and perioperative care to become safer.