At the most recent Clinical Congress of the American Col­lege of Surgeons, I had the honor of moderating a panel on the topic of “The Highly Reliable Operating Team.” The pan­elists were Benjamin Sachs, M.B.B.S., discussing “Improving Team Performance,” Michael Leonard, M.D., discussing “Improving Communication,” and Forrest Calland, M.D., discussing “Standardization and Checklists.” 

From my notes of the discussion, I will convey the following suggestions about how surgeons can help make the operat­ing team safer:

1. Be a good role model. Participate in the pre­operative time out; pay attention to incorrect sponge counts; honor other safety practices.
2. Introduce yourself and everyone else on the team.  It has been shown that people who know each other by their first names are more likely to speak up if they see a problem.
3. Specifically ask people to speak up if they have concerns or questions. 
4. Include contingency planning in your pre-operative time out.
5. Double check that equipment works and supplies are available before you start the case.
6. Bring all information you might need to make intra­operative decisions to the operating room.
7. Help people understand your goals by saying why you want something as well as what you want.
8. Make confirmation feedback a habit for your operating team.
9. Don't be afraid to ask for help.
10. Adhere to best practice standards, when they ex­ist.
11. If you find yourself doing a “work-around,” ask yourself “What can I do to keep this from occurring again?”
12. Have a short debriefing after the case.

John R. Clarke, M.D., F.A.C.S.
Clinical Director, PA-PSRS