Surgical accountability: a framework for trust and change

Alastair Thompson, Peter A Stonebridge and Allan D Spigelman
Med J Aust 2005; 183 (10): . || doi: 10.5694/j.1326-5377.2005.tb07147.x
Published online: 21 November 2005

The Western Australian Audit of Surgical Mortality is a prototype for a national scheme

Most surgical care is conducted to a high standard; when a death occurs under surgical care, the patient is usually elderly, with comorbid disease, and a gathering momentum of events leads towards death. However, this does not abrogate the need for accountability in the safety and quality of surgical care. Across the world, established programs promote a culture of reflective practice in surgery and anaesthesia1,2 which have been used as the basis for developing guidelines for perioperative care.3 For sustained accountability, programs require a high degree of perceived clinical ownership, confidentiality, safeguards for the process and participants (such as legal privilege), transparency, and a health care system oriented towards system improvement. Other requirements are robust quality assurance and safeguards to prevent suppression of process or practice failures, as well as full participation and complete data collection, with protected time for individual clinicians, if improvements in health care are to be facilitated.

  • Alastair Thompson1
  • Peter A Stonebridge2
  • Allan D Spigelman3

  • 1 University of Dundee, Dundee, UK.
  • 2 Ninewells Hospital and Medical School, Dundee, UK.
  • 3 John Hunter Hospital, Newcastle, NSW.



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