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Workflow disruptions and surgical performance: past, present and future
  1. Douglas A Wiegmann1,
  2. Thoralf M Sundt2
  1. 1 Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
  2. 2 Division of Cardiac Surgery, Massachusetts General Hospital, Massachusetts, USA
  1. Correspondence to Dr Douglas A Wiegmann, Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA; dawiegmann{at}

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The earliest contributions of human factors engineering to surgery probably occurred just over a century ago. Already well-known for their pioneering scientific approaches to management, Frank and Lillian Gilbreth turned their expertise in time and motion studies and the psychology of management to optimising the operating room environment (and various aspects of hospital operations).1 Some readers may know this real husband and wife pair of early management gurus as the parents depicted in ‘Cheaper by the Dozen’. Written by two of their 12 children, it humorously depicted the application of the science of efficiency to the lives of this family of 14. The book, first published in 1946, generated a film (1950), a television series and an updated film in 2003. None of the antics in these various productions convey the real-life contributions of either of the Gilbreths. For instance, the modern approach to laying out surgical instruments in regular and consistent patterns grew out of their detailed analyses of filmed surgeries, in which the Gilbreths noticed that surgeons often spent more time searching for their instruments than they did operating.1

Within contemporary circles, however, many would likely cite de Leval and colleagues2 as the first to empirically demonstrate the relationship between human factors in the operating room (OR) and surgical error. They studied surgical performance and outcomes across a series of 243 arterial switch operations performed by 21 surgeons. One of their most notable findings pertains to the role that system factors play in the aetiology of errors. Such factors were generally referred to as ‘minor’ events and included such factors as failed alarm systems, coordination problems with the blood bank, perfusion issues and inappropriate task delegation. These minor events tended to disrupt to the flow of a surgical procedure, which subsequently impacted negatively the performance …

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