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      Enhanced Recovery After Surgery: A Complete Guide to Optimizing Outcomes 

      Toward a Learning System for ERAS: Embedding Implementation and Learning Evaluation

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      Springer International Publishing

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          The Cultural Adaptation of Prevention Interventions: Resolving Tensions Between Fidelity and Fit

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            Five system barriers to achieving ultrasafe health care.

            Although debate continues over estimates of the amount of preventable medical harm that occurs in health care, there seems to be a consensus that health care is not as safe and reliable as it might be. It is often assumed that copying and adapting the success stories of nonmedical industries, such as civil aviation and nuclear power, will make medicine as safe as these industries. However, the solution is not that simple. This article explains why a benchmarking approach to safety in high-risk industries is needed to help translate lessons so that they are usable and long lasting in health care. The most important difference among industries lies not so much in the pertinent safety toolkit, which is similar for most industries, but in an industry's willingness to abandon historical and cultural precedents and beliefs that are linked to performance and autonomy, in a constant drive toward a culture of safety. Five successive systemic barriers currently prevent health care from becoming an ultrasafe industrial system: the need to limit the discretion of workers, the need to reduce worker autonomy, the need to make the transition from a craftsmanship mindset to that of equivalent actors, the need for system-level (senior leadership) arbitration to optimize safety strategies, and the need for simplification. Finally, health care must overcome 3 unique problems: a wide range of risk among medical specialties, difficulty in defining medical error, and various structural constraints (such as public demand, teaching role, and chronic shortage of staff). Without such a framework to guide development, ongoing efforts to improve safety by adopting the safety strategies of other industries may yield reduced dividends. Rapid progress is possible only if the health care industry is willing to address these structural constraints needed to overcome the 5 barriers to ultrasafe performance.
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              Recovery after laparoscopic colonic surgery with epidural analgesia, and early oral nutrition and mobilisation

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                Author and book information

                Book Chapter
                2020
                March 31 2020
                : 361-372
                10.1007/978-3-030-33443-7_39
                0c0e1562-9b47-4a01-9e43-5977e67bda5e
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