How Regulators Assess and Accredit Safety and Quality in Surgical Services

  • Stephen Leyshon
  • Tita Listyowarodojo Bach
  • Eva Turk
  • Aileen Orr
  • Bobbie N. Ray-Sannerud
  • Paul Barach


A number of hospitals around the world have allowed themselves to develop cultures of “normalized deviance,” where (below) average performance becomes the norm, people are afraid to speak out and leaders are either unaware of or deny failure. Such weaknesses have led to high-profile incidents. The patients who come to surgery are generally among the sickest and at more advanced stages of disease. The very act of treatment involves interventions that are often considerably invasive with vigorous and unpredictable physiologic responses. The level of complexity, both in task-oriented and cognitive demands on clinical team, results in a dynamic, unforgiving environment that can magnify the consequences of even small process failures, lapses and errors. Because of better-educated patients, more demanding payers, push towards transparency, more discerning regulatory agencies, safety and quality have become prominent criteria for evaluating surgical care. Providers are increasingly asked to document these areas, and patients are using this documentation to select surgeons and hospitals. Payers are using the data to direct patients to providers, and potentially to adjust reimbursement rates. Therefore, health care policy makers, health service researchers, and others are aggressively developing and implementing quality indicators for surgical practice. Given the complex interplay of structure, process, and outcomes, assessment of surgical quality presents a daunting task.

Most importantly, health care providers must acknowledge mistakes and poor practices, and empathize with patients and their families. We must firmly establish the links between these elements to validate current and future metrics to support public reporting, while engendering more robust support by surgeons, health care executives, regulators and payers.


Accreditation Certification Patient safety ISO Teamwork Quality assurance Reliability 


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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Stephen Leyshon
    • 1
  • Tita Listyowarodojo Bach
    • 1
  • Eva Turk
    • 1
  • Aileen Orr
    • 2
  • Bobbie N. Ray-Sannerud
    • 1
  • Paul Barach
    • 3
  1. 1.Strategic Research and Innovation, Healthcare ProgramHøvik, OsloNorway
  2. 2.Healthcare UKLondonUK
  3. 3.Clinical Professor, Children’s Cardiomyopathy Foundation and Kyle John Rymiszewski Research ScholarChildren’s Hospital of Michigan, Wayne State University School of MedicineDetroitUSA

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