Leadership in Perioperative Quality

To ensure high-quality care for patients, coordination among team members is critical. Over the past decade, we have learned that simply knowing the best approach to care is insufficient to achieving the goal of best outcomes. We now know that implementation of strategies at a local level is critical, as has been demonstrated by the variability in the effectiveness of strategies such as the World Health Organization (WHO) safe surgery checklist. Institutional culture has been shown to be one of the key factors in success or failure of any quality improvement (QI) initiative. Culture is, in large part, created by leadership. Leadership does not always mean the authority figure but can include all members of the team. In many high-risk industries, the importance of a “just culture” has become clear, and everyone needs to be able to speak up or errors occur. A leader can help set the culture and the vision for the organization and help create an environment of psychological safety where all team members can feel it is “safe” to express ideas, ask questions, and admit mistakes ( Fig. 38.1 ).

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Accountability for meeting demanding goals.

(Adapted from Edmondson AC. The competitive imperative of learning. Harv Bus Rev . 2008;86(7–8):60–67, 160.)

This chapter will outline some key attributes for leadership in perioperative QI.