Professor Cartmill (on right) and colleague examining the operating theatres at Macquarie University Hospital.
Professor Cartmill (on right) and colleague examining the operating theatres at Macquarie University Hospital.

Systemic safety in contexts of surgical care

Surgical teams are associated with the material reality of medical practice – the team, their actions, and the instruments have an immediate, direct bearing on bodies and wellbeing.

But operations only take place because of the hierarchy of human institutions, values, decisions, allocations of resources, and constraints of space and time. To understand and anticipate what can go wrong in a well organised, highly trained context like an operating theatre, one has to focus on the way all the levels – government policies, legal advisers, administrative officers and managers, clinicians, and teachers – influence each other.

Surgical practice is a system within systems of values, not just of matter. It is a realisational system.

Our aim was to anticipate problems and disruptions around surgical teams and operating departments. After 20 days of video recordings with Professor John Cartmill operating at Nepean Hospital, the data gave the linguists David Butt and Alison Moore a new kind of “map” of operating departments within a hospital. Our first target was “symbolic traffic” between different roles: the scrub nurse, the surgeons, the scout, the anaesthetist, and all attendees.

The longer term aim of this work is a change in professional vision. The vision has become part of the ethos and training (and cameras) taken up in Macquarie’s new hospital, Professor Cartmill’s new home. It has also had a dramatic effect on those who have considered the issues at professional conferences (eg Operating Theatre Association 2006) and at forums on complex systems (eg Evolving System Safety: Medicine and Aviation 2006).

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