Targets and budgets 'compromising surgeons' work'

Surgeons fear that management targets and budgets may be putting patients at risk on the operating table, a study showed today.

A total of 40% of surgeons said they had been involved in a "near miss" during the two weeks prior to answering the questionnaire and 19% had experienced an "adverse event".

The surgeons were involved in more than 19,000 operations, equating to 2.42% with a "near miss" and 0.8% an adverse event - 0.3% of which were serious.

Those figures, totalling 3.22%, are higher than the 1.64% reported by the National Patient Safety Authority but lower than the latest research in North America, the study said.

A total 549 members of the Association of Surgeons of Great Britain and Ireland were surveyed by Bournemouth University, 65% of whom have more than 20 years' experience.

They identified key causes of adverse events mainly due to target, budget and "numbers-oriented" management.

Surgeons said they have full clinical responsibility but are not in full clinical control, they operate on too many patients who they have not seen before due to micro-management of the operating list by managers.

They highlighted targets as causes for concern and treating operations as if they had the same weighting, ignoring the variability and complexity of patients.

The surgeons, who answered anonymously, said they sometimes had inadequate equipment or an inadequate workforce to respond to the needs of the patient list.

Another factor mentioned was the key differences in the perspectives of surgeons, who are seen as patient orientated, and managers, who are seen as budget and target orientated.

One experienced consultant said he tells his registrar: "When the manager asks you to make do, don't think you're being heroic, you are not, you're being dangerous."

Lead author Professor Colin Pritchard, of Bournemouth's School of Health and Social Care, said: "Surgery is not without risk and to err is human but based upon the number of operations that 549 surgeons performed, they had a serious adverse event 33 times in 10,000 which is two-thirds lower than that reported in the USA.

"The other big thing is that it is quite clear our respondents were totally patient orientated."

He added: "You cannot eradicate risk or human error, you have to recognise where some of the pressures are coming from. This is where the problem lies. The surgeon has full clinical responsibility but is not in full clinical control.

"What we have to do is to return the control of theatres and the wards back to the surgeons and the nurses."

The study, published in the Annals of the Royal College of Surgeons, also recommends that surgeons recognise that managers are under pressure from politically-driven targets with inadequate budgets.

It urges improvements in the theatre team be made to ensure continuity and cohesion and to improve safety, as well as more time for pre and post- operative briefings.

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