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(Free)
Abstract
How many of your hospitals have a program aiming at Zero? Zero Infections, Zero Never Events, Zero Harm?
These terms and initiatives are currently so ubiquitous that their impact on the vast majority of us is certain. Some of you may say, “Why is this even a question? Is it not obvious that we need to aim at Zero?”
Certainly, our patients believe that the answer to the question of our commitment to Zero harm as a goal should universally and emphatically be “Yes!”. But, what if aiming at Zero actually had a downside? And if so, how might we negotiate with our patients the concept that Zero may not be the optimal goal in surgery? The purpose of this Surgical Perspectives is to explore the conflicts associated with “Aiming at Zero,” and to propose an alternative paradigm.
To begin with, I reflect on a traveling fellowship that I was fortunate to be awarded in 2009. I chose to visit the Japanese Red Cross Hospital in Tokyo in order to meet Professor Masatoshi Makuuchi, one of the most famous liver surgeons in the world and a foundational leader in the field.
Immediately upon arriving at his hospital, I was brought to the operating theater. During the next 10 hours of a complex third-time reoperation for neuroendocrine liver metastases, I distinctly recall Professor Makuuchi pounding away at the poor quality of American surgery. Hour after hour after hour he kept saying, “the problem with American surgery is that you build operations for a hundred people, and we build operations for a thousand people.”
In the moment, the implications of this charge did not hit home. What I did not know at the time was that Japan has a national registry of liver surgery outcomes.