High Reliability Organizations and Surgical Microsystems: Re-engineering Surgical Care

Juan A. Sanchez, Paul R. Barach

Research output: Contribution to journalReview articlepeer-review

41 Scopus citations


Error prevention and mitigation is the primary goal in high-risk health care, particularly in areas such as surgery. There is growing consensus that significant improvement is hard to come by as a result of the vast complexity and inefficient processes of the health care system. Recommendations and innovations that focus on individual processes do not address the larger and often intangible systemic and cultural factors that create vulnerabilities throughout the entire system. This article introduces basic concepts of complexity and systems theory that are useful in redesigning the surgical work environment to create safety, quality, and reliability in surgical care.

Original languageEnglish (US)
Pages (from-to)1-14
Number of pages14
JournalSurgical Clinics of North America
Issue number1
StatePublished - Feb 2012
Externally publishedYes


  • Clinical microsystems
  • High reliability
  • Normal accident theory
  • Patient safety
  • Safe culture
  • Teams

ASJC Scopus subject areas

  • Surgery


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