Patient safety in surgical residency: root cause analysis and the surgical morbidity and mortality conference--case series from clinical practice.

Although the surgical morbidity and mortality conference (SMMC) has been a core educational venue for surgical education and quality assurance (QA), its current format focuses mainly on human errors rather than system failures, which are responsible for the vast majority of medical errors. To avoid having surgeons seemingly put on trial, root cause analysis (RCA) can be used as an effective way of analyzing system failures and of finding possible solutions for them. Preliminary data confirm the value of RCA in that respect and promise a great potential for improving patient safety away from the culture of blame. Bringing the findings of RCA to the SMMC has the advantage of having both perspectives--human errors and systems failures--thus enhancing surgical education, improving QA, and hopefully improving patient safety. However, although this seems to be a novel approach, several factors should be considered before its implementation, such as the quality of analysis, cost-effectiveness, and actual impact on patient safety. We believe that to maximize learning, sentinel events that currently require RCA should not be discussed in SMMCs until the findings of RCA are available for review. The use of some of the tools of RCA should be considered when discussing nonsentinel events during SMMCs.