Innovation in safety, and safety in innovation

Modern surgery’s heritage has been based on the introduction of innovative approaches to the way surgery was practiced, all in an attempt to improve patient outcomes. Innovations ranged widely from purely technical advances to simple changes in practice norms that resulted in safer surgery. These innovations in surgical safety had a profound impact on patient mortality and would transform the manner in which surgery, and medicine, would hence be approached. In 1867, for example, Joseph Lister introduced the use of a preoperative antibacterial preparation, at a time when surgical site and deep soft-tissue infections were common and often the cause of postoperative patient morbidity and mortality. 1 In the United States, William Stewart Halsted insisted on universal operative hand scrubbing as a patient safety maneuver to decrease postoperative infections. 2 These innovations were simple and are common sense by today’s standards, yet they effectively transformed the practice of surgery; they made it safer and allowed for the complexity of procedures to increase. The public’s perception of the surgeon changed as well, evolving from the experimental anatomist and radical thinker exemplified by John Hunter in the 18th century to the effective healer and possessor of special skill of modern times. 3