The Impact of Complications and Errors on Surgeons.

Abstract

Background Adverse events within the context of healthcare can lead to significant physician psychological distress. Contemporary research links the experience of adverse events to the prevalence of burnout, depression, and impaired quality of life. Most of the prevailing literature focuses on the impact of adverse events on all healthcare professionals. This PhD thesis recognises that some aspects of medical practice are exclusive to surgery, and the role of the surgeon. Therefore, this research investigates the unique impact of adverse events on surgeons. Furthermore, sub-types of adverse event (complication vs error) experienced within healthcare are often conflated within the literature, with very little differentiation made between a recognised complication of a surgery, and an error made by the surgeon. This research comprises a quantitative study exploring the impact of complications and errors on surgeons: Exploring the effect of type of adverse event on psychological outcomes and providing insight into the experience of surgeons following an adverse event, using surgeon responses to standardised measures to establish predictive statistical models. Methods UK Surgeons were invited to participate in an online survey. An opportunistic sampling strategy was used, involving organisations such as the Royal College of Surgeons of England and appeals at surgeons’ conferences and events. A single-factor (event: error or complication) between-groups design was used. Demographic and professional information, such as current grade and surgical specialty was collected. A detailed account of the nominated adverse event and the impact that this had on them in both a professional and personal capacity was then gathered. Standardised measures utilised within the survey, included the Work-related Acceptance and Action Questionnaire (WAAQ), the Primary Care PTSD Screen (PC-PTSD), the Brief Resilience Scale (BRS), the 21 item Depression, Anxiety and Stress Scale (DASS-21) and the Big Five Inventory personality measure (BFI). Results 445 surgeons completed the online survey. The extent to which surgeons are negatively affected by adverse events is significant. The data demonstrates that surgeons are negatively affected by adverse events, but do not possess the adaptive coping strategies to deal with them effectively. Confirmatory factor analysis confirmed five input variables within the model: event type (complication or error), nature of event (emergency or elective), severity of patient outcome (categorised by Clavien-Dindo score), timeframe of event occurring, and formal investigation. SEM identified three observed variables; feelings, PTS symptomology and worry about colleagues. The relationships between the input and observed variables were found to be moderated by training and personality factors and were mediated by resilience and psychological flexibility. Conclusion Prior to this research, it was unclear how surgeons were psychologically affected when they experienced an adverse surgical event. This gap within our understanding meant that any training, support, or intervention strategies would be unlikely to meet the specific needs of surgeons who were negatively affected. Given the mediating effects of resilience and psychological flexibility against negative outcomes, strategies should be incorporated to maximise these traits within surgeons. The findings from this research support targeted interventions focussing on the development of individual resilience and psychological flexibility. The need for changes to surgical culture are addressed, and recommendations are made to ensure that training, interventions, and support pathways within surgical training and the wider NHS are fit for purpose.