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Executive Summary

The purpose of this resource

The aim of this new interactive web resource is to improve the quality of discussion about surgical practice, and the action that takes place in response to it.

Surgery is a highly demanding and critically important part of patient care. It can involve challenging and emotive circumstances for patients and their surgeons. Providing the highest quality of surgical care can be difficult and complex. In many areas of surgery, patient outcomes are of a consistently high standard and surgeons are leading the way in delivering major improvements to the quality of peoples’ lives. In a smaller number of other areas, more needs to be done to improve the quality, and to reduce the variability, of surgical outcomes and the standards of patient care provided by the NHS.

This resource describes the challenges that can arise from the practice of an individual surgeon or within a surgical service. It is based on the RCS’s experience of invited reviews.

We propose a proactive approach to thinking about surgical services and the challenges that can arise when delivering them. We have developed this interactive web resource to help surgeons and those responsible for surgical services to reflect on and improve the quality of patient care.

We hope that our resource can be used to improve the discussion of the challenges of surgical practice and to ensure they are addressed at an early stage, before they lead to problems that have an impact on the quality of patient care.

Executive summary

Caring for patients and ensuring that they receive the highest possible standard of surgical treatment is at the core of our values here at RCS. The delivery of good surgical care is not straightforward, however, and there are many daily challenges for surgeons and their teams that can be difficult to resolve.

This makes it all the more important that any concerns about the performance of an individual surgeon or surgical unit are reviewed and resolved as soon as possible.

Since 1998, the RCS has offered an Invited Review service, which provides hospitals with an independent, external and professional review of an individual surgeon or surgical service. This typically involves two senior surgeons and one lay person being invited into a hospital to talk to staff on a confidential basis and examine information over the course of two to three days to determine whether there is a cause for concern and make recommendations for improvements.

We believe that Invited Reviews are a highly valuable resource to help hospitals deal with concerns before they develop into more serious problems and one that can offer practical solutions that improve care. Surgical teams work in high-pressure environments, and it is through reliable and trustworthy peer and patient led review that the answers to problems can be found.

The reports of specific reviews are the responsibility of the hospital to address, but we are keen to highlight the regularly recurring problems that are identified within surgery so they can help surgeons, managers and other healthcare staff to promote action being taken to resolve problems at an early stage.

We have surveyed a sample of 100 consecutive reviews that have taken place this decade and identified lessons about how problems occur and where improvements need to be made.

In over three-quarters of the 100 reviews we looked at there was a need for improvement in:

  • an aspect of the way that surgical care was being delivered
  • team working between surgeons

In over half of the 100 reviews we looked at there was a need for improvement in:

  • the timely recognition and resolution of concerns
  • multidisciplinary teamworking
  • individual surgical behaviours
  • leadership and management
  • outcomes data
  • facilities and resources

In over a quarter of the 100 reviews we looked at there was a need for improvement in: 

  • audit
  • relationships with surgeons in training
  • morbidity and mortality meetings
  • activity data
  • managing change
  • appraisal
  • learning from patient experience
  • patient consent and candour

In 17 of the 100 reviews we looked at there was some form of concern about probity and in 16 of the 100 reviews there was an issue related to the introduction of new techniques or new technologies that needed to be considered further.


To begin your discussion around the challenges of surgical practice, please use our interactive tool to explore key areas.