Patient Safety from the Start! How SAS/LED Surgeons can lead from the front 

This year’s World Patient Safety Day focuses on Safe Care for Every Newborn and Child. As a specialty doctor in paediatric surgery, I am acutely aware of how vulnerable this patient group is to risks arising from unsafe care. Newborns and children often rely entirely on the vigilance and advocacy of their healthcare teams, and the consequences of errors can be profound. 

SAS (Specialty and Associate Specialist) and LED (Locally Employed Doctors) make up around one-third of the licensed medical workforce. Despite this, many feel their opportunities to step into leadership or non-clinical roles are limited. Much like the children we care for, SAS/LED doctors can sometimes feel overlooked or undervalued. Yet we are uniquely positioned to champion patient safety and lead initiatives that ensure every child receives high-quality, safe surgical care. 

Using the Royal College of Surgeons of Edinburgh’s ‘Top Ten Tips for Surgical Safety’, I reflect on my own experience and outline practical ways in which SAS/LED surgeons can lead from the front. 

Tip 1 – Put patients at the heart of care 

At the centre of safe surgical practice lies the patient. For paediatric patients, this means not only treating the child but also listening to, supporting, and advocating for their families. 

As SAS/LED surgeons, we are often the most consistent presence in a child’s care, reviewing them daily and building trust with parents or carers. This continuity gives us a unique perspective. When we speak up—whether in ward rounds, handovers, or multidisciplinary meetings—we ensure that concerns are heard and acted upon. 

Breakdowns in communication are one of the most common factors in adverse outcomes, as repeatedly highlighted in Significant Event Reviews and Team-Based Quality Reviews. By prioritising open, compassionate communication, we can be the voice for patients who cannot yet speak for themselves, as well as their families. 

Tip 2 – Prioritise team well-being 

Patient safety depends on the health and resilience of the surgical team. Burnout, fatigue, and emotional distress directly affect clinical performance. 

In my hospital, I act as a peer supporter, part of a service offering confidential, compassionate support to colleagues in times of acute stress. Trained in psychological first aid, we provide a safe space to process difficult experiences and signpost ongoing care when needed. 

Evidence consistently shows that healthier, happier teams deliver safer care. Leaders such as Michael West have demonstrated how compassionate leadership enhances both staff well-being and patient outcomes. As SAS/LED surgeons, we can take simple but effective steps: checking in on colleagues, advocating for protected rest, or even helping establish local peer support schemes. 

Tip 3 – Work within skill set 

Surgery is a profession of lifelong learning. Advances in technology, evidence, and practice demand that we continually refresh our knowledge and skills. 

In Scotland, the SAS NES Development Fund provides vital support, enabling SAS doctors to acquire new skills or enhance existing ones in ways that directly benefit patient care. In addition, the College offers a wide array of courses specifically designed for SAS/LED surgeons to attend. 

Equally important is recognising the scope of one’s practice. In my department, I am fortunate to work within a well-supported team that enables me to focus on my narrower scope of practice while contributing meaningfully to more complex cases. Setting clear objectives at appraisal and actively seeking out training opportunities helps ensure that we both remain safe and continue to grow professionally. 

Tip 4 – Use a surgical safety checklist 

The value of checklists in improving patient safety is now beyond question. Inspired by the WHO Surgical Safety Checklist, many hospitals have developed tailored tools for theatre safety briefs, ward rounds, or even specific clinical scenarios. 

In my hospital, we display a large poster in every theatre and work meticulously through each step before operating. We also adapt checklists for ward rounds, ensuring that no aspect of patient care—from nutrition to safeguarding concerns—is overlooked. 

However, vigilance is needed to prevent “checklist fatigue,” where routine breeds complacency. Leaders can help by regularly refreshing and reinforcing the checklist culture. As Atul Gawande powerfully argues in The Checklist Manifesto, checklists are not about bureaucracy—they are about saving lives. 

Tip 5 – Never underestimate the importance of Civility 

Civility Saves Lives is more than a slogan—it is an evidence-based initiative with profound implications for patient safety. Research in neonatal intensive care has shown that exposure to rudeness can reduce diagnostic and procedural performance by up to 20%, while also halving key teamwork behaviours such as information sharing. 

Within my trust, we have recently formed a civility working group to tackle unprofessional behaviour and support staff in addressing it constructively. The College also offers excellent anti-bullying resources, which SAS/LED surgeons can champion locally. 

How we treat one another at work matters. A respectful, supportive culture is not simply “nice to have”—it is essential for safe patient care. 

Tip 6 – Ensure there is a Just Restorative Culture 

Mistakes are an inevitable part of surgical practice, but how we respond to them shapes both individual resilience and patient safety culture. 

Too often, surgeons experience shame and isolation after an error. A just culture focuses instead on learning, support, and open discussion. The College’s True Cut workshops provide invaluable training in how to communicate with patients and families after adverse events, while also equipping surgeons with coping strategies. 

Creating an environment where staff feel safe to admit mistakes without fear of blame is a powerful way SAS/LED doctors can lead by example. 

Tip 7 – Learn from mistakes and strive for improvement 

In my role as lead for morbidity and mortality meetings, I have seen firsthand the value of structured, multidisciplinary learning. These meetings are not about blame but about reflection and improvement. 

One particularly effective framework is the Team-Based Quality Review, which emphasises collective learning and system improvement. Could you champion this within your department? Even small steps—such as sharing case reflections across specialties—can generate meaningful change. 

Tip 8 – Think human factors and team training 

Technical skills are vital, but non-technical skills—such as communication, leadership, and situational awareness—are equally critical to patient safety. 

I have developed a programme of regular simulation training for acutely unwell children in my hospital, bringing together multidisciplinary teams to rehearse stressful, real-to-life scenarios. Evidence strongly supports simulation as a means of improving outcomes, and the College’s Non-Technical Skills for Surgeons (NOTSS) course is an excellent foundation. 

SAS/LED doctors often bring a wealth of clinical experience. Harnessing that experience to lead training—whether in a simulation suite or through in-situ ward exercises—benefits both colleagues and patients. 

Tip 9 – Be aware of external surgical guidance 

Professional growth does not stop at the hospital door. Staying current with guidelines, protocols, conferences, webinars, and even podcasts is essential. 

Beyond traditional CPD, stepping into wider roles can be transformative. I have pushed beyond my initial comfort zone to join the Paediatric Surgery Specialty Board and the College’s SAS and Locum Consultants Committee. These roles have opened doors into teaching, examinations, and national advocacy for SAS/LED doctors. 

Leadership opportunities also exist outside formal structures. In my current practice, I chair our patient safety group, contribute to local and remote and rural paediatric trauma training, and have joined the Scottish Patient Safety Programmes Paediatric Advisory Group, all areas where I feel I have an impact. For SAS/LED doctors, the challenge is often overcoming self-doubt—but the rewards are substantial, both personally and for the profession. 

Tip 10 – Factor ergonomics into the surgical environment 

Children’s surgical care presents unique ergonomic challenges. Adjustable tables, child-sized instruments, and thoughtful room design are not luxuries but essentials for safe, efficient surgery. 

Equally important is the well-being of the surgical team. In our centre, we schedule two-hourly pauses during long procedures. These allow for patient checks but also ensure staff can hydrate, stretch, or rest briefly. Such breaks reduce fatigue and model good practice for trainees. 

Ergonomic thinking extends to the emotional environment as well. Child-friendly theatres, recovery areas, and anaesthetic rooms can reduce anxiety and improve the overall care experience. 

Conclusion 

SAS/LED surgeons are not passive participants in surgical teams—they are leaders, advocates, and innovators. By embracing the Top Ten Tips for Surgical Safety, we can champion safer care for every newborn and child. 

As Frederick Douglass once said: “It is easier to build strong children than to repair broken men.” And in the words of Nelson Mandela: “Children are our greatest treasure. They are our future.” 

By leading from the front, SAS/LED surgeons can ensure that every child’s right to safe, high-quality surgical care is upheld from the very start.