Patient Safety, Complex Case Management, Consultant Collaboration & Teamwork

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27 November 2025

Society for Cardiothoracic Surgery in Great Britain & Ireland (SCTS)

Following the recent Unit Representatives (BORS) meeting in September 2025 several important issues were raised, to which the SCTS leadership team, lay representative and Trustees have prepared the following statement.

This provides clarity to our members, the public and to the healthcare administration of our professional society views.

Aman S Coonar
President SCTS
November 2025

 

Statement to the Membership:

Patient Safety, Complex Case Management, Consultant Collaboration & Teamwork

As your professional society, we reaffirm that patient safety is, and must always remain, our highest priority. Every element of our practice and culture, from the operating theatre to the ward and clinic, from training to service design, must be guided by this fundamental duty to safeguard our patients.

At the same time, we recognise that the greatest benefits in cardiothoracic surgery are often achieved in patients with higher risk profiles or more complex needs. Our role is not to avoid these cases, but to ensure that robust systems are in place to manage them safely, consistently and transparently.

To that end, SCTS emphasises the following principles:

1. Safety above all

All decisions should be tested against one simple question: does this maximise safety and minimise avoidable harm?
Efficiency and innovation are important, and they must always serve, not compromise, patient welfare.

2.  Risk reduction, not risk avoidance

Our philosophy must be risk reduction, not risk avoidance. Systems should be designed to minimise variation and eliminate single points of failure, while still enabling patients with complex disease to be offered safe surgery where the potential benefit can be greatest.

3. The role of the safety net

Structured safety nets such as checklists, multidisciplinary team (MDT) decision-making, active peer review, transparent morbidity and mortality (M&M) processes, and clear escalation protocols are essential.

These mechanisms protect patients, strengthen professional practice, and give teams more confidence to undertake high-risk or complex work within a controlled and safe environment.

4. Dual and multiple consultant operating and anaesthesia

For high-risk or complex procedures, dual or multiple consultant operating is a proven model of care. It enhances decision-making, reduces individual cognitive and physical burden, and ensures oversight at critical phases. Mentoring and proctoring are encouraged and essential in the introduction of new procedures.

This approach can reduce complications, support training, and most importantly make surgery possible for patients who might otherwise be deemed too high risk.

5. Organisational culture and team-working

We are highly trained individuals with very specialised skills working in intensely pressured situations. Healthy team dynamics relies on calm professionalism and a culture that values different opinions.

Structures and working patterns should actively encourage collaboration and team-working across all professional groups. A culture that promotes mutual respect, shared responsibility and open communication is critical to ensuring safety, supporting learning, and delivering high-quality outcomes for patients.

6. Transparency and improvement

Continuous data collection, outcome monitoring and open discussion are fundamental to progress. Sharing results, including complications and near-miss events, is vital for collective learning and ongoing improvement. Transparency also includes shared decision making with patients, including being open with data on outcomes to allow fully informed consent.

7. The role of administration and system leadership

While consultant surgeons and anaesthetists provide clinical direction and care, hospital administrations, commissioners and system leaders must ensure the necessary resources, staffing and organisational structures.

This includes job planning for safe dual consultant operating, resilient rotas, protected time for audit, education, service improvement, peer review and other core safety activities.

Job planning must be realistic, remunerated and support these essential processes.
Without these sustained commitments, our profession cannot consistently deliver the standard of safety and excellence that patients deserve.

On behalf of patients, SCTS will continue to support our members in embedding these principles to make heart, chest and lung surgery better.
 

We call on administrators and healthcare leaders to provide the structures and resources required to deliver the safest and best possible care.

By reinforcing safety nets, ensuring realistic job planning, and embracing consultant collaboration and a culture of team-working, we can ensure that our patients, including those at greatest risk, receive the best outcomes and the compassionate, expert care they deserve.

 

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