Surgeons and astronauts share an important trait—both have chosen to work in environments that demand excellent individual and team performance. As one of the few physician astronauts in the history of space flight, David R. Williams, OC, OOnt, MSc, MD, CM, FRCS, a retired Canadian Space Agency astronaut and now president and chief executive officer of Southlake Regional Health Centre, Newmarket, ON, has devoted his professional life to forestalling death in both environments.
Dr. Williams will discuss his personal story of striving for excellence while minimizing and mitigating errors during Monday’s Martin Memorial Lecture, Personal Best: Reflections of a Physician Astronaut on Leadership and Teamwork. Dr. Williams flew two space shuttle missions and completed three spacewalks, more than any other Canadian astronaut.
“In the astronaut corps, we refer to space as a zero-fault-tolerant environment—an environment that is intolerant of error, an environment where error can have catastrophic consequences,” Dr. Williams said. “We also know that according to the 1999 Institute of Medicine report that ‘to err is human,’ and we are all human. The real question is, how do we prevent the errors we make in space or in the operating room from affecting mission success and the patient?”
Space travel, like surgery, relies heavily on teamwork and communication to manage unexpected situations, Dr. Williams said. One of the stories he will share during Monday’s lecture illustrates the point.
When the heat shield of his space shuttle was damaged by foam debris during lift off, the flight team had to quickly assess the damage and immediately began planning a spacewalk to repair the breach and allow the shuttle to survive the 20-minute, 2,000-degree inferno of reentry into the Earth’s atmosphere. Dr. Williams likens the effort to a trauma patient with a catastrophic injury in which the care team immediately begins planning an appropriate surgical approach. As in the operating room, success depends on the individual and shared expertise of the team, he said.
Coping mechanisms are also critical during space travel and in the operating room. The key is preventing a single mistake from initiating a cascade of errors that result in catastrophe. One solution is the five-second rule.
When you make a mistake in space, you have five seconds to get over it, Dr. Williams explained. You can do whatever you need to do to get over it, but five seconds later you have to be performing at your highest level to prevent further mistakes.
“The same is true in the operating room and the trauma bay,” he said. “You make a mistake and start ruminating on it—you overthink, you lose concentration, and initiate a cascade of errors. Take your five seconds, get over it, and get back to your high performance level. In space or in the operating room, it’s all about our relentless commitment to excellence.”
Dr. Williams described spaceflight as “witnessing the spectacular beauty of our planet cast against the infinite void of space.” He compared that experience to “those intraoperative moments where we flirt with perfection, where every team member seamlessly works together to achieve a remarkable outcome.”
The Martin Memorial Lecture was established in 1946 to honor Franklin H. Martin, MD, FACS, founder of the American College of Surgeons, and his wife, Isabelle Hollister Martin. The Martin Memorial Lecture is alternately nominated by the Advisory Council for Urological Surgery and the ACS Honors Committee.