Bring your life into FOCUS!

Nancy A. Nussmeier, MD‡ All of us make mistakes. The nature of being human is to err. John Nance, speaking at the Society of Cardiovascular Anesthesiologists (SCA) 29th Annual Meeting (April 22, 2007, Montreal, Canada) during the Flawless Operative Cardiovascular Unified Systems (FOCUS) initiative opening address noted, “although individuals may make mistakes, it is possible for teams to be flawless.” Although this concept has been embraced by other high-risk industries, notably aviation and nuclear power, it has not yet been embraced by medicine. Cockpit (crew) resource management (CRM) is a key facet of the safety culture in aviation. CRM represents a culture of safety within the entire team responsible for servicing, preparing, and flying the aircraft, and includes the concept that if anyone notes anything untoward, they are to speak up, be heard, and know that they will be taken seriously for the safety of all. It recognizes that no one individual, no matter how high their rank, is infallible. Checklists, guidelines, and standardizations are all part of CRM. Above all, teamwork through communication for a common goal, safety, is paramount. Each team member creates crosschecks through briefings, debriefings, expectations, and supervision in the overall spirit of creating a flawless outcome. Therefore, CRM is a culture, or unified human system, by which teams can operate flawlessly! FOCUS represents a progressive, revolutionary leadership initiative for the SCA. The anagram for this program was chosen carefully, because it is only through teamwork that we can be flawless. In this editorial, we summarize the vision and progress that is the FOCUS initiative. The goal of the FOCUS initiative is to substantially decrease the incidence and severity of human error in the cardiac operating room through scientific analysis leading to culture change.