Abstract
Medical errors are a global public health challenge, with a 10% annual incidence of adverse events, increased mortality and high costs for healthcare systems, worldwide. The Journal of Medical and Surgical Errors mission is to recognize, report, and discuss errors in a multidisciplinary approach to minimize recurrence and enhance patient safety.

By investigating the factors influencing error recurrence and effective preventive strategies, we aim to contribute to reducing preventable medical errors.

Our role extends beyond publications; it is a commitment to transformative change in approaching errors in healthcare.
We invite researchers to contribute to building a comprehensive body of knowledge that advances our understanding of errors in medicine and surgery. Together, let us shape a future where transparency, learning, and patient safety are paramount in medical practice.

Background
When I was proposed to manage the Journal of Medical and Surgical Errors (JMESE), I confess that I did not immediately agree with using the term ‘error’, feeling uncomfortable like every surgeon or physician feels when confronted with negative results of a decision-making process or procedure that he or she has put in place.

Clinicians equate errors with failure, with a breach of public trust, and with harming patients despite their mandate to “first do no harm.”
Then I went deeper, starting from the etymology of this term, which finds its Latin root in the verb “errare” meaning ‘to wander’, ‘to err’, and in realizing that ‘to err’ originates from getting lost in our decision-making process, this is where we set out to act.
Medical errors are a serious public health problem and a leading cause of death, worldwide. A systematic review found an annual incidence of adverse events of around 10%, among which 50% were found to be preventable [1]. The mortality rate following such adverse events was estimated at around 8% [2]. The most common adverse events reported in the literature are correlated to [1-4]:

• Surgical specialties;
• Medications and fluid-related;
• Healthcare-associated infections.

Recognising, reporting, discussing in a multidisciplinary approach, learning about our errors might eventually minimise the chances of a recurrent event, offering key prevention to improve patient safety.

Definitions
There is currently not an established and shared “medical/surgical error”definition.
A lack of standardized nomenclature and overlapping definitions of medical errors has hindered data analysis, synthesis, and evaluation.
In general practice, there are two major types of errors [1-5]:

1. Errors of omission occur as a result of actions not taken.
2. Errors of the commission occur as a result of the wrong action taken (active errors).

• Active errors are made by people on the front line such as clinicians and nurses. For example, operating on the wrong eye or amputating the wrong leg are classic examples of an active error.
• Latent errors occur in system or process design, faulty installation or maintenance of equipment, or ineffective organizational structure. Latent errors are basically “accidents waiting to happen.” When a latent error occurs in combination with an active human error, an event manifests in the patient. The active human error triggers the hidden latent error, resulting in an adverse event.
• A medical error is defined as the failure to complete (omission) the intended plan of action or implementing (commission) the wrong plan to achieve an aim, or deviations from the process of care, which may or may not result in an unintended harm.
• An adverse event (AE) is a harmful and negative outcome often associated with medication errors. Adverse events can be either preventable or unpreventable; only preventable AEs are attributed to medical errors.
• A negligent AE is a preventable event that fails to meet the reasonably expected standard of care of an average, qualified healthcare worker looking after a patient in question within similar circumstances.
• A noxious episode is untoward event, complication, and mishap that results from acceptable diagnostic or therapeutic measures that are deliberately instituted.
• A near miss event is a potential AE that could have caused harm but did not, either by chance or because someone or something intervened. Near misses provide opportunities for the development of preventive strategies and actions, and should receive the same level of scrutiny as adverse events.

Focusing on the main issue: the culture of blame
Errors typically occur from the convergence of multiple, environmental and human, factors. Health care professionals experience profound psychological effects such as anger, guilt, inadequacy, depression, or the loss of clinical confidence and suicide due to real or perceived errors.

Public and legislative intolerance for medical errors illustrates a lack of understanding that some errors may not, in fact, be preventable with current technologies or the resources readily available to the practitioner. The fear of punishment, disciplinary action, and job loss make healthcare professionals reluctant to report errors and share the progression of DM with their team– which duly leads to AEs.

Human factors must be studied, and identifying errors permits the undertaking of improvement strategies. In particular, blame or punishment for errors due to systemic causes neither addresses the causes nor prevents a repetition of the error.
The necessary trend is for patient safety experts to focus on improving the safety of health care systems to reduce the probability of errors and mitigate their effects rather than focus on an individual actions. Errors represent an opportunity for constructive changes and improved education in health care delivery.

Our mission
Some experts hold that the term “error” is excessively negative, antagonistic, and perpetuates a culture of blame. Many experts suggest that the term “error” should not be used at all due to its negative connotation. We believe that adverse patient outcomes may inevitably occur because of errors, and the medical community should learn to accept that errors, unfortunately, are part of our practice. Despite provider best efforts, medical error rates remain high with significant disability and death.

Most errors are preventable. Healthcare providers have the obligation to improve outcomes while reducing the risk of patient harm. Governmental, legal, and medical institutions must work collaboratively to remove the culture of blame and punishment while retaining individual accountability. When this challenge is met, health care institutions will not be constrained from measuring targets for process improvement, including all errors–even those with adverse outcomes. Preventable medical errors significantly contribute to global healthcare costs.

Van Den Bow et al estimated that the annual cost of measurable medical errors that harm patients was $17.1 billion in 2008. According to their data, pressure ulcers were the most common measurable medical error, followed by postoperative infections and by post-laminectomy syndrome [6].

Aghighi et al reported that 2 main categories of factors were identified as influential in error recurrence: human factors (fatigue, stress, inadequate knowledge) and environmental and organizational factors (ineffective management, distractions, poor teamwork). The six effective strategies for preventing error recurrence included the use of electronic systems, attention to human behaviors, proper workplace management, workplace culture, training, and teamwork [7].

Our role in contributing to limit and learn from errors to improve patient safety will occur through the following:

Exploring the delicate balance between accountability and blame, seeking to shift the narrative from punishment to a culture that encourages open reporting, acknowledging that errors can be systemic rather than individual; Investigating the emotional toll on healthcare professionals when confronted with errors is a vital component that often remains overlooked. We aim to shine light on the emotional struggles faced by physicians and surgeons, creating a safe space to share experiences, discuss coping mechanisms, and ultimately foster a supportive community prioritizing mental well-being;
Stating the environmental factors that can determine a human error and a consequent adverse event.

The World Health Organisation defines “patient safety” as “the absence of preventable harm to a patient and reduction of risk of unnecessary harm associated with health care to an acceptable minimum.” Encompassing “a framework of organized activities that creates cultures, processes, procedures, behaviours, technologies and environments in health care that consistently and sustainably lower risks, reduce the occurrence of avoidable harm, make error less likely and reduce impact of harm when it does occur.”[8]

As we embark on this groundbreaking journey, we invite researchers, practitioners, and advocates in the field of patient safety to contribute their insights, research findings, and reflections. Together, let us build a robust body of knowledge that advances our understanding of errors in medicine and surgery.

Conclusion:

The JMESE is not just a publication; it is a commitment to transforming how we approach errors in healthcare. Through collaboration and open dialogue, we aspire to drive change, improve patient outcomes, and support the dedicated professionals who work tirelessly to enhance the safety and quality of delivered care today.

Thank you for joining us on this transformative venture. Together, let us shape a future where transparency, learning, and patient safety are at the forefront of medical practice.