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OBJECTIVE(S): The relationship of surgeons’ behavior to clinical outcomes has not been adequately studied. This report presents data that identifies deficiencies in surgeons’ behavioral practice patterns - elements of care that require more diligence and time than knowledge and skill to accomplish tasks instead of feats - that cause bad outcomes in spite of sound medical knowledge and technical skill.
METHODS: Standardized data were collected from closed general surgery claims from five professional liability insurers. One company provided national coverage; the others provided coverage in the mid-west, northeast, southeast, and west coast regions of the country. Between April 2004 and February 2006, 40 board-certified surgeons reviewed 460 closed claims that exceeded ,000 and that were closed during 2003 and 2004. In addition to the standardized data, each claim-review included a narrative. The data were reconciled and statistically analyzed.
RESULTS: Failures in behavioral practice patterns occurred in 78% of the cases and were frequently responsible for causing or escalating preventable injuries. When behavioral practice violations and technical misadventures occurred together, care was more likely to be classified as unsatisfactory and complications preventable than if a technical misadventure occurred in the absence of behavioral practices violations. Among several flawed behavioral practices, failures to communicate were especially pervasive.
CONCLUSIONS: Medical organizations and other health care policymakers should focus on physician behavior in crafting shifts in institutional cultures, in targeting new CME toward behavioral patterns of care, and developing evidenced-based behavioral practices.

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