behavior of senior surgeons is often a factor," writes Nancy Berlinger,
PhD, and Elizabeth Dietz in the AMA Journal of Ethics.
If nurses or staff express a concern during the time-out, but don't
think that the surgeon is taking their concerns seriously, they may
stop expressing these concerns, add Dr. Berlinger and Ms. Dietz.
"The surgical time-out is a strategy that, in part, is designed to sup-
port personnel often seen by some as subordinates — such as nurses,
students and resident physicians — in their roles in maintaining
patient safety, as well as to prevent harm by compensating for difficul-
ty of speaking up in hierarchical environments and challenging one's
own supervisor or other superior in those environments."
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