Anesthesia Spotlight: Jeffrey Cooper, PhD, and Pioneering Patient Safety in Anesthesia

Anesthesiology was the first medical specialty to champion patient safety as a specific and important focus, and Jeffrey Cooper, PhD, was a pioneering leader. Professor of anesthesia at Harvard Medical School (HMS), anesthesia faculty at Massachusetts General Hospital and founder of the Center for Medical Simulation, Dr. Cooper’s career first began in the 1970s when he led seminal research in medical errors — the first research conducted of this nature.

In 1972, Dr. Cooper joined the anesthesia bioengineering team at Mass General, a team created by former Mass General anesthesia department chair, the late Richard Kitz, MD. Through his work at Mass General, Dr. Cooper became interested in the ways that technological and human-based error impacted patient safety and sought for ways to identify and reduce risk.

“I was encouraged by supportive leadership to explore and innovate, even when it was provocative,” says Dr. Cooper. “My team and I recognized that anesthesia technology, which was relatively primitive at the time, was associated with sometimes lethal errors.”

The term “patient safety” was officially coined in 1983 by Ellison (Jeep) Pierce, Jr., MD, during his year as President of the American Society of Anesthesiologists (ASA). He and Dr. Cooper partnered to establish the Anesthesia Patient Safety Foundation (APSF), the first independent organization established to help avoid preventable adverse clinical outcomes.

In celebration of his upcoming retirement and a career marked by many accomplishments, Dr. Cooper shares more about his experience carving out “patient safety” as a new field and his efforts to incorporate it into the culture of health care.

Q: You led the team that conducted some of the first studies of human error in medicine. How did this originate?

In 1973, I was invited to a NATO-sponsored conference to present a paper about anesthesia machine human factors. At this conference, it was suggested that we study errors in the operating room using the critical incident technique (an approach to collecting qualitative information about significant incidents from those with firsthand experience). Our team then set out to gather data about those faults in order to design error-reducing technology. We did so by conducting open-ended interviews in which providers talked about things that often go wrong, technological or otherwise. We realized that there was something deeper in this area than we had initially thought.

Those studies led to the publication of our landmark paper in 1978, which disclosed some of the most frequent errors that we found in our multi-hospital studies such as breathing-circuit disconnections, inadvertent changes in gas flow, and inadequate communication among personnel. This study was an important step in launching the movement in anesthesia patient safety.

Q: What skills helped you pursue innovation in patient safety?

As an engineer at Mass General, although it wasn’t my job, I was given relatively free rein to explore the work taking place in the hospital; I was able to see things that often went unnoticed by those who were immersed in the activities. Most importantly, I worked with a smart, diverse team of colleagues, and I had an inherently curious nature that wasn’t squashed. I think there’s also possibly a neurotic element in my personality of wanting to do things that others aren’t doing. That’s gotten me into some trouble here and there but overall, I’m happy with how it’s turned out.

Q: What challenges did you experience as a pioneer in the field?

Today, it’s the norm that health care providers think about patient safety in almost every aspect of patient care, from hand hygiene to the design of buildings. There are training programs, certifications, and a large body of research dedicated to patient safety.

Because of the lack of attention on patient safety at the time, the biggest challenge was getting funding since almost no one had thought much about studying errors or safety in health care. We cobbled together enough small grants and support to do the work, but we never got big funding. Especially in the early days, I also got some pushback from a few people locally who regarded me as an engineer telling physicians what to do.

That said, I don’t think that my pursuits were nearly as challenging as they could have been had it not been for the support of our leadership. Dr. Kitz and others made all the difference by allowing me to pursue my ideas. Overall, I received great support from anesthesia providers as my work gained traction.

Q: What do you consider to be your greatest accomplishments?

I like to think that I was pivotal in catalyzing patient safety in anesthesia years before it was identified elsewhere in health care. I have no doubt that it would have happened eventually without me, but Dr. Pierce and I partnered to make it happen sooner rather than later.

I am also proud of my work launching simulation training at Mass General and the other HMS anesthesia departments. I feel good about the great culture of biomedical engineering I helped build here at Mass General and beyond. Of course, I did nothing on my own. I had great teammates and invaluable support from leadership.

Q: When you founded the Center for Medical Simulation, was there already a precedent for using simulation in patient safety efforts? What improvements has it helped to make in patient safety, both at Mass General and beyond?

In my early days working in health care, using simulation for training in intubation or resuscitation was relatively primitive and unrelated to patient safety. I was frustrated by how challenging it was to initiate a change in the patient safety culture and I thought simulation could be a useful tool to make it happen. Fortunately, several HMS anesthesia department leaders combined their resources to build the first simulation center dedicated to training and, because of my interests, patient safety. That is now the Center for Medical Simulation.

How we’re using simulation to improve the art and science of teaching in health care may be the most important influence. Although not yet fully adopted, using it in this way is now more widespread than ever and seems to be slowly changing the culture — both for how to train providers to ensure patient safety during medical procedures and for improving teamwork in many fields.

Q: What advice would you give to someone with similar career aspirations?

For me, I just did what I found interesting, different, and challenging yet possible. If you have the option, do what you love because you love it, not for money, fame, or power. Surround yourself with people who are smarter than you and who are great, ethical colleagues, as you should be also. When you fail, remember that those experiences build wisdom and strength, so long as you learn from them.

Q: What are you looking forward to in your retirement?

Fortunately, I will remain at Mass General as a non-employee to continue the patient safety and education research projects that I am working on now as well as continuing to mentor, advise on quality and safety and simulation, handle manuscripts for the simulation journal, and review others.

I am looking forward to spending more time with my wife and enjoying our shared hobbies such as dancing Argentinian tango, including in Buenos Aires. I’ve also started taking more online courses like cooking, writing, history, and art. Maybe I will get back into playing piano. Who knows what else!