Introduction

Patient safety increasingly depends on health professionals' ability to deal with the technological, organisational and social complexity of their working environment.1 The operating room (OR) is such a complex dynamic environment, not just because of the increasing use of technology, such as information technology (IT), monitoring and surgical devices to assist surgical procedures,2 ,3 but also because of less obvious factors, such as an increasing number of comorbidities per patient1 and the pressure to increase productivity and efficiency.2 ,4 Although many efforts have been made over the years to improve patient safety in the OR, considerable avoidable harm to patients still occurs in the operative process.2 ,4–7

This paper starts from the assumption that supporting medical staff to deal with the increasing complexity of day-to-day OR practices will increase patient safety. This paper provides an overview of the current discussions on standardisation on the one hand, and flexibility on the other, as approaches to deal with complexity in the OR (section 2). We argue that a balance must be struck between standardisation and flexibility to ensure patient safety. More specifically, we propose to develop technological support systems based on an approach (section 3) in which standardisation and flexibility are reconciled to both reap the benefits of standardisation and maintain the ability to anticipate unexpected events. We call this adaptive support. Then we propose a stepwise approach to provide adaptive support (section 4) by: (1) ensuring high-level understanding of OR processes, (2) real-time recognition of the situation that is at hand, and (3) providing technological support accordingly. We describe how technology already provides some ways to make systems that adapt to day-to-day variability in the OR, but conclude that more work is needed to make adaptive support possible.