Time to Think Systems in Difficult Airways: ‘The SCOOP on Safety in Thyroid Surgery’ (12 December 2025)

Summary

Despite clear national guidance, patients who have complications where a difficult airway can be anticipated, continue to experience avoidable harm. This article explores the implementation gaps that contribute to this risk and highlights how systems thinking can illuminate the barriers, using post-thyroidectomy haematoma as an illustrative case.

In this case, the patient experienced a “near miss”, despite a quality improvement project related to management of this airway emergency being successfully introduced. The near miss provides an opportunity for learning. Using systems tools to analyse the case, the authors demonstrate how deeper diagnostic work can reveal complexity, latent system vulnerabilities and opportunities for more effective, sustainable interventions. Moreover, by applying a systems lens, the authors seek to show that organisations can better design, measure and monitor such patient safety initiatives to build genuine resilience.