Core Concept

The Fundamental Attribution Error (FAE) is a common but often overlooked cognitive bias with significant implications in surgical settings. It arises when we attribute colleagues’ errors or behaviours to personal traits or competence (e.g. “the surgeon is careless” or “the anaesthetist is incompetent”) while explaining our own errors by external circumstances (e.g. “The list was delayed because the first case was a complex obese patient and I lacked adequate assistance” or “I didn’t write in the notes because I was too busy with other patients”). Nowhere is this more evident than in poorly run M&M discussions, where the clinician under review often highlights external factors, while others focus on individual human errors.

Why It Happens in Surgery

The key issue is a failure to recognise that most imperfections or errors stem from the systems that govern the environment, rather than from inherent abilities or personal traits. In the operating theatre, pressures such as time constraints, hierarchy, ad-hoc teams, and limited awareness of colleagues’ workload, fatigue, or competing demands provide fertile ground for this bias.

Impact in the Clinical Environment

Unchecked, the FAE can directly undermine patient safety and team dynamics by:

• Creating a blame culture: Focusing on individual fault instead of system flaws deters openness, learning, and improvement.
• Damaging team cohesion: Even thinking of colleagues as “slow,” “inattentive,” “unreliable,” or “incompetent” undermines trust and erodes psychological safety.

Strategies to Mitigate FAE

1. Assume good intent – begin with the presumption that colleagues are competent and working in good faith.
2. Ask yourself structured, system-based questions such as: I)People: Was the team appropriately staffed and rested? Were roles clear? II)Tasks: Were protocols, checklists, or guidelines available and followed? (III)Environment: Was equipment functional and accessible? Were there distractions, interruptions, or time pressures? (IV)Communication: Was the handover complete? Was information shared clearly and consistently? (V)Organisation: Were scheduling, workload distribution, and support systems adequate?
3. Use of structured communication in regular face-to-face team meetings helps share context and reduce assumptions. Providing safe informal spaces, such as staff rooms where clinical teams can meet regularly over coffee, foster better understanding among colleagues.
4. Debrief with empathy – essential to an effective M&M process. Focus on what happened rather than who failed, ensuring all perspectives are heard.

Key Takeaway

When reflecting on our own shortcomings, the responsibility is twofold: to acknowledge our part honestly and to identify the system issues that contributed, so they can be addressed. Equally, when considering the errors of others, we have a duty to extend the same systems-based lens rather than defaulting to personal blame. By holding ourselves and our colleagues to this standard, we move from a culture of excuses or blame to one of shared learning and collective responsibility.