Michael Vitale, Chief of Pediatric Spine Surgery at Columbia, joins me to talk about one thing: how to make surgery safer.

We walk through why he became obsessed with safety, and how high-stakes spine surgery forced a rethink of teams, errors, and systems under pressure.

We break down core principles: planning, standardization, human factors, checklists that actually work, and psychological safety in the OR.

We talk innovation: navigation, robotics, AR—how to adopt new tech without creating new failure modes.

Finally, we discuss metrics, outcomes, and performance measures, and why the future of quality in orthopedics depends on transparency, benchmarking, and shared learning.