Authors: Feldman J et al.
Anesthesia Patient Safety Foundation Newsletter, volume 41, number 1, February 2026.
Summary
This article explores prosocial behavior as a practical and underutilized strategy for reducing clinician burnout while simultaneously improving patient safety and operational efficiency in perioperative environments. Prosocial behaviors are defined as voluntary actions intended to benefit others or the group as a whole, including cooperation, kindness, gratitude, respectful communication, and shared problem-solving.
The authors frame the discussion within the context of mounting pressures on perioperative services, including staffing shortages, growing clinical demand, production pressure, and rising burnout. These forces place significant cognitive and emotional strain on clinicians, impair teamwork, and increase the risk of inefficiency and patient harm. While traditional interventions such as checklists, briefings, and team training offer some benefit, they do not fully address the cultural dynamics that undermine collaboration.
Using a realistic operating room vignette, the article illustrates how production pressure and hierarchical behaviors can erode team function, increase tension, and compromise both efficiency and safety. The authors emphasize that procedural care is inherently team-based, often involving individuals who may not regularly work together. In such environments, prosocial behaviors become essential for building trust and enabling effective coordination.
The article introduces a conceptual framework rooted in the work of Elinor Ostrom and further developed through behavioral science, outlining Core Design Principles that characterize successful collaborative groups. These principles include shared identity and purpose, equitable distribution of costs and benefits, inclusive decision-making, transparent monitoring of behaviors, fair conflict resolution, and the authority for teams to self-organize. When applied to perioperative teams, these principles reveal common gaps that limit performance and contribute to burnout.
Acceptance and Commitment Training is presented as a validated method to operationalize prosocial change. ACT focuses on increasing psychological flexibility, helping individuals recognize unhelpful behaviors driven by stress or coercive pressures and replacing them with behaviors aligned with shared goals. The ACT Matrix is described as a practical tool for analyzing team behaviors and guiding both individual and organizational cultural change.
The authors conclude by describing a future-state perioperative environment in which prosocial behaviors are embedded into routine practice. In this model, proactive communication, mutual recognition of pressures, inclusive decision-making, and expressions of appreciation become standard. Such a culture supports efficient workflow, enhances job satisfaction, reduces burnout, and strengthens patient safety. The authors argue that while cultural transformation is challenging, the current workforce crisis and efficiency demands make prosocial change both necessary and timely.
Key Points
Burnout, staffing shortages, and production pressure threaten perioperative safety and efficiency
Prosocial behaviors promote collaboration, reduce cognitive load, and improve team performance
Procedural care relies on effective teamwork among individuals who may not regularly work together
Traditional interventions alone are insufficient without addressing underlying cultural behaviors
Core Design Principles provide a framework for building effective and resilient teams
Acceptance and Commitment Training offers a validated approach to fostering prosocial behavior
Embedding prosocial culture can improve staff well-being, retention, efficiency, and patient safety
Thank you to the Anesthesia Patient Safety Foundation for allowing us to summarize and share this important APSF Newsletter article focused on burnout, teamwork, and patient safety.