Enhancing Team Dynamics in Anesthesia: A Multidisciplinary Framework for Success

Effective perioperative team dynamics enhance the delivery of high-value care. Value-based models aim to improve outcomes with renewed focus on the multidisciplinary care team, real-time diagnostics, and enhanced clinical decision support (JAMA 2020;324:2485-6; Appl Clin Inform 2021;12:984-95). This article explores the essential elements of effective teams, identifies potential breakdowns in team function that compromise patient outcomes, and introduces innovative strategies for improvement.

What are the critical factors that enhance team dynamics in anesthesia, and how can we implement them?

Critical factors in enhancing team dynamics include clear communication, defined roles, psychological safety, and supportive leadership – all of which can be implemented through structured training and regular feedback (Am Psychol 2018;73:433-50).

Mental recall acronyms can help ease the stress on clinical care teams during demanding situations, like the Setting, Perception, Invitation, Knowledge, Emotion, Summarize (SPIKES) protocol for delivering bad news (Oncologist 2000;5:302-11). As we discuss the elements of teamwork, we provide an easy-to-remember CLEAR framework for team success.

C – Closed-loop communication: Clear methods of communicating are paramount to an effective team, where misunderstandings have grave consequences. In closed-loop communication, messages are confirmed, thereby reducing the risk of errors. Closed-loop communication can be implemented using verbal or visual confirmation. Examples of verbal confirmation include checklists for preoperative briefing and surgical timeout, additional timeouts during critical portions of the procedure, and standardized staff handoffs for breaks and shift changes (Qual Saf Health Care 2004;13:330-4). Examples of visual confirmation include color-coded reminders for medication types or doses, emergency manuals, diagrams, and monitors that display all pertinent patient information relevant to the procedure from the electronic health record. These tools help generate habits that confirm understanding and responsibility among team members (Qual Saf Health Care 2004;13:i85-90).

L – Leadership: Creating a supportive environment of trust and inclusivity is foundational for effective teamwork. Leaders of care teams should huddle with their colleagues early in a shift to identify themselves, their position, their role within the team, expectations, and important contact numbers. Leaders building dedicated teams should spend time outside of the work environment to participate in team-building activities and provide open forums for feedback. Psychological safety fosters an environment where team members feel comfortable expressing concerns and where voices are validated. Leadership training focused on active listening and responsiveness can help create an atmosphere of psychological safety where team members feel empowered to speak up. Encouraging a “see something, say something” mentality promotes innovation and collaboration (asamonitor.pub/49zsyr1).

E – Empowerment: Empowering all team members to speak up is critical to patient safety. Each team member’s input is valued regardless of their role or rank; this fosters an atmosphere where everyone feels comfortable sharing insights and raising concerns. Clinicians can adopt the “two-challenge rule,” which encourages team members to raise any concerns at least twice if they feel an issue has not been adequately addressed (Cochrane Database Syst Rev 2017;6:CD000072). Regular debriefings after procedures can also help reinforce this empowerment by allowing team members to reflect on what went well and what can be improved.

A – Accountability: Clarity in role definition is vital for successful perioperative outcomes. When team members understand their responsibilities, the likelihood of successful patient outcomes increases. Anticipating events using structured preprocedure briefings and checklists can help clearly define roles. Taking a few moments at the beginning of an event to clearly define roles ensures a smooth team-centric and task-based mindset. Regular feedback sessions during a structured debrief, where team members discuss accountability and peer support programs, can also help build a culture of reliability (Front Psychiatry 2023;14:1078797).

R – Resilience: Anesthesia teams often operate within a range of clinical locations with defined supervision structures. Recognizing diverse perspectives enhances engagement and performance. By creating a nonpunitive environment where input is valued and actively solicited, we can encourage all team members to share their insights regardless of position (Administrative Science Quarterly 1999;44:350-83). Simulation and regular training sessions mirror complex, high-stress scenarios that help teams maintain focus under pressure and adapt to quickly changing clinical environments. High-fidelity simulations such as escape rooms are emerging to enhance team training.

Evolution of the team concept and potential breakdowns

Despite advancements, communication breakdowns and unclear roles continue to pose significant challenges (asamonitor.pub/49zsyr1). Identifying and addressing these issues are essential for continuous improvement. Conducting regular team assessments, utilizing surveys, and engaging in debriefing sessions can help determine areas for improvement and promote accountability. The new Institute for Healthcare Improvement Root Cause Analysis and Actions curriculum discusses these methods in detail (asamonitor.pub/3CeNF6U).

To effectively evolve and support a team approach to care, programs can consider the following practical strategies:

1. Interdisciplinary training modules: Develop curriculum components that involve professionals from various disciplines to participate in joint training sessions. This can include case-based learning where teams collaborate to manage complex clinical scenarios and share expertise.
2. Simulation-based exercises: Utilize simulation centers to conduct interdisciplinary simulations that mimic real-life situations. These exercises can help teams practice communication, decision-making, and crisis management in a safe environment.
3. Regular team meetings: Establish routine touchpoints for teams to discuss patient care, share insights, and foster a culture of open communication. This practice can enhance understanding of each team member’s role and promote collaborative problem-solving. It is especially useful at the beginning or end of a day.
4. Mentorship programs: Pair trainees and inexperienced staff with mentors from different specialties to encourage cross-disciplinary learning and support professional development. Mentorship can help bridge knowledge gaps and build stronger interprofessional relationships.
5. Feedback mechanisms and teamwork evaluation: Create structured feedback processes that allow team members to evaluate each other’s contributions during training exercises and after real-time events. This can help identify areas for improvement and reinforce collaborative behaviors.
6. New programs that encourage team support, action plans, and psychological safety: The Institute for Healthcare Improvement has just revised its root cause analysis process to include action plan development. This root-cause analysis process illustrates how teamwork can be enhanced in safety event reviews. The emphasis on multidisciplinary collaboration in root-cause analysis processes can be applied in our practices to enhance learning from safety events and prevent recurrence.

TeamSTEPPS and its five domains

For institutions wishing to explore a more in-depth look at team dynamics, the TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) curriculum provides a framework that includes Communication, Team Leadership, Situation Monitoring, and Mutual Support (asamonitor.pub/49zsyr1). By incorporating TeamSTEPPS training into onboarding processes and ongoing education, these principles become part of daily operations. Available through the Agency for Healthcare Research and Quality, this curriculum offers implementation strategies, pocket guides, handoff examples and mnemonics, and steps to shift toward a culture of safety.

Simulating teamwork: Escape rooms and qualitative simulations in education

Innovative training methods, such as escape room simulations, offer health care teams valuable opportunities to practice collaboration under pressure (Future Healthc J 2020;7:112-5; J Patient Saf Risk Manag 2021;26:126-34; Med Teach 2022;44:366-71). Escape rooms may be particularly effective because they engage participants in a hands-on, dynamic environment where they must rely on one another’s expertise. For example, an escape room might involve clinical scenarios where participants must use medical knowledge and procedural steps to “escape” by solving sequential medical or diagnostic puzzles. These scenarios can reinforce clinical knowledge while strengthening interprofessional collaboration and adaptability under pressure.

Integrating simulations into routine training sessions can provide practical, hands-on experiences that reinforce teamwork and communication skills. Several opportunities for these simulations align with current multidisciplinary drills for malignant hyperthermia, fire, and local anesthetic toxicity, and can be expanded to include code blue, airway emergencies, and other rare scenarios with high patient mortality.

The effectiveness of multidisciplinary anesthesia teams relies on cultivating a culture that values communication and psychological safety. The CLEAR framework serves as a practical guide for optimizing team dynamics in the evolving field of anesthesiology. By regularly reviewing our practices, seeking feedback, and being open to new ideas, we can ensure our teams remain responsive and effective in delivering high-quality care.