As an anesthesiologist, I recall countless occasions when colleagues from the other side of the drape addressed me, like, “Anesthesia, did the patient receive antibiotics?” or “Anesthesia, I need more muscle relaxation here!”

Especially in my first years as a young physician full of insecurities, it intimidated me, so I never complained and only spoke up when vital.

Nowadays, I grasp the unspoken rules of the OR and can navigate the daily challenges and manage difficult situations. In the meantime, I learned to appreciate working in teams where people know and respect one another. Not only do I enjoy those days far more, but I also work less stressed and more focused — what a treat!

But it’s not only about my well-being.

Teamwork and communication are a question of patient safety

Communication and teamwork are imperative in an environment as complex, dynamic, and emotionally charged as the OR. Good teamwork decreases mistakes, improves emergency management, and boosts job satisfaction.

The opposite — poor communication and teamwork — can induce sentinel events (death, permanent and severe harm, or the need for extended care, as the statistics of the Joint Commission showed.

But working in teams can be challenging

The team in the OR is diverse and ever-changing. Team members come from various backgrounds, cultures, and education with different skills and functions. It’s common for people in the room not to know each other. Still, they must work together smoothly, even if it is for the first time. Mixing up names and roles is easy, hindering communication of dangers or concerns. Especially younger professionals may hesitate to speak up if they don’t know whom and how to address it.

The result is frustration, anxiety, decreased credibility, and communication problems. One can quickly forget that everyone in the room is in the same boat with one common goal: providing the best care for the patient.

Good communication is the foundation for seamless teamwork

Teamwork relies on the shared understanding of the circumstances, procedures, and goals. Clear communication is the only way to bring everyone to the same page.

In communication in the OR, we think all that matters is delivering parameters and information about the patient. While this is true, beyond the “what,” the “how” is equally important in conveying information successfully. We tend to underestimate how even a tiny change in the “how” can open doors (and minds). A clinical trial showed that hearing one’s own name increases brain activity (34), which can lower the threshold for accepting the information. So, how about calling one another by the name?

This simple thing can foster trust, collaboration, and better patient care.

Who is who? 

Let’s be fair; knowing the names of all our team members is quite demanding. The team changes daily, sometimes even during the day; everyone wears the same clothes and hides their faces behind masks.

An easy, cheap, and accessible solution could be using labeled surgical caps. In a study, clinicians used caps labeled with names and roles – 80 percent of the participants felt that teamwork improved significantly through using the caps.

Other ways to boost teamwork

• The WHO safety checklist provides time and space to clear all relevant pre-, intra-, and postoperative care details. The checklist also enables everyone in the room to introduce themselves, express concerns, and ask questions. Its implementation had a positive effect on morbidity and mortality all over the world.
• Smartphone applications can improve communication. In a study, team members entered closed chat groups to clarify details and share concerns about upcoming operations. Participants found this virtual heads-up user-friendly and practical. The app promoted multidisciplinary relationships and trust. The virtual huddles proved influential in complex cases, while in simple routine surgeries, the groups tended to remain passive.
• Conflict resolution courses can support young physicians in dealing with situations with tension. Anesthesiology residents who participated in such a course demonstrated better skills to de-escalate conflict situations — 14 out of 15 residents (93 percent) who took the course succeeded. In contrast, without the course, only 1 out of 5 (20 percent) managed to de-escalate potential conflicts.
• In the future, virtual reality may become an option to train communication in the OR.

Finding my voice in the OR

Even after ten years, my willingness to speak up varies daily depending on many factors like stress resistance, sleep deprivation, private issues, the mood in the OR, and yes, if I know my colleagues. On some days, I find it effortless; on others, it is overwhelming. I do it anyway. But on the bad days, my anxiety can skyrocket for the rest of the day if the reception is unfriendly.

I don’t expect miracles from any tool, but they facilitate direct and effective interactions between team members. And let’s admit every simplification counts in a complex environment like the OR. Less cognitive load, interpersonal conflict, better patient safety, and more enjoyment in the daily work —isn’t it what we all want?

We can all start today:

• Let’s communicate respectfully.
• Call one another by name.
• Establish a culture of collaboration, not hierarchy.

Zsuzsa Csik is an anesthesiologist in Brazil.