What roles and qualities do anesthesiologists (medical doctors who administer anesthesia) have in teamwork?

Anesthesiologists' Roles and Qualities in Teamwork

Anesthesiologists function as critical team leaders and collaborators in perioperative care, requiring both technical expertise and strong nontechnical skills including communication, situational awareness, and the ability to coordinate multidisciplinary teams across the entire surgical episode. 1

Core Leadership Roles

Anesthesiologists serve as perioperative coordinators who extend beyond the operating room to impact the entire surgical journey. 1 The American Society of Anesthesiologists emphasizes that anesthesiologists should lead transformation of healthcare by:

• Directing preoperative optimization clinics that provide comprehensive risk assessment, including evaluation of frailty, cognitive status, cardiopulmonary function, and psychosocial factors 1
• Coordinating multidisciplinary teams comprised of surgeons, primary care providers, and specialists in shared decision-making approaches 1
• Managing postoperative care pathways including pain management, opioid stewardship, and palliative care services 1

Essential Teamwork Qualities

Communication Skills

Anesthesiologists must master closed-loop communication and participate actively in briefing sessions before critical situations. 1 The 2023 guidelines on human factors recommend:

• Pre-procedure briefings (2-4 minutes) that establish shared mental models, assign specific roles, and improve team performance while reducing adverse events 1
• Active collaboration with all team members during the surgical pause to assess high-risk situations and agree on prevention and management strategies 1
• Immediate debriefing after procedures to enhance learning and safety culture 1

Situational Awareness and Crisis Management

Each anesthesiologist should be assigned specific crisis management tasks and execute them immediately without waiting for others to act. 1 This includes:

• Developing situation awareness through cognitive aids and crisis checklists to improve quality of care 1
• Participating in regular fire drills and simulation training with the entire OR team during dedicated educational time 1
• Understanding pre-assigned responsibilities in emergency protocols, then assisting teammates once individual tasks are complete 1

Critical Pitfalls in Teamwork Perception

A major caveat exists: physicians and nurses perceive teamwork quality very differently. 2 Research shows surgeons rate collaboration with other surgeons as "high" or "very high" 85% of the time, while nurses rate their collaboration with surgeons as "high" or "very high" only 48% of the time. 2 Anesthesiologists must recognize this perception gap and actively work to bridge it through:

• Validating nurses' perspectives and acknowledging their concerns
• Using scientifically validated teamwork measurement tools rather than assuming teamwork is adequate 2
• Recognizing that excellent communication does not automatically translate to optimal patient care 3

Technical vs. Nontechnical Skills Integration

Both technical and nontechnical skills are essential, and separating them in practice may be damaging. 4, 3 Anesthesia professionals emphasize that:

• Nontechnical skills require more concentrated focus than traditionally given, especially during complex procedures like robotic-assisted surgery 4
• The start-up phase of procedures is the most demanding in terms of teamwork coordination 4
• Teams can communicate excellently while still failing to follow clinical guidelines, making integration of both skill domains critical 3

Expanded Value-Based Roles

Anesthesiologists should leverage their expertise in data analytics, risk stratification, and systems improvement to impact hospital-wide performance. 1 This includes:

• Building clinical decision support systems using perioperative domain knowledge to implement value-based care initiatives 1
• Developing risk prediction algorithms through machine learning to identify high-risk patients requiring preoperative optimization 1
• Leading performance improvement initiatives in rapid response teams, sedation services, and mechanical support programs 5

Surgeon-Anesthesiologist Dyad

The surgeon-anesthesiologist relationship is the most critical element of overall team performance. 6 A dysfunctional relationship can promote unsafe conditions and contribute to adverse outcomes, while a well-functioning relationship is conducive to safe, effective care. 6 Both professions must:

• Address negative stereotypes each has of the other
• Take deliberate actions to improve working relationships for safer patient care and greater professional satisfaction 6
• Develop joint plans for sedation levels, oxygen delivery, and risk management in high-risk procedures 1