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An Anesthesia Care Team Optimization Committee (ACTOC) Reached Over 200 Clinicians to Repair Trust
Overview
What was the reason for the change?
Our anesthesia care team experienced an acute trust fracture in 2019 that significantly impeded communication and collaboration. Relationships between anesthesiologists and nurse anesthetists were ice cold and patient safety became a genuine concern. An outside facilitator was brought in to mediate a 5-year recovery process.
What were we trying to accomplish?
Enhance communication and collaboration by building relationships and trust amongst anesthesia care team members.
How will we know that a change is an improvement?
Studying “culture” is difficult but not impossible. We have done numerous surveys, and comments on changes advanced by ACTOC have been overwhelmingly positive. As we move into “ACTOC 2.0” in 2025 we are pursuing IRB-approved qualitative research on surveys and comments from attendees of a newly developed teamwork and leadership workshop series.
Implementation
How long did it take to get up and running?
The first year was dedicated to remediation, and the journey was not easy. Early conversations were especially difficult, as emotions were running high. The early guidance of our facilitator was masterful and incredibly vital. After a year or so, we began to feel that we were making the jump from emotion to logic, and that a mutual understanding and respect was beginning to take root. Task forces were then implemented and given a few years’ time to implement their initiatives. We are now over 5 years removed from our trust fracture, and we have transitioned to ACTOC 2.0. We have coalesced our task forces into 3 primary efforts: a teamwork and leadership workshop series, an interprofessional Clinical Practice Optimization Committee (CPOC), and regular educational and social events under the heading of “Anesthesia Scholarly Connections” (ASC).
How was readiness assessed & required resources identified?
Readiness was assessed through a palpable and abrupt shift in trust in communication. The hospital system acknowledged that this was a threat to patient safety and stepped in to resource the ACTOC initiative primarily by funding the outside facilitator. Downstream ACTOC efforts have been jointly funded by the department chair and the VP of perioperative services.
What were the missteps and lessons learned along the way?
The primary lesson learned was that we simply could not over-communicate the ACTOC message. There were many questions early on, and regular communication via various mechanisms was vital. The primary misstep was trying to advance too quickly. We now understand that culture-change is a multi-year effort and cannot be rushed, and we have transitioned to a long-game mindset.
Solution Design
What changes can we make that will result in an improvement?
Our ACTOC team led many departmental initiatives. After our initial facilitator-led remediation, we invited more people in, dividing them into task forces. Each task force had an anesthesiologist and nurse anesthetist “co-lead” and task force members were similarly “interprofessional”. Our 4 task forces were in the domains of clinical, teamwork, educational, and scholarship. The clinical task force developed a new preoperative communication tool and also facilitated a transition to an encrypted texting system to foster more robust team discussions about patient management. The scholarship task force has now had numerous publications about our ACTOC journey. The education task force developed a “joint” journal club for anesthesiologists, nurse anesthetists, residents, and nurse anesthesia students, as well as regular “team meals” and “lunch and learn” sessions. The teamwork task force developed and now delivers a teamwork and leadership workshop series that has reached over 200 of our clinical providers in 2025, with the goal of reaching over 300 providers in this calendar year.
What was your implementation strategy and critical steps?
We do not believe that this initiative would have ever launched without the guidance of an outside facilitator. Our teams were too wounded to think that we would have succeeded on our own. Communication early on was critically important and was delivered in a variety of ways: Town hall sessions with key ACTOC leaders, regular email updates, and regular quarterly presentations in our CQI conference. It was also CRITICALLY important that the importance of this message was delivered as a non-negotiable imperative from both the chairman of our department as well as the VP of perioperative services, who later became the CEO of our hospital.
Adoption & Sustainability
How did you communicate the tactic to those affected by it?
We implemented a town-hall style forum early on, followed by regular email updates and regular ACTOC presentations at CQI conference.
How did you design for sustainability of the change?
ACTOC 2.0 is much leaner, with fewer people needed to deliver the current format. I personally deliver the teamwork and leadership workshop series, in partnership with the UAB Leadership Development Office. Our CPOC consists of 2 physicians and 1 nurse anesthetist. One of the physicians is our department’s vice chair for operations and the other is our vice chair for quality and patient safety. The nurse anesthetist leader is our hospital’s vice president of perioperative services. Our ASC leaders are volunteers, with 2 nurse anesthetists and 1 faculty anesthesiologist scheduling and delivering our educational/social events.
Evidence & References
- interprofessional communication
- teamwork
- trust
