Trust between surgeons and anesthesiologists: Developing and implementing a qualitative method to identify keys to relationship and teamwork success

May Pian-Smith, MD, MSMay Pian-Smith, MD, MS
Associate Professor of Anesthesia, Critical Care and Pain Medicine
Massachusetts General Hospital
Harvard Medical School

Dr. Pian-Smiths’ Clinical Research submission is entitled: “Trust between surgeons and anesthesiologists: developing and implementing a qualitative method to identify keys to relationship and teamwork success.”

Background: Work in the operating room (OR) is characteristically complex and requires that skilled workers are both independent and interdependent. The Institute of Medicine (IOM) has called for increased trust, respect and transparency in communication to improve the quality of care. The important impact of the surgeon-anesthesiologist dyad to set the tone for collaboration in the OR has been highlighted by Dr. Cooper in his recent publication in the APSF newsletter. 1 According to relational coordination theory, colleagues can collaborate best when there is high-quality communication (frequent, timely, accurate and problem-solving), which is enhanced by high-quality relationships (shared goals, shared knowledge and mutual respect).2

This project is intended to gather pilot data for further study. Lingard and others have described observations of the differing perspectives between members of the OR team, but with no specific focus of that between surgeons and anesthesiologists. 3 Katz has written about conflict in the OR and how to manage it, but without empirical data of the type we are proposing to gather.4

Aims: We will build on the qualitative interview-based methodology used by Dr. Cooper in his Critical Incident studies5 to answer the following questions: What are key behaviors between individual anesthesiologists and surgeons that facilitate trust and collaboration or create barriers to trust and collaboration during perioperative care? Are there differences in the personal relationships between anesthesiologists and surgeons, including their perspectives and preferences, based on sex, practice setting or whether teams are “dynamic” vs. “intact”? Are there specialty-identities and assumptions or stereotypes that individual anesthesiologists and surgeons hold toward their counterparts that may help or interfere with an effective, patient-safe working relationship?

Implications: We do not know the incidence of poor outcomes in the OR that are precipitated specifically by poor interactions between anesthesiologists and surgeons. Personal anecdotes about the OR and published studies on ICU interactions suggest the incidence of conflict is significant and that this is an important area for study and improvement. Studies have shown that optimizing teamwork has impact on the patient experience, and improving quality outcomes (such as length of hospital stay, and mitigating harm from errors and intraoperative adverse events). Improved relationships can enhance worker resilience, support joy and meaning in the workplace and decrease the costs of workforce turnover.

This will be the first study to identify behaviors and characteristics that can engender “trust” across surgeon and anesthesiologist role-groups during perioperative care. This information will be important for defining professionalism within both specialties and will impact training methods and content. The results can inform and improve interdisciplinary and interprofessional team-training aimed at improving patient safety outcomes. Key behaviors can also be incorporated into a novel assessment tool of non-technical skills of OR personnel and such tools can subsequently be used to link observed behaviors with real patient clinical outcomes.

Funding: $149,601 (January 1, 2021- December 31, 2022) This grant was designated the APSF/ASA 2021 President’s Research Award.


  1. Cooper JB. Healthy relationships between anesthesia professionals and surgeons are vital to patient safety. APSF newsletter, 2020, 35:8-9.
  2. Gittell JH, Weinberg DB, Pfefferle S, et al. Impact of relatinal coordination on job satisfaction and quality outtcomes: A study of nursing homes. Human Resource Management Journal. 2001. 18(2): 154-170.
  3. Lingard L, Espin S, Whyte S, et al. Communication failures in the operating room: An observational classification of recurrent types and effects. BMJ Qual Saf. 2004, 13(5):330-334.
  4. Katz JD. Conflict and its resolution in the operating room. J Clin Anesth. 2007, 19: 152-158.
  5. Cooper JB, Newbower RS, Long CD, et al. Preventable anesthesia mishaps- A human factors study. Anesthesiology. 1978, 49:399-406.