Episode #300 Pro-Social Teams: Safer, Faster, Kinder

[Duffy] “What I hope to accomplish with this project is to make those positive safety behaviors more visible, more measurable, and easier to teach. We spend a lot of time in healthcare studying errors, which is essential, but we study far less what teams do well, even though that is what patients experience most of the time.

If we can define and normalize these pro-social team behaviors, we can strengthen psychological safety, improve communication, coordination, and support a healthier perioperative culture. My hope is that this becomes a practical, scalable way for teams to improve both clinician wellbeing and patient safety at the same time.”

[Bechtel] Hello and welcome back to the Anesthesia Patient Safety Podcast. I’m your host, Alli Bechtel, anaesthesiologist and podcaster. Today, we are talking about prosocial behavior, which involves voluntary actions intended to benefit others including kindness, cooperation, and gratitude and can be a powerful tool to reduce cognitive load, improve communication, mitigate clinician burnout, improve operational resilience, and enhance patient safety. So, stay tuned.

Before we dive further into the episode today, we’d like to recognize Vertex, a major corporate supporter of APSF. Vertex has generously provided unrestricted support to further our vision that “no one shall be harmed by anesthesia care”. Thank you, Vertex – we wouldn’t be able to do all that we do without you!”

Our featured article is from the February 2026 APSF Newsletter. Our featured article is “Reduce Burnout, Improve Safety and Efficiency: Consider Prosocial Behavior” by Jeffrey Feldman and colleagues. To follow along with us, head over to APSF.org and click on the Newsletter Heading. The first one down is the current newsletter. Then, you can scroll down until you get to our featured article and I will include a link in the show notes as well.

We are so excited to talk about this article and we have exclusive content from the article authors. Let’s hear a little more from Jeffrey Feldman and why he helped write this article.

[Feldman] “ My name is Jeffrey Feldman and I am a recently retired anesthesiologist from the Children’s Hospital of Philadelphia, former board member of the Anesthesia Patient Safety Foundation, and current chair of the APSF Committee on Technology.

I wrote this article to draw attention to the potential impact of culture on team performance in the operating room. I began my career in anesthesiology more than 40 years ago and find it notable that despite the attention to safety, we continue to struggle to eliminate preventable harm.

One cannot help but notice as well the stress on providers that has led to reduced job satisfaction, burnout, and staffing shortages. The prevailing behaviors between team members in many operating rooms is impersonal and inconsistent with effective team performance. The pro-social approach is based upon scientifically validated Nobel Prize winning work by Eleanor Ostrom, and is designed to help individuals within a group develop behaviors that lead to team success.

This article is intended to highlight typical existing behaviors and the potential for improving efficiency, staff wellbeing, and patient safety through pro-social culture change.”

[Bechtel] I also asked Jeffrey what’s next for this project. Here is his response.

[Feldman] The APSF Board of Directors has identified perioperative culture as an important patient safety initiative and is funding a two-year project to investigate the impact of pro-social culture change. The project team will be led by Dr. Caoimhe Duffy and includes anesthesiologists, nurses, surgeons, and an organizational psychologist. I am very excited about this project and believe that a focus on culture will foster positive change in team performance. More importantly, I believe that a mindset of team collaboration will make the work more satisfying and enjoyable for all involved.

Stay tuned.”

Prosociality is any behavior that is oriented toward the welfare of others or one’s group as a whole. If you think about your most recent experience providing anesthesia care. Was prosociality demonstrated? Is this something that is a regular part of your day to day in the perioperative environment or is it lacking? If we step back, we see that the demand for health care services including anesthesia services continues to grow. At the same time, staffing shortages also continue. This increases the stress on our already vulnerable systems where burnout rates are high, the ability to provide services may be limited and it is difficult to achieve and sustain efficiency and patient safety targets. There is a call to action for perioperative services to use time and human resources efficiently and we need a new approach to support a stable, engaged workforce. This brings us back to prosocial behaviors which can lead to effective teamwork and greater satisfaction.

The authors provide an example for what is pretty typical operating room behavior and we think that you will agree that these typical behaviours are counterproductive to providing safe, effective, and efficient care and even to just having a nice day. Here we go:

“A surgeon has scheduled three procedures during an 8-hour block of surgical time. Two are robotic prostatectomies and one just a “short” cystoscopy case. The nursing team consists of an experienced circulating nurse and a relatively new scrub technician. The anesthesiologist is responsible for managing two operating rooms along with a CRNA in each room. The CRNA assigned to the robotic cases is an experienced traveling CRNA working for four weeks in the facility. The first patient was identified to have a difficult airway in the preoperative review the day before the procedure.

The surgeon arrives in the morning 20 minutes before the scheduled start time and tells the circulating nurse that they have to start and finish the day “on time” so she can get to a meeting with the chair of surgery. The nurse responds he has been asked to stay late all week for long cases and cannot stay late today. In addition, the same nurse is instructing the scrub tech on preparing and managing the robot and asks the anesthesia team not to bring the patient to the room until they are ready. The anesthesiologist tells the team he will be starting his other room first to reduce the time pressure when caring for the patient with the difficult airway. The patient is brought to the room almost 10 minutes after the scheduled start time and the surgeon asks why the case is starting “late.” The surgeon also questions if the fiberoptic-guided intubation will take extra time. The anesthesiologist and CRNA have not worked together previously, and it takes about 30 minutes for the patient to be anesthetized and intubated. The surgeon comments that the day will never be able to finish on time if the remaining cases take this long to get started.”

I am sure that many anesthesia professionals have experienced similar production pressure at work. When teams are working productively together, some production pressure can be helpful. But there are many counterproductive behaviours brought about by production pressure that leads to reduced efficiency, staff burnout, decreased staff retention, and avoidable patient harm. Each patient has unique needs and providing safe and effective care requires excellent teamwork. Let’s meet our team members. The primary proceduralist or surgeon, nurses, technicians, and anesthesia professionals during the procedure as well as other personnel and clinicians who help to get the patient ready for surgery, order and prepare instruments and supplies, and clean the environment. There are definitely examples of well-functioning teams who work in procedural areas. These teams likely work together regularly and develop shared expertise and camaraderie. Does this describe your team? If not, it may be that your team consists of people who may or may not know each other well and do not work together regularly. Even though these team members have the shared knowledge to complete the procedure safely and effectively, it may be difficult to coordinate efforts and collaborate and prosocial behaviours may be lacking.

Before we continue with the article, we are going to hear from another author who shares with us how this project builds on her past APSF grant and what she hopes to accomplish. Let’s take a listen now.

[Duffy] “Hi, my name is Caoimhe Duffy. I’m an anesthesiologist at the University of Pennsylvania, and my work focuses on patient safety, human factors, and teamwork, particularly in the perioperative setting.

I’ve been really fortunate to receive an A PSF Fair Mentor Training grant in 2024 that grant focused on airway safety and understanding the cognitive and behavioural strategies that clinicians use to keep patients safe during intubation. What that work taught me is that a lot of safety lives in the everyday action that clinicians take, small, proactive behaviors that help teams prepare, communicate, and adapt before harm occurs. This current pro-social project builds on that idea, but broadens it beyond just airway management to the whole perioperative team, how we identify, reinforce, and spread the behaviors that make safe care possible every day.

What I hope to accomplish with this project is to make those positive safety behaviors more visible, more measurable, and easier to teach. We spend a lot of time in healthcare studying errors, which is essential, but we study far less what teams do well, even though that is what patients experience most of the time. If we can define and normalize these pro-social team behaviors, we can strengthen psychological safety, improve communication, coordination, and support a healthier perioperative culture. My hope is that this becomes a practical, scalable way for teams to improve both clinician wellbeing and patient safety at the same time.

Thank you.”

[Bechtel] Thank you so much to Caoimhe for contributing to the show today. Let’s get back to the article. The authors remind us that enhancing procedural team performance is not a new concept. There are studies on briefings, checklists, team training, and debriefing. There is a study that found a positive correlation between team consistency and heightened efficiency for patients undergoing spinal fusion surgery. Other studies have shown that familiarity between team members improves patient safety and team collaboration. The Association of Operating Room Nurses or AORN has published a comprehensive guide that includes strategies to enhance team communication in the operating room. There are simple interventions that may have a positive impact on teamwork and patient safety such as the use of the compassionate pause as a moment of reflection for surgical teams during a time-out. Building teams that work together regularly can be challenging due to individual schedule needs, procedural block times, and the use of temporary or traveling staff.

We are almost out of time for today, but I just want to leave you with a spoiler for next week. The authors present a new model for consideration. This has not yet been applied to perioperative care, but it could be the out of the box solution that we are looking for to build collaborative working relationships. This model comes from the work of Elinor Ostrom who was awarded the 2009 Nobel Prize in Economics for her research on group collaboration. Ostrom’s work describes a set of Core Design Principles or CDPs that are common in groups of people who successfully share a common limited resource. Then, David Sloan-Wilson generalized the CDPs and applied them to understanding any group where there is a shared common goal.

Check out Table 1 in the article for a list of the Core Design Principles along with the generalized prosocial principles and the adaptive impact. The 8 Ostrom Principles include:

• Clearly defined boundaries
• Proportional equivalence of benefits and costs
• Collective choice arrangements
• Monitoring
• Graduated sanctions
• Conflict resolutions and mechanisms
• Minimal recognition of rights to organize
• And Polycentric governance.

Here are the generalized prosocial principles:

• Shared identity and purpose
• Equitable distribution of costs and benefits
• Fair and inclusive decision-making
• Monitoring agreed behaviors, which means transparency
• Graduated response to helpful and unhelpful behaviors
• Fast and fair conflict resolution
• Authority to self-govern
• And collaborative relations with other groups.

Don’t worry we’ll be back next week to talk more about these important core design principles and prosocial behaviours. Plus, we will be hearing from a couple more authors.

Thank you so much to the authors for contributing to the show and for your hard work on this project.

If you have any questions or comments from today’s show, please email us at [email protected]. Please keep in mind that the information in this show is provided for informational purposes only and does not constitute medical or legal advice. We hope that you will visit APSF.org for detailed information and check out the show notes for links to all the topics we discussed today.

That’s it for today’s episode. If this conversation sparked a thought or gave you something to take back to your practice, make sure you’re subscribed so you don’t miss future episodes. You can listen wherever you get your podcasts, and sharing the show with a colleague really helps spread the word about improving patient safety in anesthesia. Thanks for listening.

Until next time, stay vigilant so that no one shall be harmed by anesthesia care.

© 2026, The Anesthesia Patient Safety Foundation