Introduction
Anesthesiologists are required to maintain close communication with surgeons, nurses, and operating room technicians across multiple critical stages, including preoperative assessment, intraoperative management, and postoperative analgesia
[1,2]. However, because patients’ conditions are often complex and dynamic, and surgical workflows are usually intensive and time-sensitive, information asymmetry and overlapping roles frequently occur. These factors may lead to friction in interprofessional collaboration. Without an effective mechanism for communication and coordination, such friction may rapidly escalate into high-intensity conflicts, thereby posing potential risks to patient safety and the reputation of the department.
In addition, the traditional vertical command structure in the Department of Anesthesiology has several limitations in coordinating horizontal relationships, such as a single communication pathway, unclear role boundaries, and overly layered decision-making processes. When unexpected events occur, team members may find it difficult to reach consensus within a limited time, which may result in missed opportunities for timely intervention. Therefore, exploring a more inclusive and transparent team governance model is of great significance for improving collaborative efficiency in the Department of Anesthesiology and ensuring patient safety
[3].
1 Materials and Methods
1.1 General Information
This was a single-center departmental quality improvement study using an uncontrolled pre–post intervention design
[4]. Based on the management practices of the Department of Anesthesiology in our hospital and the operational management experience of anesthesiology departments in several large general hospitals, the research team designed and developed a progressive team-based intervention program around four core components: shared mission, process clarification, psychological safety, and continuous feedback. The program was implemented for 6 months in the Department of Anesthesiology, West Branch of The First Affiliated Hospital of University of Science and Technology of China.
The baseline observation period was January 1 to June 30, 2025. The 6-month intervention was implemented from July 1 to December 31, 2025. During the study period, no other work-related policies were introduced in the department. No apparent workload-related influence on the study outcomes was noted.
Surgical cases were eligible if they involved operative procedures managed by the Department of Anesthesiology during the baseline or post-intervention observation period and had anesthesia and perioperative records sufficient for outcome assessment. Cancelled operations, non-surgical anesthesia procedures, and cases missing essential outcome information were excluded. Duplicate records referring to the same operation were removed. Each surgical procedure was treated as one case and classified once as having or not having at least one perioperative adverse event.
Staff were eligible for the questionnaire evaluation if they were anesthesiologists or nursing staff with direct perioperative clinical responsibilities, worked in the department during both assessment periods, participated in the intervention, and voluntarily completed both questionnaire assessments. Staff who were temporarily rotating through the department, were unavailable for either assessment, or did not provide complete and matchable pre-intervention and post-intervention questionnaires were excluded from the paired analysis. Of the 42 departmental staff members, 30 met these eligibility and questionnaire-completion criteria and were included in the analysis.
A total of 105 conflict events were recorded during the same period, including 9 high-severity conflict events. In addition, 120 postoperative anesthesia patients were selected for the satisfaction survey, including 60 patients before the intervention and 60 patients after the intervention.
1.2 Current Status of the Anesthesiology Team and Analysis of Conflict Types and Causes
This study was based on the routine operational management practices of the Department of Anesthesiology, West Branch of The First Affiliated Hospital of University of Science and Technology of China. A systematic review was conducted of key work processes, including surgical scheduling, anesthesia implementation, intraoperative collaboration, emergency and critical care rescue, postoperative recovery handover, and adverse event reporting. The research team classified and analyzed 105 team conflict events recorded during the study period by combining departmental management records, work meeting minutes, conflict event registration data, and feedback from team members. This analysis aimed to clarify the main types, causes, and subsequent intervention priorities of team conflicts in the Department of Anesthesiology.
The Department of Anesthesiology in our hospital currently has 42 medical and nursing staff members and completes more than 15,000 anesthesia cases annually, almost all of which are anesthesia for tumor surgery. Elderly patients and patients with underlying diseases account for more than 70% of cases. Because patients with tumors often have complex conditions and are frequently complicated by cardiopulmonary dysfunction, malnutrition, anemia, coagulation abnormalities, and other problems, higher requirements are placed on anesthesia risk assessment, intraoperative vital sign management, and postoperative recovery monitoring.
Meanwhile, the daily operation of the department involves multiple operating rooms running in parallel, tight surgical turnover, interspersed emergency surgeries, rescue of critically ill patients, and temporary adjustment of anesthesia plans. Team members are required to complete information judgment, resource allocation, and role assignment within a limited time. When communication pathways are ineffective, role boundaries are unclear, or resource coordination is insufficient, delays in collaboration and team friction may easily occur, thereby affecting patient safety and surgical operational efficiency.
According to the conflict event registration data, the 105 conflict events were mainly classified into four categories: resource allocation conflicts, information transmission conflicts, role boundary conflicts, and value orientation conflicts. Among them, information transmission conflicts and role boundary conflicts accounted for relatively high proportions, indicating that the main problems in anesthesiology team collaboration were concentrated in insufficient closed-loop communication at key nodes, unclear division of responsibilities, and poor coordination among multiple positions. The specific classification and causes are shown in Table 1.
Resource allocation conflicts mostly occurred when multiple operating rooms were running simultaneously, emergency surgeries were inserted unexpectedly, or complex oncological surgeries were scheduled intensively. These conflicts were mainly related to overlapping demands for key resources, including ultrasound machines, video laryngoscopes, fiberoptic bronchoscopes, depth-of-anesthesia monitoring devices, and post-anesthesia recovery beds. In the absence of clear rules for equipment reservation, allocation, and prioritization, problems such as waiting for equipment, poor communication during temporary borrowing, and delayed coordination during recovery transfer may easily arise.
Information transmission conflicts were mainly concentrated at key perioperative nodes, including preoperative risk assessment, adjustment of anesthesia plans, management of special intraoperative situations, postoperative analgesia plans, and recovery handover. Because perioperative collaboration involves multiple roles, including anesthesiologists, surgeons, operating room nurses, anesthesia nurses, post-anesthesia care unit staff, and ward medical and nursing staff, the information transmission chain is relatively long. If key risk information is not synchronized in a timely manner, it may lead to insufficient nursing preparation, deviations in surgical cooperation, omissions during recovery handover, or unclear priorities for subsequent ward observation.
Role boundary conflicts mainly occurred during major oncological surgeries, prolonged procedures, surgeries involving critically ill older patients, and emergency rescue situations. Anesthesiologists, anesthesia nurses, and circulating operating room nurses need to collaborate across multiple tasks, including patient positioning, temperature management, fluid management, intake and output monitoring, intraoperative medication verification, preparation of rescue drugs, and recovery transfer. If job responsibilities and reporting pathways are not clearly defined, duplicated work, responsibility gaps, or temporary avoidance of responsibility may occur, thereby reducing the efficiency of team collaboration.
Value orientation conflicts were mainly reflected in differences between surgical turnover efficiency and patient safety assurance. In our hospital, the surgical volume is high, and surgical continuity and turnover efficiency directly affect patient waiting time and operating room efficiency. However, because patients with tumors often have poor baseline conditions and high perioperative risks, the anesthesia team must also attach great importance to safety checks, risk assessment, intraoperative monitoring, and the quality of postoperative recovery. When efficiency requirements and safety requirements are not fully communicated and balanced, disagreements may arise during surgical turnover, preparation for anesthesia induction, intraoperative risk management, recovery transfer, and postoperative analgesia management.
Taken together, team conflicts in the Department of Anesthesiology in our hospital were not caused by a single event. Rather, they resulted from the combined effects of complex conditions among patients in an oncology specialty hospital, tight surgical workflows, long chains of multidisciplinary collaboration, concentrated demands for key resources, and the coexistence of efficiency and safety goals. These findings suggest that team management in the Department of Anesthesiology should not rely solely on experience-based coordination or administrative instructions. Instead, from the perspective of organizational behavior, targeted measures should be adopted according to the main causes of conflict, including shared mission building, RACI-based process clarification, dual-channel communication, psychological safety development, and graded conflict intervention. These measures may help shift team conflict management from “post-event conflict resolution” toward “pre-event prevention and process control.”
1.3 Construction of Anesthesiology Team Cohesion and Management Strategies
1.3.1 Theoretical Basis
(1) Team development stage theory: According to Tuckman’s model of team development, teams go through several stages during their formation, among which the storming stage is inevitable
[5]. At this stage, if internal conflicts within the team are handled positively, tensions can be effectively alleviated and the team can be accelerated toward the norming stage. Active management during this period is essential for the long-term stability and efficient functioning of the team.
(2) Psychological safety: Edmondson’s research indicates that, in high-risk work environments, psychological safety among team members is one of the key factors for successful collaboration
[6]. Only when members feel safe enough to express their views and concerns can potential problems be identified and addressed in a timely manner. Psychological safety not only promotes internal team communication but also strengthens members’ sense of belonging and responsibility.
(3) Conflict management model: The Thomas–Kilmann model provides five conflict-handling strategies: competing, avoiding, compromising, accommodating, and collaborating. This model emphasizes that conflict management strategies should be flexibly selected according to the specific context
[7]. Different types of conflicts and team environments require different responses; therefore, contextual adaptability is central to effective conflict management.
(4) Organizational support theory: Organizational support theory suggests that team cohesion and responsibility depend not only on interactions among team members but also on the resources and emotional support provided by the organization. Adequate resource support ensures efficient team operation, whereas emotional support enhances members’ sense of belonging and loyalty. The combination of both can substantially improve team cohesion and overall performance
[8].
1.3.2 Enhancement of Team Cohesion
(1) Building a shared mission: “Patient safety roundtable” meetings were organized, inviting members at different levels in the Department of Anesthesiology, including anesthesiologists, nurses, and technicians, to discuss typical cases and jointly develop surgical safety goals. In this way, abstract slogans were transformed into specific action principles, with the aim of clarifying each member’s responsibilities and the shared goals of the team. The development of a shared mission was intended to strengthen team members’ sense of belonging and responsibility and provide a shared foundation for team collaboration.
(2) Process clarification: The RACI method, namely Responsible, Accountable, Consulted, and Informed, was used to review key work processes in the Department of Anesthesiology and clarify the responsible person, decision-maker, consulted person, and informed person for each step. These responsibility assignments were publicly released to ensure that team members clearly understood the scope of their duties and to avoid work gaps caused by the assumption that “someone else will do it.” Process clarification was intended to help the team operate more efficiently and reduce conflicts and misunderstandings caused by unclear responsibilities.
(3) Establishing dual-channel communication:
First, a technical channel was established. The electronic medical record system was used to achieve real-time linkage and integration of information. Through this system, anesthesiologists could promptly record key information such as adjustments to anesthesia plans and changes in patients’ vital signs, while ensuring that such information was transmitted in real time to other relevant medical staff, including surgeons and nurses. The establishment of this technical channel was intended to reduce delays and errors in information transmission.
Second, an emotional communication channel was established. A 15-minute standing meeting was arranged each week to provide team members with a platform for candid feedback and emotional communication. During the meeting, members could share difficulties, stress, and suggestions encountered at work, with the aim of promoting mutual understanding and support within the team. This regular emotional communication was intended to relieve work-related stress and strengthen team cohesion.
1.3.3 Graded Conflict Intervention
A “conflict thermometer” tool was introduced to assess conflict intensity through anonymous scoring. For high-intensity conflicts, a third-party mediation mechanism was introduced, with professional mediators helping both parties analyze the problem rationally and identify possible solutions. For low-intensity conflicts, guided dialogue was adopted to encourage the parties involved to repair relationships through self-reflection and communication. This graded intervention strategy was intended to manage serious conflicts and promote team members’ ability to resolve minor conflicts independently, thereby supporting team harmony.
To strengthen psychological safety, a “no-blame discussion” system was established, in which errors were regarded as opportunities for improvement rather than tools for accountability. When medical errors or deviations occurred, team members could jointly analyze the causes and propose improvement measures in a no-blame atmosphere, with the aim of reducing the likelihood of concealing errors due to fear of punishment. In addition, points-based rewards were provided to members who actively identified problems and offered constructive suggestions, encouraging team members to participate proactively in problem detection and quality improvement. The development of psychological safety was intended to enhance team members’ confidence and initiative and promote continuous team improvement and development.
1.3.4 Implementation Pathway
The project was implemented in three stages. Each stage had clear objectives and specific tasks to ensure the effective implementation and continuous advancement of the strategies.
Stage I: Basic construction and mission consensus, 0–1 month.
First, a responsibility matrix was developed. Through team collaboration, a detailed responsibility matrix was drawn up to clarify the duties, authority, and collaborative relationships of each position. This process was intended to help team members clearly understand their work scope and role positioning and reduce conflicts caused by unclear responsibilities.
Second, the shared mission was released. A “patient safety roundtable” meeting was organized, inviting all members of the Department of Anesthesiology to participate in discussions around surgical safety goals and to form a shared mission for the team. By releasing the shared mission, abstract goals were transformed into specific action principles, with the aim of strengthening team members’ sense of belonging and responsibility.
Stage II: Communication optimization and continuous improvement, 2–5 months.
First, the dual-channel communication platform was officially launched, including both the technical channel and the emotional communication channel. The technical channel achieved real-time linkage and integration of information through the electronic medical record system, ensuring that key information could be promptly transmitted to all relevant personnel. The emotional communication channel provided a platform for candid feedback and emotional exchange through a weekly 15-minute standing meeting, with the aim of promoting mutual understanding and support within the team.
Second, short-cycle Plan–Do–Check–Act (PDCA) reviews were introduced. A short-cycle PDCA mechanism was used to regularly review team workflows and collaboration. Through this mechanism, the team could identify problems in a timely manner, analyze their causes, and implement improvement measures, with the aim of supporting continuous optimization and progress.
Stage III: Strategy adjustment and comprehensive promotion, 6 months.
First, intervention strategies were adjusted. Based on data collected through the “conflict thermometer,” the types and intensity of conflicts were analyzed, and conflict intervention strategies were dynamically adjusted. For high-intensity conflicts, the third-party mediation mechanism continued to be optimized. For low-intensity conflicts, the guided dialogue process was further improved to encourage team members to resolve problems independently.
Second, standard operating procedures (SOPs) were improved and promoted. Based on the practical experience gained in the first two stages, SOPs for the Department of Anesthesiology were refined to ensure that each step had clear operational standards and quality requirements. These SOPs were then promoted to subspecialty teams to ensure a unified and efficient collaboration model throughout the department.
1.4 Expected Evaluation Methods
To ensure the scientific rigor and objectivity of the project evaluation, this study adopted multiple evaluation methods to comprehensively assess changes associated with the project from several dimensions. The main evaluation indicators were as follows.
(1) Improvement in team cohesion
The evaluation indicator was an increase of at least 15% in the mean score of the self-developed 15-item team cohesion questionnaire, ICS-15. Before and after the implementation of the project, team members were surveyed using the ICS-15, which was developed within the department for this local evaluation. The changes in team cohesion were evaluated by comparing the results of the two surveys.
(2) Conflict management outcomes
Conflict management was assessed using conflict resolution duration, with separate analyses for all recorded conflicts and the high-severity subgroup. Conflict severity referred to the degree of interpersonal escalation, communication breakdown, and disruption of clinical cooperation associated with a disagreement. Lower-severity conflicts involved disagreements that could be addressed through clarification and guided dialogue. High-severity conflicts involved substantial escalation or disruption of cooperation requiring third-party mediation or managerial involvement. The term “high-severity” was used consistently throughout the manuscript. The conflict thermometer was a locally developed management tool used to obtain anonymous ratings of perceived conflict severity on a numerical scale from 0 to 10, with 0 indicating no conflict and 10 indicating the most severe conflict imaginable. Scores of 1–3 indicated low severity, 4–6 moderate severity, and 7–10 high severity. Ratings supported the selection of guided dialogue or third-party mediation.
(3) Patient safety outcomes
Patient safety was assessed using the incidence of perioperative adverse events, defined as documented harmful clinical occurrences associated with anesthesia or perioperative care, including anesthesia-related adverse reactions and postoperative complications. Events were identified from anesthesia records, the hospital information system, and adverse event reports.
Each surgical procedure was classified once as having or not having at least one adverse event, regardless of the number of events recorded for that procedure. The adverse event rate was calculated as the number of surgical cases with at least one event divided by the total number of included surgical cases in each observation period. Rates were compared between the baseline and post-intervention periods to assess changes in recorded patient safety outcomes associated with project implementation.
(4) Improvement in team members’ work engagement
The evaluation indicator was a continuous increase in team members’ work engagement. Electronic surveys were conducted regularly among team members using the nine-item Utrecht Work Engagement Scale (UWES-9)
[9,10]. The scale assesses vigor, dedication, and absorption, with three items per dimension. Items are scored from 0 (never) to 6 (every day); the overall score is the mean of the nine items and ranges from 0 to 6, with higher scores indicating greater work engagement. In addition, one-on-one interviews were conducted to gain deeper insight into team members’ work experiences and suggestions for improvement. Quantitative and qualitative data were cross-validated to ensure the objectivity and accuracy of the evaluation results.
(5) Improvement in anesthesia patient satisfaction
A self-developed anesthesia patient satisfaction questionnaire was used in this study. The questionnaire included five dimensions: preoperative visit and communication, anesthesia service attitude and humanistic care, anesthesia procedures and pain experience, intraoperative comfort and safety assurance, and postoperative recovery follow-up and adverse reaction management. The questionnaire contained 20 items in total. Each item was rated on a 5-point Likert scale, ranging from 1, indicating very dissatisfied, to 5, indicating very satisfied. The total score ranged from 20 to 100, with higher scores indicating greater satisfaction with anesthesia services. Questionnaires were administered to patients before and after implementation of the intervention. Differences in dimension scores and total scores before and after the intervention were compared to evaluate improvement in anesthesia patient satisfaction.
(6) Sources of evaluation data
First, data were extracted from the information system. The hospital’s existing information system was used to automatically collect data related to patient safety, conflict management, and team collaboration, ensuring the timeliness and accuracy of the data.
Second, electronic surveys were conducted. Electronic questionnaires were regularly sent to team members to collect feedback on team cohesion, work engagement, and job satisfaction.
Third, interviews were conducted. One-on-one interviews were used to gain deeper insight into team members’ actual experiences and suggestions for improvement, providing richer contextual information for the evaluation results.
Through these diversified evaluation methods, changes associated with project implementation could be assessed from several perspectives. This uncontrolled evaluation could not establish whether the intervention caused changes in team collaboration or patient safety.
1.5 Statistical Analysis
Statistical analysis was performed using SPSS 23.0. Continuous variables that conformed to a normal distribution were expressed as mean ± standard deviation ( ± s). Paired t-tests were used to compare team cohesion and work engagement scores before and after the intervention among team members. Independent-samples t-tests were used to compare patient satisfaction scores between patients surveyed before and after the intervention.
For the duration of conflict resolution, independent-samples t-tests or non-parametric rank-sum tests were used according to the data distribution. Categorical variables were expressed as frequencies and percentages. Between-group comparisons were performed using the χ2 test, continuity-corrected χ2 test, or Fisher’s exact test, as appropriate. For perioperative adverse events, both the uncorrected Pearson χ2 test and the two-sided Fisher’s exact test were reported, and interpretation accounted for the small event count and differences between the tests. A P value < 0.05 was considered statistically significant.
2 Results
2.1 Comparison of Team Cohesion and Work Engagement Scores
Before and after implementation of the intervention, anonymous questionnaire surveys were conducted among 30 members of the Department of Anesthesiology using the self-developed 15-item team cohesion questionnaire (ICS-15) and the UWES-9. The differences in ICS-15 scores and work engagement scores before and after the intervention were statistically significant (P < 0.05), as shown in Table 2.
2.2 Comparison of Conflict Resolution Duration
Conflict events that occurred and had been resolved during the two observation periods before and after the intervention were collected separately from the departmental conflict event registry and work management logs. A total of 105 conflict events were recorded during the study period, including 60 before the intervention and 45 after the intervention. There were 9 high-intensity conflict events in total, including 5 before the intervention and 4 after the intervention.
The conflict events recorded before and after the intervention were independent events newly occurring during different observation periods, rather than repeated measurements of the same group of events. Welch’s independent-samples t-test was used for comparison. The results showed that the mean conflict resolution duration after the intervention was shorter than that before the intervention, and the difference was statistically significant (P < 0.05), as shown in Table 3.
2.3 Comparison of Perioperative Adverse Events
Based on the hospital information system (HIS), the surgical anesthesia system, and the adverse event reporting system, data from 2184 surgical cases before the intervention and 2246 surgical cases after the intervention were retrieved. The number and incidence of perioperative adverse events were calculated. The observed perioperative adverse event rate was lower after the intervention, but the difference was borderline and depended on the test used (uncorrected Pearson χ2 = 3.980, P = 0.046; two-sided Fisher’s exact P = 0.054), as shown in Table 4.
2.4 Comparison of Anesthesia Patient Satisfaction
A total of 60 postoperative anesthesia patients were selected before the intervention and another 60 patients were selected after the intervention for on-site questionnaire surveys. The results showed that the patient satisfaction score after the intervention was significantly higher than that before the intervention, and the difference was statistically significant (P < 0.05), as shown in Table 5.
3 Discussion
From the perspective of organizational behavior, this study developed a progressive intervention model for improving team cohesion and conflict management in the Department of Anesthesiology. The model was designed according to the characteristics of our department, including a high proportion of patients with tumors, rapid surgical workflows, long chains of interprofessional collaboration, and frequent unexpected events. The intervention focused on four core components: shared mission, process clarification, psychological safety, and continuous feedback. After 6 months of implementation, higher team cohesion, work engagement, and anesthesia patient satisfaction scores and shorter conflict resolution durations were observed compared with those before implementation. These associations suggest that the model warrants further evaluation; the perioperative adverse event difference was borderline and did not establish a patient safety benefit.
The ICS-15 team cohesion score and work engagement score of the anesthesiology team both increased significantly after the intervention, showing an association between the intervention period and higher reported cohesion and work engagement. In this study, patient safety roundtable meetings were used to build common goals, the RACI responsibility matrix was used to clarify job responsibilities, and the dual-channel communication mechanism was used to promote information transmission and emotional expression. These measures were intended to reduce collaboration barriers caused by unclear responsibilities and insufficient communication. This finding is consistent with Edmondson’s theory of psychological safety, which emphasizes speaking up, tolerance of trial and error, and team learning
[6]. It is also broadly consistent with previous research findings
[3].
The average conflict resolution duration and the resolution duration of high-intensity conflicts were both significantly shortened. In this study, a “conflict thermometer” was used to identify and grade conflict intensity. Drawing on previous research on conflict resolution in the field of anesthesiology, differentiated interventions were implemented according to the intensity of conflict
[1]. For low-intensity conflicts, guided dialogue was mainly used to clarify misunderstandings in a timely manner. For high-intensity conflicts, third-party mediation and managerial involvement were introduced to prevent further escalation. At the same time, process clarification and closed-loop information management were intended to address possible contributors to conflicts, such as resource allocation problems, information gaps, and unclear role boundaries. The intended shift in conflict management was from post-event resolution to pre-event prevention and process control. Booij
[2] also discussed the importance of clear responsibilities and communication in managing conflicts in operating room teams.
The perioperative adverse event rate was 0.46% before and 0.13% after the intervention. This difference was borderline (uncorrected Pearson P = 0.046; two-sided Fisher’s exact P = 0.054), and patient satisfaction scores were higher after the intervention; neither finding establishes a causal effect of the intervention. Patient safety in anesthesiology depends not only on individual technical competence but also on team-based information sharing, role coordination, and risk warning capacity. By strengthening safety consensus, clarifying role boundaries, establishing closed-loop information management, and implementing a no-blame discussion mechanism, the intervention was intended to reduce information omissions and responsibility gaps at key work nodes and decrease collaboration-related deviations. Meanwhile, improved team communication may have enhanced the continuity of preoperative visits, intraoperative cooperation, and postoperative recovery follow-up, which is a possible explanation for the increase in patient satisfaction. These are hypotheses rather than mechanisms established by the present analyses. However, because the number of perioperative adverse events was small, this result should be further verified in controlled studies with larger sample sizes.
The hospital encouraged adverse event reporting and provided incentives for such reporting, with the aim of supporting psychological safety and reducing reporting-related concerns. During routine departmental management, no apparent adverse psychological impact was noted among staff involved in the 105 recorded conflicts. However, these conflict events were not linked to standardized psychological assessments; therefore, this observation does not establish the absence of conflict-related psychological effects.
This study has several limitations. First, it was a single-center pre–post intervention study without a concurrent control group, and the results may have been influenced by time effects and changes in the management environment. Consequently, the observed changes cannot be attributed solely to the intervention. Second, the intervention period was only 6 months, which was not sufficient to fully evaluate the long-term effects of the model. In addition, some indicators were derived from departmental records and questionnaire surveys, which may have introduced recording bias or subjective evaluation bias. The small number of adverse events and the borderline, test-dependent difference further limit conclusions about patient safety. The use of a department-developed ICS-15 questionnaire may also limit comparability with studies using established cohesion measures. Future prospective multicenter studies with control groups and longer follow-up periods are needed to further verify the stability and generalizability of this intervention model. Nevertheless, the uncontrolled before-and-after design and the unequal observation periods limit the ability to exclude workload-related confounding.
4 Conclusion
In the high-risk environment of the Department of Anesthesiology, achieving both patient safety and work efficiency is a core team goal. The findings of this departmental quality improvement study are preliminary and do not establish causality. To achieve this goal, anesthesiology teams need to make coordinated efforts in four key dimensions. First, a shared mission should be established to clarify common goals and values and enhance members’ sense of responsibility and belonging. Second, workflow management should be optimized to ensure clear responsibilities and smooth collaboration at each step. Third, information transparency should be improved so that team members can obtain and share key information in a timely manner. Finally, a psychologically safe atmosphere should be created to encourage team members to speak up actively and provide timely feedback, with the aim of supporting overall team collaboration.
The practical toolkit proposed in this study, including patient safety roundtable meetings, the RACI responsibility matrix, and the dual-channel communication mechanism, offers a preliminary framework for internal collaboration in anesthesiology teams. Further evaluation is needed before these tools can be recommended for wider use in departments of anesthesiology in different hospitals. The observed changes in staff scores, conflict resolution duration, and patient satisfaction support further controlled assessment of this approach.
The observed reduction in perioperative adverse event rates was borderline and test-dependent. Controlled studies with larger samples and longer follow-up are needed before conclusions can be drawn about patient safety benefits, sustained effectiveness, or use in other settings.
2026 The Third Affiliated Hospital of Sun Yat-Sen University and Higher Education Press Limited Company. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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