I. Improving teamwork in anaesthesia and critical care: many lessons still to learn.

The idea that anaesthesia needs to mimic other high-stakes industries may have been oversimplified and overdone. However, aviation (as the most cited example) still provides too many lessons to be ignored. Like aviation, evidence from acute care medicine increasingly shows that inadequate teamwork (and the related topic of inadequate communication) is one of our most common reasons for preventable error. – 6 Aviation prioritized the ‘science of reducing complexity’ and the ‘science of team performance’. So should we. Similarly, medical training should promote ‘team-dexterity’ (and ‘verbal dexterity’), not just capacious brains and nimble hands. 6 7 Like aviation, it is time to encourage more ‘we’ and less ‘me’. After the 1935 crash of the B17-bomber, it was lamented that ‘the modern plane is just too much for one man to fly’. Similarly, the modern patient is too much for one clinician to manage. The modern intensive care unit patient has been estimated to require upwards of 180 steps per-patient per-day. Regardless of the exact number, this complexity outstrips even the most capable individual. It also means that without effective teamwork, safe patient care may be illusive. It is not enough to demand that we work as a team. We need to practice and perfect the team structure. After all, ‘a team of experts is not always an expert team’.