Hierarchy in surgeon-anaesthetist relationships

Operating theatres are steeply hierarchical, and yet the hierarchy between surgeons and anaesthetists is unclear, even blurry. Both the steep hierarchy and the blurriness at the top can present a risk to patient safety through inhibiting speaking up with concerns and negotiating safe patient care. A recent study in the British Journal of Anaesthesia explores hierarchy in the surgeon-anaesthesia dyad in China, in particular, the effect of increased seniority gap between surgeons and anaesthetists on anaesthesia-related adverse outcomes. There is very limited information on hierarchy in the surgeon-anaesthetist dyad despite its pivotal importance for patient outcomes. The study prompts us to confront hierarchy in operating theatres and to address its negative effects. This might include explicit whole-team reflections on the hierarchies that divide us, working to overcome divisions through identifying our common values and goals in patient care, and building shared decision-making into our organisational structures and patient care processes so that they no longer reinforce historical hierarchies but rather reflect the needs and realities of modern healthcare.