Leveraging the perfusionist-surgeon dyad to improve the culture of safety

The cardiac surgical operating room is a complex, high risk environment dependent on efficient teamwork and communication between multiple role groups to deliver safe and effective care. As awareness of the critical importance of culture on team performance broadens, there has been increasing focus in cardiac surgery on developing a culture of safety to minimize, trap and recover from errors in order to optimize patient outcome. Fundamental to this effort are concepts such as Just Culture, collective responsibility and perhaps most fundamentally the establishment of psychological safety where individuals have a "sense of being able to show and employ oneself without fear of negative consequences to self-image, status or career". Team members who are engaged and feel empowered to raise concerns can help to recognize issues, improve intraoperative decision making and contribute to resilience of the team. Over the past decade we have made a concerted effort in our institution to establish such a culture, and have found principles of organizational psychology helpful in this endeavor.