Toolkit to Promote Collaboration Between Surgeons and Anesthesiologists: Addressing Common Barriers to Perioperative Teamwork

BACKGROUND: Collaboration between surgeons and anesthesiologists is central to perioperative safety, yet interpersonal and systems barriers within this dyad remain poorly characterized. This qualitative study aimed to identify sources of conflict and practical strategies used by clinicians to improve collaboration during peri-operative care. STUDY DESIGN: A qualitative phenomenological study was conducted using semi-structured virtual interviews with practicing surgeons and anesthesiologists in the United States. Participants were recruited via respondent-driven snowball sampling to achieve geographic and practice diversity. Forty physicians (20 surgeons and 20 anesthesiologists) from 24 states, ages 31-81 years, were interviewed between February 2022 and June 2024. Transcripts were coded by multidisciplinary investigator teams using qualitative analysis software, with consensus coding and thematic analysis to identify patterns describing barriers to collaboration and strategies promoting effective teamwork. RESULTS: Seven themes describing conflicts and barriers to collaboration were identified: Systems and Professional Identity, Communication, Relationships, Personality Traits, Behaviors, Trainees, and Medical Management. Five themes describing strategies to enhance collaboration emerged: Communication across the pre-, intra-, and post-operative phases; Relationship Building; Team-Building Attitudes; Team-Building Actions; and Rebuilding Trust. Interviewees described practical tactics to strengthen collaboration, including fostering familiarity (eg, introductions and first-name communication), communicating thoroughly (eg, early case discussions, explaining clinical reasoning, announcing intra-operative status changes), and adopting a shared mentality emphasizing openness, respect for expertise, and assuming positive intent. These insights informed development of a clinician-level "toolkit" summarizing actionable behaviors to support effective peri-operative teamwork. CONCLUSIONS: Surgeons and anesthesiologists identified multiple interpersonal and systems factors that hinder collaboration but also described practical behaviors that can strengthen working relationships. Deliberate communication, relationship building, and shared team attitudes represent actionable strategies that may improve peri-operative teamwork and support safe, effective patient care.