Team dysfunction and patient outcomes in paediatric heart care: communication, culture, and system-based interventions in high-risk clinical teams

Abstract Paediatric heart care is among the most complex, high-risk environments in medicine. Care is delivered by multidisciplinary teams across operating rooms, catheterisation laboratories, cardiac ICUs, and step-down settings, where small failures in communication or coordination may have serious consequences. Although advances in congenital and paediatric cardiac care have improved survival, dysfunctional team dynamics remain an underrecognised contributor to adverse events, inefficiency, clinician distress, and loss of family trust. This review synthesises evidence on how team dysfunction affects outcomes in paediatric heart care, identifies principal forms of dysfunction, and review system-based interventions that may improve team performance and safety. Drawing on literature from paediatric cardiac care, perioperative safety, critical care, interprofessional collaboration, organisational theory, and team science, the review is informed by the Input-Process-Output model, relational coordination, social exchange theory, psychological safety, and high-reliability organisation principles. Common forms of dysfunction include communication failures, hierarchical barriers, unclear role delineation, weak care transitions, and interpersonal conflict. These factors impair shared situational awareness, delay escalation, increase the risk of errors and complications, and affect family trust and clinician well-being. Evidence supports multifaceted strategies including simulation-based team training, structured communication tools, multidisciplinary case review, debriefing, cross-training, conflict-resolution approaches, leadership engagement, and measurement of teamwork processes. Emerging digital tools and artificial intelligence may support situational awareness and information reliability when carefully implemented. Team performance is a central determinant of safety and quality in paediatric heart care. Improving outcomes requires sustained investment in communication, psychological safety, role clarity, mutual respect, and organisational learning.