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After a long day in the operating room, two doctors sit in front of the television. A Formula 1 race is on. A car pulls into the pits, a group of mechanics swarms over it, and seconds later it is back on the track. Surgeon Martin Elliott and intensive care specialist Allan Goldman of Great Ormond Street Hospital in London see something familiar in it – only done far better. An example of the Team Principle of Attunement.
The Most Dangerous Fifteen Minutes
Situation
Great Ormond Street Hospital is a children’s hospital with a large cardiac surgery program. After heart surgery, the child is moved from the operating room to the intensive care unit. Within a short time, everything changes: the equipment, the responsibility and the knowledge about the patient. One team hands over, another takes over. At the same hospital, cardiac surgeon Marc de Leval had studied the role of human factors in cardiac surgery early on.
Connection to the team principle
The Team Principle of Attunement says: a team becomes good when everyone knows what the others know, what they can do and what they will do next. A handover is the acid test. Two groups meet here, each experienced in its own right. Everything one group knows has to reach the other in full while tubes and cables are being reconnected. Anyone who doesn’t know at that moment what the person beside them is doing will either get in their way or count on something nobody is actually doing.
Experts in the Two-Second Stop
Situation
Elliott and Goldman have their handovers filmed and show the footage to motor racing experts. The team visits Ferrari in Maranello and talks to the racing team’s technical director. Two British Airways pilots also advise them. The racing experts’ verdict is blunt: no clear leadership, several conversations at once, no fixed sequence, a great deal of commotion.
Connection to the team principle
The doctors weren’t lacking expertise. What they lacked was what defines a pit crew: everyone knows their own move and everyone else’s. That it took outsiders to see this so clearly is typical. From the inside, it is hard to tell how poorly attuned a team is – people have grown used to the commotion.
Four Steps and a Laminated Sheet
Situation
Human factors researcher Ken Catchpole distills the lessons into a four-step protocol. First, the intensive care unit is notified about 30 minutes before the transfer. Second, the equipment is switched over – with no handover talk at the same time – and a safety check follows at the end. Third, only then comes the verbal handover, using a memory aid; only one person speaks at a time. Fourth, everyone discusses the plan and possible problems together. The anesthesiologist leads at first, then hands over leadership to the intensive care specialist – modeled on the “lollipop man” who signals the driver at a pit stop. Everyone has a fixed task and a fixed position at the bedside. A dance choreographer was brought in to plan the movements. The protocol hangs, laminated, at the bedside. Training takes 20 to 30 minutes.
Connection to the team principle
For everyone at the bedside, the protocol answers three questions: What am I doing? What are the others doing? What comes next? That is exactly what the core statement means. Separating the switchover from the talking ensures that everyone can listen when the knowledge is passed on. The fixed position keeps people from getting in each other’s way. And one person leads – not because they are the most important, but so that everyone knows whom to watch.
What Could Be Measured
Situation
A study compares 23 handovers before the protocol was introduced with 27 afterward. It was published in 2007 in the journal Paediatric Anaesthesia. The result: fewer technical errors and fewer omissions of information, in less time. A secondary source reports a drop from 5.4 to 3.1 technical errors and from 2.1 to 1.1 omissions per handover. Before, equipment and information errors had occurred together in about 30% of patients; afterward, in about 10%.
Connection to the team principle
The numbers are a case example, not proof: a small before-and-after study at a single hospital, with no control group. But they are consistent with what research has found elsewhere. Robert S. Huckman and Gary P. Pisano studied cardiac surgeons who operate at several hospitals. Their patients’ mortality fell as the number of procedures the surgeons had recently performed at that same hospital rose – but not with the number they had performed elsewhere. Performance, then, depends not only on individual skill but on a familiar team and setting. Great Ormond Street didn’t wait for this familiarity to develop; it built it.
Key takeaways
Key Lessons
- Find the handovers in your team. Wherever work passes from one group to another is where the most gets lost.
- Let outsiders watch. Film a process or invite someone from a completely different industry – what seems normal to you will jump out at them right away.
- Separate doing from talking. When something important is being said, no one should be doing something else on the side, and only one person should speak.
- For critical processes, define who stands where, who does what and who leads. Write it on one page and post it where the work is done.
- Don’t wait for a team to become attuned on its own. A clear process and half an hour of training can do much of that work up front.
Summary
Great Ormond Street Hospital didn’t hire better people. It made sure that during the handover from the operating room to intensive care, everyone knows what the others are doing and what comes next: fixed roles, a fixed sequence, one person leading. The idea came from the Formula 1 pit stop; the effect showed up in a small study. The example is encouraging because it shows that attunement doesn’t just grow over time – it can also be built.