Progress in Pediatric Cardiology
Prog Pediatr Cardiol (2011), doi:10.1016/j.ppedcard.2011.10.011
Expectations of pediatric cardiac surgeons grow as the specialty evolves and yesterday's challenges become
tomorrow's routine. The pioneering era of fast-paced major technical advances is behind us. Integration of surgery,
cardiology and intensive care is nowthe basis of incremental improvements in perioperative and long termoutcomes.
Surgeons can be natural leaders of this process because their skills, roles and experience are crucial in the
preoperative, intra-operative and postoperative care of the patient and their family. However, the personality
traits that draw physicians to the specialty and contribute to the drive to become a successful technical surgeon
may be at odds with the collaborative aspects of this microsystem, both inside and outside the operating room.
The potential for disruptive behavior on the part of the surgeon to impede the functioning of a large multidisciplinary
teamproviding care of the upmost complexity raises fundamental questions about howto design reliable
pediatric cardiac surgery teams. A new dynamic is needed to support team members, including the surgeon, in
times of extreme stress and to help them avoid destructive,maladaptive responses. Focusing these efforts around
the clinical microsystemrequires a detailed analysis of the teaminteractions, the underlying culture and support,
and the clinical engagement of staff. Building and nurturing a resilient systemin a highly specialized environment
where burnout, bullying and loss of staff exist remains a constant challenge.