• Jennifer M Weller.
• Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand; Auckland City Hospital Department of Anaesthesia and Perioperative Medicine, Auckland, New Zealand; Australian and New Zealand College of Anaesthetists, Melbourne, VIC, Australia. Electronic address: J.weller@auckland.ac.nz.
• Br J Anaesth. 2025 Jan 1; 134 (1): 232523-25.

AbstractOperating theatres are steeply hierarchical, and yet the hierarchy between surgeons and anaesthetists is unclear, even blurry. Both the steep hierarchy and the blurriness at the top can present a risk to patient safety through inhibiting speaking up with concerns and negotiating safe patient care. A recent study in the British Journal of Anaesthesia explores hierarchy in the surgeon-anaesthesia dyad in China, in particular, the effect of increased seniority gap between surgeons and anaesthetists on anaesthesia-related adverse outcomes. There is very limited information on hierarchy in the surgeon-anaesthetist dyad despite its pivotal importance for patient outcomes. The study prompts us to confront hierarchy in operating theatres and to address its negative effects. This might include explicit whole-team reflections on the hierarchies that divide us, working to overcome divisions through identifying our common values and goals in patient care, and building shared decision-making into our organisational structures and patient care processes so that they no longer reinforce historical hierarchies but rather reflect the needs and realities of modern healthcare.Copyright © 2024 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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