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The outcomes of these team training exercises should lead to change in practice where needed.⁷⁶

The anaesthetic department should have a lead for multidisciplinary team training and simulation.⁷⁶

The department should have access to the resources to support a comprehensive system of multidisciplinary team training in all clinical settings to achieve enhanced patient care.⁷⁶

There should be transparent processes in place to facilitate ownership by the department of aspects of clinical governance specific to anaesthesia.  This should link with the wider organisation governance processes, especially where there is overlap with other services.

The organisation of clinical governance in the department should bring all different aspects so that it is managed as a whole.

Departments should consider establishing a clinical governance committee/group which covers all aspects of governance pertinent to the anaesthetic service and can feed into the wider organisation/board governance structures.

The clinical governance workload for all but the smallest department is such that the governance leadership should be divided into subsets, for example leads for guidelines, incidents, quality improvement, ACSA.

There should be effective processes for communication within the anaesthetic department and between other departments in the organisation to ensure that any learning to improve safety or quality is embedded in practice, excellent practice is recognised and poor behaviour is addressed. Systems should be established that minimise the opportunities for human error.

The departmental ethos should foster an open safety culture in all aspects of the service.^77,78

All members of the anaesthetic department should promote a safety culture, engaging in collaborative team working with a flattened hierarchy. All team members should be positively encouraged to: reflect and debrief, challenge negative behaviours, acknowledge positive behaviours, reflect on decision making and performance, report, document and review actual incidents and near misses and excellence.