What Leading A Cardiac Arrest Team Taught Me About Team Work

Ventricular Fibrillation (VF)
Ventricular Fibrillation (VF) (Photo credit: Popfossa)

As a very young doctor, fresh out of medical school, I led the hospital cardiac arrest team. Yep, that is right. I made life or death decisions; treating patients whose hearts had effectively stopped. It was utterly terrifying, and when we saved a life, wonderful and miraculous.

The really cool thing about cardiac arrest teams is that they function as an effective team from the moment that team members arrive in the room; even though they often have never worked together before.

Decisions get made quickly and are acted on immediately.  And sometimes, as a result of those decisions, people are brought back from the dead. It is wonderful.

Why do cardiac arrest teams work so well together?

Because they are well set up.

The purpose of the team is very clear and everyone agrees what that purpose is.

Everyone in the team understands who is responsible for what. They know who will do which action. They know which decisions each team members makes individually; which they will make in consultation with others and which decisions the whole team will make by consensus.

If one member of the team is unable to respond to the ‘Cardiac Arrest on Ward A1‘ call, there is a clear agreed way of sharing out the work, so that it all gets done. Team members don’t have to waste time renegotiating responsibilities.

The situation itself also helps the team to work well together. There is immediate feedback. The doctor takes an action and can see the result within seconds. Either the patient’s heart rhythm improves or it doesn’t.

These characteristics are important in building effective cooperative effort:

If you want your team to be more effective, pause for a moment. Have you set your team up to work well together? How is the situation influencing their behaviour?

How to Build A Cooperative Team

Whenever we work in a team there is a tension between getting the outcomes we want and contributing to the outcomes that others need.

If I spend time giving John the information he needs to get his board paper written, then I might have to delay my meeting with my direct report, Sarah, and as a result she doesn’t meet her deadline. I will need to trust that, at some point in the future, John will return the favour.

Humans are incredibly good at quickly recognising whether to cooperate with others or whether to just look out for ourselves. Within minutes of joining a group we size up the situation and adjust our level of contribution accordingly. We have learnt this skill because being cooperative in a competitive environment is a really bad idea.


David Sloan Wilson has been doing some cool research on this in his home town of Binghamton. He has found that the culture of the suburb where teenagers live determines to a large extent how prosocial they are (i.e. how readily they will take voluntary actions to benefit others, such as sharing, comforting, helping, rescuing). If teenagers move from a harsh suburb to a more nurturing environment, they often become more prosocial.

It looks like certain environments encourage people to be cooperative, trusting and kind and other environments don’t.

So what does this mean for you and your team? If your team aren’t very cooperative; it may not be because they are selfish or difficult; it may be because the environment isn’t set up to encourage prosocial behaviours. How do we create those environments?

Press conference with the laureates of the mem...
Press conference with the laureates of the memorial prize in economic sciences 2009 at the KVA: Elinor Ostrom. (Photo credit: Wikipedia)

In his work with groups at Binghamton, Sloan Wilson uses Elinor Ostrom‘s design principles, which are:

  1. Strong group identity and purpose
  2. Clearly defined boundaries
  3. Getting rewarded for contribution. Members of the group agree a system that rewards people for their contribution to group outcomes
  4. Group members create their own ground rules and make group decisions by consensus
  5. Monitoring – a process to check for free-riding or active exploitation by individual group members
  6. Graduated consequences for inconsiderate or selfish behaviour
  7. Mechanisms for fast and fair conflict resolution which are cheap and easy to access
  8. Local Autonomy – The group (and subgroups within the larger team) have some authority to manage their own affairs
  9. Where the group is part of a larger system, they are organized as multilayered nested enterprises. Each group has its own governance that fits within the larger group. Local efforts are linked together.

Ostrom found that groups that have these principles in place are more likely to work together to look after group resources rather than compete for and ultimately deplete them.

Sloan Wilson has been applying these principles to create changes in schools and neighbourhoods with surprisingly good effect.

My experience is suggesting they are helpful for workplace teams too.


Sadly Elinor Ostrom passed away on June 12th. My hope is that her contribution will live on, helping us to improve the way we interact with each other and the world.