**2. Challenges of evolving healthcare system complexity**

Over the last 20 years, significant progress across our healthcare systems has been made when it comes to clinical knowledge, scientific research, and technological advances. Modern technologies have the potential to play an important role in enhancing patient safety via improving hospital algorithms and methodologies for prevention of patient safety adverse events, such as central venous catheter infections, ventilator-associated infections, surgical site infections, and nosocomial urinary tract infections [9, 10]. The medical literature demonstrates that healthcare errors and detrimental events appear to be associated with the ever increasing complexity of medical care as well as poorly optimized workflows [10]. With escalating focus on the centrality of the patient as the core constituent in the clinical safety arena, promoting salubrious practices while eliminating deleterious patterns of expanding healthcare complexity have the potential to facilitate patient safety [8].

Novel implementations of advances in medical knowledge, new medical techniques, and innovative devices empower physicians to provide better, more effective care. However, this sometimes comes at the cost of greater complexity of care. In the process, new contemporaneous challenges may emerge, including the necessity to constantly keep abreast of the latest medical scientific discoveries and devices, further incorporate the ever-expanding role of electronic health records (EHR), and integrate a myriad of new parameters into daily clinical practice, perhaps without fully considering the effects of information overload on the ability to effectively process critical information [11, 12]. Among the unforeseen consequences of this tremendous systemic growth and development is the appearance of situational circumstances that are nearly impossible for a single individual to comprehend, analyze, and act upon. In response to the impact of the rapid increase of complexity of technology on patient safety, many potential solutions have focused on team-based approaches as a foundational value of modern patient-safety approaches [13, 14].

The institutional practice climate has gradually evolved toward a framework that encourages teamwork via emphasis on better communication skills, professionalism, and communal respect among all the clinical and nonclinical care providers [15]. The relationship between patient-safety culture and teamwork has been studied quite extensively in the most complex of hospital environments, critical care units, and other clinical environments to help determine if this relationship improves patient outcomes and impacts staff satisfaction (and safety) [7]. Although differences exist between critical care units in terms of housestaff training versus no housestaff, private versus public, closed versus open "workflow architecture," intensivist versus non-intensivist staffed, and cardiac versus surgical versus neurological versus medical units, team-based approaches within these units have both enhanced perceptions of safety and correlated with beneficial clinical outcomes, staff satisfaction, and staff retention [7, 13].
