Patient safety relies on the interaction between healthcare professionals, organisational systems and clinical equipment. While this interplay is frequently complex, similar themes often emerge when adverse events are reviewed. One of the commonly described contributory factors is the rigid hierarchical structure of clinical teams within the National Health Service (NHS) which, despite these observations, frequently remains.1 2 This is particularly relevant to cardiologists because of our reliance on effective teamworking across a range of clinical settings. Furthermore, given the potential risks of procedures performed in the catheter laboratory, which are often time-critical, effective teamworking is essential.

In the 1970s the aviation industry noted that a steep hierarchy was an element in a number of catastrophes.1 One contributor to this hierarchy is the use of titles based on seniority because it creates a status difference, akin to the asymmetrical address used between adults and children.3 The aviation industry therefore mandated the use of first names within the team regardless of seniority.3 4

In common with the aviation industry, a number of healthcare organisations have also recommended using first names …