Teamwork as a Clinical Competency in Pediatric Cardiology: A Measurement-Feedback-Simulation Framework for Improving Decision-Making and Outcomes.

The care of patients with pediatric and congenital heart disease is intrinsically complex and relies on coordinated multidisciplinary teamwork. While advances in diagnostics and intervention have improved survival, variability in outcomes persists and is increasingly linked to team performance, decision-making, and organizational culture. This Perspective draws on evidence from pediatric cardiology, healthcare systems research, and organizational science to examine the role of team-based care in pediatric and congenital cardiology. Emphasis is placed on multidisciplinary decision-making, team dynamics, leadership, and organizational culture, with the aim of stimulating reflection and informing everyday clinical practice rather than providing a systematic or exhaustive review. Effective teamwork is associated with improvements in patient safety, clinical outcomes, patient and family experience, and staff well-being. Multidisciplinary decision-making forums, empowered nursing roles, and psychologically safe cultures emerge as central to high performance. Leadership, accountability, and transparency of outcomes data strongly influence team behaviour, while evidence from pediatric cardiology highlights the vulnerability of clinical decision-making to cognitive bias, heuristics, and organizational context. Optimising decision-making processes, fostering supportive organizational cultures, and investing in team development represent important opportunities to improve outcomes. We propose a practical Measurement-Feedback-Simulation (MFS) framework to support the measurement and improvement of teamwork as a clinical competency.