CRAFT-SHARED: 11 Principles for Communication Under Pressure
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For 27 years as an anesthesiologist, I worked where communication
mistakes cost lives.
This framework distills what works when stakes are high, time is
short, and mistakes aren't an option.
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CRAFT = Individual communication skills
SHARED = Team & relationship principles
These aren't theories. They're what kept patients alive when everything
else was falling apart.
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CRAFT: INDIVIDUAL COMMUNICATION SKILLS
C - CLARITY
Precision beats speed every time.
"Give something for pressure" → vague, wastes time
"Phenylephrine 100 mcg IV push" → precise, immediate action
One sentence of clarity now prevents hours of confusion later.
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R - REDUNDANCY
Assume communication will fail—design around it.
Close the loop:
1. Give instruction
2. Hear repeat-back
3. Confirm
4. Get completion report
The 5 seconds to verify saves hours correcting mistakes.
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A - ADDRESS EARLY
Problems don't age well.
1st time: Could be coincidence
2nd time: That's a pattern—address it NOW
Small conflicts addressed early stay small. Ignored, they become crises
that destroy relationships.
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F - FRAMING
Behavior not character.
"You're arrogant" → Shuts down conversation
"When you interrupted without hearing my input, I felt dismissed" → Opens dialogue
People can change what they do. They can't change who they are.
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T - TRANSPARENCY
Honesty (with compassion) builds trust.
When mistakes happen:
→ Disclose immediately
→ Explain clearly
→ Apologize sincerely
→ Show what's changing
→ Stay present
People forgive mistakes. They don't forgive dishonesty.
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SHARED: TEAM & RELATIONSHIP SKILLS
S - STOP & REASSESS
Sometimes the right move is to pause.
When something feels wrong, halt momentum.
Action isn't always progress.
Trust your gut. Say: "Stop—let's reassess."
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H - HAZARDS (LASA)
If it can be confused, it will be.
Look-Alike, Sound-Alike risks are everywhere:
→ File names differing by one character
→ Product codes that look identical
→ Ambiguous pronouns ("Send it to him")
Make distinctions obvious. Add verification.
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A - ALIGNMENT
Shared mental models prevent chaos.
Never assume everyone sees the situation the same way.
Before high-stakes moments: Align explicitly.
"Our goal is X. If conflict arises, X wins. Clear?"
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R - ROLES
Clear ownership prevents chaos and gaps.
When everyone knows their lane:
→ Nothing falls through cracks
→ Nobody duplicates effort
Name who owns what. Verify understanding.
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E - EXAMINE
Brief before, debrief after.
Before: What's the plan? What could go wrong?
After: What worked? What changes next time?
5 minutes total = massive improvement over time.
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D - DEVELOP TRUST
Crisis reveals what you've already built.
Team cohesion doesn't appear in emergencies. It exists because of what
you built beforehand.
Invest in relationships before you need them.
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QUICK REFERENCE
CRAFT (Individual):
C - Clarity: Precision beats speed
R - Redundancy: Close the loop
A - Address Early: Occurrence 2 = time to talk
F - Framing: Behavior not character
T - Transparency: Honesty builds trust
SHARED (Team & Relationship):
S - Stop & Reassess: Pause when something feels wrong
H - Hazards (LASA): Design to prevent confusion
A - Alignment: Check shared understanding
R - Roles: Clear ownership always
E - Examine: Brief + debrief = improvement
D - Develop Trust: Build before you need
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This framework took 27 years to learn.
Practice it deliberately. One principle at a time.
Start with the principle your team needs most right now.
Next week: The story of a problem I ignored—until it chose the worst possible moment to resurface.
(Spoiler: the patient should have been waking up. Instead, he was fully paralyzed.)
- Dr. Anand Shankar