No one can whistle a symphony: harnessing team member ability to shape tone in the operating room

Teamwork is an essential component for safe and efficient care in the operating room. It has been suggested that the “tone” of the operating room shapes team dynamics to influence key team factors. However, we lack an understanding of how the tone emerges among team members. The objective of this study is to explore the role of each profession in the emergence of tone.

A constructivist grounded theory study was conducted to build our understanding of the role of the professions in shaping the tone of the operating room. Twenty participants representing various professions (surgeons, nurses, anesthesiologists), specialties and demographic factors were recruited to participate in a one-on-one semi-structured interview. Participants reflected on their experiences working as part of a team in the operating room with a focus on tone. Recruitment and analysis were conducted in an iterative fashion.

The tone of the operating room emerges from team interaction. The degree of influence each team member has on the tone is dependent on hierarchical and relational factors. Surgeons were viewed as “tone-setters” ultimately in control of the tone while anesthesiologists were tone “modifiers” and nurses were tone “facilitators”. Inter-relational contextual factors could often blur the boundaries of these roles and active engagement could shift greater influence onto non-surgeon staff members.

Although tone setting is traditionally viewed as the responsibility of the attending surgeon, non-surgeon staff members can take on an active role to shape the tone for safe and efficient teamwork.