Contextual Influences on Leadership and Teamwork in Surgical Operating Rooms: A Qualitative Study

Error rates in surgery are high relative to other areas of healthcare, with preventable errors more likely to be related to nontechnical issues such as failures in teamwork. Drawing on 34 semi-structured interviews with cardiac surgery professionals and observations of 22 cardiac surgery cases, this article explores factors that affect teamwork in cardiac surgery operating rooms in order to inform the design of evidence-based interventions to improve teamwork. Participants held a largely shared mental model of ideal teamwork wherein clinical work was well coordinated and flowed effortlessly. Relational competence and surgeons’ leadership were considered important, but there were discrepancies in participants’ preferences for how these interactions should look in practice, leading to tension and divergent expectations. Team functioning also depended on contextual factors, including case-related factors, team composition, local organisational culture, and organisational processes. The findings reveal the co...