Improving perioperative safety requires optimal communication within the surgical team; however, classic studies have shown that teamwork in the operating room is often suboptimal. This study successfully improved communication and safety through creation of a structured preoperative briefing protocol for gynecologic and orthopedic procedures. The protocol required discussion of critical operative elements between the surgeons, anesthesiologists, and nurses prior to surgery. Checklists have been remarkably successful at reducing perioperative adverse events, and this protocol incorporated some elements of previously published perioperative checklists and The Joint Commission's Universal Protocol. However, the protocol used in this study focused on creating shared situational awareness among all team members, and did not explicitly mandate specific steps as in a checklist. An accompanying editorial discusses the cultural challenges that have accompanied attempts to improve surgical safety.