Employing a mixed-methods approach, this study found that teamwork (directly and indirectly) positively impacted professionals’ safety behavior. Teamwork indirectly impacted safety behavior by increasing individual’s positive psychological capital, thereby increasing their self-efficacy and resilience. These findings emphasize the role of hospital leadership and middle management in creating an organizational culture of safety

Nontechnical skills, such as teamwork, communication, and leadership, are essential human-centered components of safe surgical practice. This commentary discusses contextual characteristics needed to support nontechnical skill development to improve health care outcomes. The authors recommend a cultural shift away from focusing on technical performance to one that incorporates training in nontechnical skills.

Aviation has provided health care with insights regarding how systems approaches, blame-free reporting, and teamwork can prevent failure. This commentary summarizes tactics used in aviation that have been applied to surgery in support of efforts to reduce patient harm.

Stressful clinician interactions can diminish the teamwork required to support safe care. This review describes a framework for guiding understanding of how behavioral and emotional responses can affect team behavior, performance, and patient outcomes in the surgical setting. The authors recommend areas of research required to fully understand the phenomenon.

Teamwork training can improve communication and prevention of adverse events in the operating room. In this study, focus groups with clinicians and operating room staff found that team members perceived the concept of the "team" and their roles in ensuring optimal handoff communication differently. This exploratory work has implications for the design of effective teamwork training programs.

Surgical team communication is an important element of safe care. This project report describes how one hospital implemented a checklist program that utilized time outs and debriefings to support transparency and improve surgical teamwork behaviors.

According to this qualitative study at a single academic institution, staff surgeons and intensivists frequently exclude resident physicians from patient care conversations. Reasons included lack of trust, need for timely communication, and a perception that residents cannot adequately contribute to decision making. This finding has important implications for the integration of communication training during medical education.

This hospital introduced large print, wall-mounted checklist posters in their operating rooms (ORs) and specifically assigned the leadership of each domain of the checklist to a different OR group (anesthesia, nursing, and surgery). These inexpensive changes led to improvements in team engagement and compliance with the surgical safety checklist process.

Failure-to-rescue is considered a potential contributing factor in the wide variations in surgical mortality rates. This review explored the evidence regarding the surgical mortality of older patients and found system factors that affected failure-to-rescue rates, including safety culture and access to technology. The authors suggest that teamwork and communication improvement can help reduce failure-to-rescue in this patient population.

Errors in surgical care are often associated with human factors, interruptions, and staffing issues. This commentary describes a program to augment safety in ambulatory surgery centers, which includes a surgical checklist, change management, and teamwork.

Previous literature has shown that safety culture and nontechnical skills (such as communication) can affect safety and clinical outcomes in patients undergoing surgery. This systematic review identified several interventions that demonstrated effectiveness at improving various aspects of surgical culture, including teamwork and communication. A past AHRQ WebM&M commentary discussed disruptive behavior as a contributor to safety issues in surgery.

This pre-post study demonstrated increases in teamwork after introduction of an anesthesia checklist. Although evidence for checklists in real-world settings is mixed, this work demonstrates their efficacy as part of an intervention study, which is consistent with prior work.

Use of a standardized handoff tool was associated with a decrease in postoperative adverse events in pediatric cardiac surgery patients.

Interruptions were associated with an increased risk of miscommunication between team personnel during surgical procedures. Teams that had limited experience working together seemed to be particularly vulnerable to miscommunications.