• Linda Searle Leach, Robert C Myrtle, Fred A Weaver, and Sriram Dasu.
• University of California Los Angeles, School of Nursing, Los Angeles, CA, USA. lleach@sonnet.ucla.edu
• Health Care Manage Rev. 2009 Jan 1;34(1):29-41.

BackgroundHigh-performing and high-reliability teams are an important component of service delivery. With a focused emphasis on safety in acute care hospitals, understanding the nature of surgical teams and team performance is an essential component to achieving high-quality surgical care. More information is needed about the challenges to effective team functioning in the operating room, the influence of working conditions, and the environmental context on surgical team performance.PurposeThe purpose of this study is to describe the nature of surgical teams and how they perform in the operating room to contribute to a broader knowledge about high-performing and high-reliability teams in health care settings.Methodology/ApproachWe conducted a qualitative study involving direct observation and semistructured interviews. Field observations of 10 high-complexity surgeries and face-to-face interviews with 26 members of surgical teams were completed at one university medical center. A conceptual framework derived from the literature was developed to guide the selection of surgeries and surgical teams to be observed. Data were transcribed and analyzed to identify the factors and different conditions that influence the performance of these surgical teams.FindingsThe type of coordination and the degree of independent and interdependent coordination vary among the seven observed stages of the surgical process. Most of the surgical teams were ad hoc teams and as such, further challenged by consistently frequent "hand-offs" for break relief. Additional role demands influence the situational dynamics which can alter the adaptive capacity of the team.Practice ImplicationsThe surgical event evokes a changing degree of coordination and adaptation to complexity and uncertainty. In such environments, relational coordination through leadership can contribute to a successful surgical result, improvement of the overall process, including error reduction, and enhanced knowledge creation and dissemination, particularly germane in research university teaching hospitals.

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