A failure to communicate

Anna Allan, University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0SP

We all know about the stereotypical surgeon. You’ve heard the stories: Strutting around the hospital corridors, barking commands at juniors on the ward and utterly lacking in communication skills. However, a failure to communicate effectively may contribute to the occurrence of adverse events in the operating room. In fact recent root-cause analyses by an American Joint Commission identified communication breakdown as the most common factor implicated in adverse events.(1)

A recent study aimed to characterise the nature of communication failures in operating rooms in the USA. They first observed the number of intra-operative communication failures and then observed the team again after a Team Training curriculum to assess whether any improvements resulted from this intervention. Initially 76 communication errors were observed over the 150 hours of assessment. This translated into 0.737 errors/hour. Following Team Training, however, this figure dropped to 0.270 errors/hour (20 errors over 74 hours). The most common subjects leading to communication errors were equipment and progress reports, and with regards to equipment, coordination of equipment across the theatres was the area of most confusion. The study also investigated the effects of the communication errors. These were found to be inefficiencies, delays and increased tension among members of the operating room team. Looking at the study, the introduction of Team Training, which taught all theatre staff teamwork and communication skills, appeared to have a profoundly positive impact on the rates of communication errors. This significant decrease indicates that the operating environment does not need to be stressful, tense and unfriendly – with appropriate training, both stress and inefficiency can be reduced.

Within the UK, there has been increasing emphasis on team-working throughout surgical training; now team pre-operative and post-operative meetings or debriefings are a mandatory part of each theatre list, with the view to improving theatre staff communication and case reflection. Based on these research findings, perhaps it is time for us to dismiss our previous ideas of the ‘typical surgeon’ – in order to improve efficiency and productivity of staff, surgeons of today must be of a new breed. The kind of surgeon that is not only decisive, hard-working and confident, but also possesses the communication skills to lead an efficient operating team.


1. Disease-Specific Care Certification – National Patient Safety Goals. Oak Brook Terrace (IL): The Joint Commission; 2008. Available from: http://www.jointcommission.org.

2. Halverson AL, Casey JT, Andersson J, Anderson K, Park C, Rademaker AW and Moorman D. Communication failure in the operating room. Surgery 2011 March; 149(3): 305-310 http://dx.doi.org/10.1016/j.surg.2010.07.051