There is something captivating about witnessing an operating room (OR) team perform as a “team” to accomplish what is, to many people, the extraordinary: invasive procedures to the human body that cure disease (Figure 5.1). In contrast, there is an amazing sense of exasperation witnessing a team work as disconnected (and sometimes competing) individuals to try and accomplish what only a team can accomplish. If you haven’t done so already, you will experience both the captivation and exasperation of OR teamwork; hopefully more of the former, but prepare yourself for the latter.

If you have never witnessed the triumphs and failures of OR teamwork, you may be questioning why teamwork and communication in the OR are important enough to warrant a chapter dedicated to them. This is a fair question and one that we have been asked many times over the years. For the past 10–15 years, researchers around the world have spent countless hours conducting observational studies exploring the quality of communication and teamwork in the OR. The findings do not paint a pretty picture—communication and teamwork failures occur frequently, causing not only tension in the OR but also compromising patient safety.

To try to improve this state of affairs, comparisons have been made with other industries to highlight the importance of teamwork and communication in the OR. Perhaps the most common—and the most irritating to OR teams—is comparison to the aviation industry. There are so many obvious differences between surgical patients and modern aircraft that we do not need to highlight them here. There is, however, an important similarity between the two industries: strong evidence exists that serious mishaps in aviation (plane crashes) and in the OR (the patient dies or is seriously harmed in the course of an operation) are frequently associated with breakdowns in communication and teamwork. Many of the important lessons that the aviation industry has learned from analyzing accidents have been adopted by the surgical community to improve the safety and quality of surgical care—the use of checklists is perhaps one of the most prominent ones.

In what follows, we highlight the uniqueness of OR teams, throw in a few anecdotes from the many hours (weeks, months, and years) we have spent being a “fly on the wall” in the OR, as well as a bit of scientific evidence—as we all love evidence-based medicine and practice—to help you appreciate the importance of communication and teamwork in the OR.