Setting the Tone in the Operating Room: a Model Guided By Emotions as Social Information Theory

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Team communication in the operating room is considered a key patient safety factor although communication failures continue to be exceedingly common. The attending surgeon is largely responsible for setting and modifying the tone of the operating room team. Existing literature suggests that the tone of the operating room may affect quality of communication, psychological safety, and ultimately, patient safety. Using Emotions as Social Information theory as a framework, we present a model which explains how emotional expression of the attending surgeon may be processed by other members of the operating room team to influence their behaviour. In response to the attending surgeon, the interaction of team members’ behaviours produces (either through setting, maintaining or altering) the tone of the operating room which influences quality of communication. The model discusses contextual factors of the operating room (i.e. role, shared mental models, hierarchy, cultural norms, and team familiarity) to explain how the observer, that is, the operating room staff observing the behaviour of the attending surgeon, understands and processes information relayed by the attending surgeon. These contextual factors interact to produce the observers’ affective reaction and inferences, in varying weights, about the situation at hand to shape their behaviour. We propose several directions for future research to advance team communication: expansion and empirical studies of the proposed model, investigation of how individual behaviours interact to produce tone, factors related to surgeon emotions, and how behaviours feedback into the proposed model to shape future behaviours.