The operating room (OR) team consists of nurses, surgeons, anesthetists, respiratory therapists, scrub techs and more. Oftentimes, hierarchy and fear discourage junior (or lower hierarchical level) members of the team from speaking up when they notice something wrong. A narrative synthesis published in the February 2019 British Journal of Anesthesia evaluated several studies that focused on how effective communication is crucial in the OR for efficiency and most importantly for patient safety. A negative outcome caused by lack of communication can lead to serious complications or even the death of the patient. Crisis Resource Management (CRM) is a set of non-technical skills that are required for effective communication in the operating room. It emerged from the airline industry’s Crew Resource Management which was created to train junior pilots on the non-technical skills needed to ensure a safe flight. CRM consists of a set of competencies, including effectively challenging authority, and is used to train OR teams and other specialties.
The synthesis concluded that hierarchy, organizational culture and education were the top three barriers to effective communication in the OR. Addressing these barriers requires a consistent, multi-faceted approach that includes simulated scenarios that present OR teams with opportunities to speak up, training on the CRM method and incorporating tools such as a surgical safety checklist. Other barriers to speaking up in the OR include age, gender and interpersonal skills.