The surgical team in a hospital operating room consists of several skilled professionals, each from different specialties.

The number and variety of people involved depends on the type of surgery. The following describes the roles and responsibilities of surgical team members in a “typical”

surgical operation. Some titles and duties vary across jurisdictions. This information refers only to “intraoperative”

tasks (during the operation); most roles also have numerous duties both before and after the operation.

The surgeon leads the operation and is the main person conducting the physical surgical intervention. The surgeon is directly assisted by a resident physician, intern, or nonphysician surgical assistant who provides a second pair of hands and eyes for the surgeon. This assistant performs suctioning, sponging, suturing, retractor holding, and related hands-on duties. The individual also monitors the patient’s vital signs and other indicators of patient health.

The third role within the “sterile field” (inside the sterile drape area of the operating room) is a scrub nurse (also called surgical or instrument nurse), although this role is alternatively called or filled by a surgical technologist. During the operation, the scrub nurse (or surgical tech) arranges all of the surgical equipment and supplies, carefully hands them directly to the surgeon and surgeon’s assistant, and removes used items from the operative field. This person also assembles some of the equipment, which others on the surgical team might not know how to do. The scrub nurse also maintains a count of the surgical items. This role sometimes also acts as the surgeon’s third set of hands, for example by holding an incision open with a retractor where the surgeon and assistant are working.

Both the scrub nurse and surgical assistant need to fully understand the surgical procedure so their behaviors are synchronized with the surgeon’s activities. For example, the scrub nurse needs to know what instruments are required for each step of the operation so they are handed to the surgeon without unnecessary communication or delay.

The anesthesiologist and usually an assistant (e.g., nurse anesthetist) are responsible for closely monitoring the patient’s vital life functions, such as breathing, heart rate and rhythm, blood pressure, body temperature, and body fluid balance. They apply anesthetics to block local sensation or render the patient unconscious during surgery, and administer other medications to stabilize other vital functions.

The anesthesiologist works in the operating theater but is usually located outside the sterile field of the operation

(i.e., not in direct or close contact with the patient or the surgeon’s instruments during the operation).

The circulating nurse also works in the operating theater but away from the sterile field. This person has overall responsibility for the operating room, particularly monitoring for any events that might compromise sterility during the operation. This person documents all procedures, actions, and events during the operation. The circulating nurse also interacts with the scrub nurse by opening supply packages

(without touching their contents) and providing additional resources (e.g., more sponges), as needed.

Surgical operations are completed under time pressure to reduce the risk of disease, effects of medications, and other complications from the surgery. Surgical team members talk to each other, mostly involving operational requests or observations, but most operations have considerable silence to minimize distraction and risk of airborne contamination. Some surgeons in specialized clinics have a dedicated team, but most hospital surgical teams have different members for each operation.

Discussion Questions 1 From the information presented in this case, diagnose the task complexity, task variability, task analyzability, and task interdependence of a typical operating room surgical team. Do these task characteristics vary among the members of this team? To what extent are these task characteristics best suited to teams than to individuals working independently of each other?

2 Explain whether and to what extent team mental models

(shared and complementary) are important for effective performance of an operating room surgical team?

3 What team norms might exist in a surgical team, even though most teams have different members for each surgical operation?