Health Care Groups and Teams Article Review

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The article “Communication failures in the operating room: anobservational classification of recurrent types and effects”discusses the negative effects of poor communication between teams inan operating room, OR. Lingard et al. (2004) explains that mostfailures that happen during operations are as a result ofcommunication events, which were ineffective. The authors conduct astudy with the objective of unfolding the characteristics of failuresin communication that happen in the operating room. In addition, theauthors describe the effects of these failures and providerecommendations on how to improve team communication.


The article presents a formal group and a functional team.

Formal Group – these refers to the individuals that are broughttogether by an organization to fulfill a common task (Burns, Bradley&amp Weiner, 2012). The operating room comprises of health carepersonnel who have been selected by the hospital and assigned toperform surgical procedures in the operation room. They work towardsthe common task of operating on the patient.

Functional Team – individuals in this kind of team synchronizetheir efforts with the objective of producing results for theorganization (Burns, Bradley &amp Weiner, 2012). In the datacollection section of the article, the authors note that data wascollected during operation procedures that involved general as wellas vascular surgery. Hence, the medical personnel involved inperforming the surgery form the functional team because they ensurethat a hospital is able to provide general and vascular surgicalservices. Also, the operating room is a department that comprises ofan OR team. The article identifies these team members as medicalpractitioners in charge of anesthesia, surgery as well as nursing.The different teams work together to fulfill the organizational goalsof performing surgeries.

Communication Failures

Information collected from the article’s study involvedobservation of 421 communication events that happen in the operatingroom. The events range from brief to more inclusive communication. Anillustration of a brief communication is a question that requires adirect answer. On the other hand, inclusive communication requiresthat the team members communicate for a long period. For instance,team members may discuss about a patient who has lost too much bloodduring the surgical procedure. Out of the 421 events, 129 wereclassified as communication failures. The article categorizes thefailures into four types. These are:

Occasion Failures – refers to the failures that happen during thecommunication event between the team members. For instance, a surgeonmay ask if the anesthesiologist has given antibiotics to the patient.Supposing that the surgeon asks the question when the surgery hasbeen performed for one hour. It is an occasion failure becauseantibiotics are supposed to be administered within the first 30minutes of surgery.

Content Failures – they occur due to lack of relevant informationduring communication. An illustration provided in the article is whenthe anesthesia staff inquires from a staff surgeon whether anintensive care unit bed has been reserved for the patient beingoperated on. The surgeon responds by noting that the bed may not berequired and it is likely that there is a bed. Pertinent informationhas been omitted from the communication due to the unresolved issueof an ICU bed.

Audience Failures – the failure happens when communication happensin the absence of an important team member. For example, theanesthesiologist and nurse may talk about the positioning of the sickindividual during surgery in the absence of a surgeon. Surgeons havespecific ways they prefer a patient to be positioned. Hence, acommunication failure may occur when the decision is made in theabsence of a surgeon.

Purpose Failures – the failures happen when the reason forcommunicating is not achieved. The article provides an example ofnurses discussing if ice is required in a basin being prepared forthe liver during liver resection. None of the nurses has an answer,but they do not discuss the issue further. The purpose of thecommunication is not achieved as it does not become clear whether iceis needed or not.

Lingard et al. (2004) note, occasion failures were the most common,which occurred when information was provided late. Content failurescomprised of communication events when important information wasmissing and when there was exchange of wrong information. Purposefailures in the operating room happened when teams did not meet theircommunication objectives, specifically when an important issue wasnot resolved. All the audience failures in the study concerned theabsence of a major team member in the event of a communication event.In most cases, the missing team member was a surgical representativenot involved in the setting up of operation equipments, how toposition and draping a patient.

Effects of Communication Failures on Team Performance/ QualityPatient Care

According to the Joint Commission (2012), communicationfailures can result in damaging effects within a health careorganization. The commission notes that close to 80% medical mistakesthat happen in organizations are as a result of ineffectivecommunication. 60% of the failures lead to patient deaths. Lingard etal. (2004) conducted analysis of all the identified communicationfailure in the operation room to validate if they led to visibleeffects. The authors concluded that “36.4% of communicationfailures resulted in visible effects on system processes whichincluded inefficiency, team tension, resource waste, workaround,delay, patient inconvenience and procedural error (Lingard et al.,2004).”

Communication failures most likely to cause visible effects areoccasion and purpose. Fewer observable effects arise from audience aswell as content failures. Both team performance and the delivery ofquality patient care were affected by the failures.

Team Performance

Inefficiency – owing to communication failures, team members arelikely to become ineffective. This is apparent when team members arerequired to repeat or undo an operation procedure.

Tension – failures in communication could result in tension amongthe team members. For instance, when a team member receive aninaccurate response, or is not fully informed on how to perform atask, they may continue to perform a task, but nervously.

Delay – it is possible for delays to happen in the surgicalprocedure owing to ineffective communication. This mainly happenswhen communication about the operation happens in the absence of oneof the team members. For instance, when nurses decide on thepositioning of a patient in the absence of a surgeon, once thesurgeon arrives they may be compelled to repeat the activity and meetthe positioning needs of the surgeon. This results in delay.

Delivery of Quality Care

When team members work under tension, it affects their ability towork effectively, which could result in medical errors. As such thepatient’s life is at risk. Communication failures may result inprocedure errors, whereby surgical procedures are performed in thewrong way.


Burns, L. B., Bradley, E. H., &amp Weiner, B. J. (2012). Shortelland Kaluzny’s health care management: Organization design andbehavior (6th ed.).Clifton Park, NY: Delmar.

Joint Commission. (2011). Summary Data of Sentinel EventsReviewed by the Joint Commission. Retrieved from:

Lingard, L., Espin, S., Whyte, S., Regehr, G., Baker, G. R., Reznick,R….Grober, E. (2004). Communication failures in the operating room:an observational classification of recurrent types and effects.Quality Safety Health Care, 13, 330-334.