Anne van Dalen

General Introduction I 17 Teamwork Teamwork and safety culture, have been identified as key ingredients to the delivery of safer surgical care. 36 37 Teamwork is defined as the collaborative effort of a group to achieve a shared goal. 38 Culture is defined as the assumptions people hold about relationships with each other and the environment that are shared among an identifiable group of people (e.g. team, organization, nation) and manifest in individual’s values, believes, social behaviour norms and artefacts. 39 The impact of cultural differences and safety attitudes on teamwork has been recognized. 37,40 The operating room is a unique high-stress environment with different professionals roles and genders, whose goals and training differ widely but who are regardless required to work closely together. 41,42 For good teamwork, it is hence important to ensure a shared mental model, by creating an environment in which the entire team knows what is expected and what by each member of the team is found important. 43,44 Nevertheless, previous research has demonstrated that operating room staff may have discrepant attitudes concerning the teamwork they experience with each other, which may be the result of differences in status or authority, responsibilities and cultures. 43,45 Situational Awareness As explained by Graafland et al. 46 , situational assessment results from a multitude of information sources in the modern operating theatre. The perception of reality of the team is not always accurate, which is caused by cognitive, communication, teamwork and environmental factors. 46 Situational awareness can be viewed as the product of an individual’s perception and comprehension of the available information, and expectations towards the future course of the procedure. 47 It may occur at both individual and team level, both relying heavily on teamwork and communication. 48 In conclusion, the team’s situational awareness emerges from coordination and communication between all members of the operating team. 41,48 This is best described by Endsley’s model as shown in Figure 2. 46