Structured team communication in a simulated operation: an ethnographic approach

Tanisha Jowsey, Carmen Skilton, Simone J Dennis, Jennifer Weller



Effective communication between operating room staff is widely acknowledged as an essential element that contributes to patient safety. Various structured communicative practices have been proposed to optimise patient safety in operating rooms.


We introduced a structured communication tool to a clinical simulation training programme that Weller and colleagues (2014) proposed for optimising patient safety during an anaesthetic crisis. The tool comprises six elements: stop, notify, assess, plan, prioritise, and invite ideas (SNAPPI). We wanted to know whether people would use the tool and the qualitative effect this tool would have on their practices. We studied 120 operating theatre staff participating in the MORSim study (a multidisciplinary operating room simulation team training study) who were shown the SNAPPI tool and then encouraged to use it during a simulated surgical crisis. The simulation was observed by members of the research team and filmed. The film was later analysed using ethnographic methods of observation to create structured field notes, which formed the data. SNAPPI scores were assigned to each surgical team based on clear SNAPPI use. We applied an ethnographic approach to the data analysis for understanding how communication manifests in the operating room. In this paper we look at the bearing that structured communication had on team engagement.


Communication is central to social interaction. In the context of an anaesthetic crisis the effectiveness of communication can be critical to informing patient safety and wellbeing. Participants in the MORSim training utilised the SNAPPI tool as a strategy to optimise communication during the simulated anaesthetic crisis.

Conclusions and implications

Operating room staff can utilise structured communication tools during simulated anaesthetic crisis. Use of structured communication tools such as the SNAPPI seems to facilitate the sharing of mental models.


Keywords: communication; simulation; operating room; medical; staff training; education; teamwork; observation

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