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Summary Several studies have reported on the negative impact of interruptions and distractions on anaesthetic, surgical and team performance in the operating theatre. This study aimed to gain a deeper understanding of these events and why they remain part of everyday clinical practice. We used a mixed methods observational study design. We scored each distractor and interruption according to an established scheme during induction of anaesthesia and the surgical procedure for 58 general surgical cases requiring general anaesthesia. We made field notes of observations, small conversations and meetings. We observed 64 members of staff for 148 hours and recorded 4594 events, giving a mean (SD) event rate of 32.8 (16.3) h‐1. The most frequent events observed during induction of anaesthesia were door movements, which accounted for 869 (63%) events, giving a mean (SD) event rate of 28.1 (14.5) h‐1. These, however, had little impact. The most common events observed during surgery were case‐irrelevant verbal communication and smartphone usage, which accounted for 1020 (32%) events, giving a mean (SD) event rate of 9.0 (4.2) h‐1. These occurred mostly in periods of low work‐load in a sub‐team. Participants ranged from experiencing these events as severe disruption through to a welcome distraction that served to keep healthcare professionals active during low work‐load, as well as reinforcing the social connections between colleagues. Mostly, team members showed no awareness of the need for silence among other sub‐teams and did not vocalise the need for silence to others. Case‐irrelevant verbal communication and smartphone usage may serve a physical and psychological need. The extent to which healthcare professionals may feel disrupted depends on the situation and context. When a team member was disrupted, a resilient team response often lacked. Reducing disruptive social activity might be a powerful strategy to develop a habit of cross‐monitoring and mutual help across surgical and anaesthetic sub‐teams. Further research is needed on how to bridge cultural borders and develop resilient interprofessional behaviours.

the quality of training and education. Lohman also stripped out a tier of management between them and the hospital's executive board, and in 2007 appointed a new chief medical officer, Melvin Samsom, a gastroenterologist with a strong research background, to drive quality improvement. Championing patient participation Samsom, who later became Radboud's chief executive, is widely credited with leading the hospital's renaissance. His enthusiasm for raising the quality and safety of patient care, for the opportunities and challenges that active partnering with patients provides, and for partnering to be extended is evident. 3 Radboud is now consistently ranked high in national comparisons of the quality and outcome of care, with cardiothoracic surgery results among the best in Europe. 4 The hospital has also acquired an international reputation for innovative ways of working with patients and helping them to take an active role in managing their health and improving care for other patients. Its ratings of patient experience and satisfaction are among the best in the Netherlands. Along with pinpointing poorly performing departments, Samsom identified strong units and staff with leadership skills. With their help, audit of the quality, safety, and outcome of