Background: Ineffective team communication is frequently at the root of medical error. The objective of this study was to describe the characteristics of communication failures in the operating room (OR) and to classify their effects. This study was part of a larger project to develop a team checklist to improve communication in the OR. Methods: Trained observers recorded 90 hours of observation during 48 surgical procedures. Ninety four team members participated from anesthesia (16 staff, 6 fellows, 3 residents), surgery (14 staff, 8 fellows, 13 residents, 3 clerks), and nursing (31 staff). Field notes recording procedurally relevant communication events were analysed using a framework which considered the content, audience, purpose, and occasion of a communication exchange. A communication failure was defined as an event that was flawed in one or more of these dimensions. Results: 421 communication events were noted, of which 129 were categorized as communication failures. Failure types included ''occasion'' (45.7% of instances) where timing was poor; ''content'' (35.7%) where information was missing or inaccurate, ''purpose'' (24.0%) where issues were not resolved, and ''audience'' (20.9%) where key individuals were excluded. 36.4% of failures resulted in visible effects on system processes including inefficiency, team tension, resource waste, workaround, delay, patient inconvenience and procedural error. Conclusion: Communication failures in the OR exhibited a common set of problems. They occurred in approximately 30% of team exchanges and a third of these resulted in effects which jeopardized patient safety by increasing cognitive load, interrupting routine, and increasing tension in the OR.R ecent evidence suggests that adverse events resulting from error happen at unacceptably high rates in the inpatient setting 1 and that ineffective or insufficient communication among team members is often a contributing factor. 2 3 In fact, communication failures have been uncovered at the root of over 60% of sentinel events reported to the Joint Commission on Accreditation of Healthcare Organizations. 4 Coroner reports also expose the role of communication in error: a recent inquest report cited ''communications difficulties at all levels of the hospital, including doctors to doctors, doctors to nurses, nurses to nurses and nurses to doctors'' as the primary cause of errors leading to the death of a paediatric patient. 5 There is a growing literature on the critical relationship between teamwork and safety in health care. 6 7 The trend in this literature is towards studying teamwork as a cluster of behaviours-for example, leadership, technical skills, coordination, situational awareness, communication-and producing multidimensional schemes to capture the quality of teamwork. [8][9][10] While these models have reinforced the importance of communication in effective team function, their multidimensionality precludes in depth attention to the individual variable of communication. Theory based attention to communication i...

Qualitative research in general and the grounded theory approach in particular, have become increasingly prominent in medical education research in recent years. In this Guide, we first provide a historical perspective on the origin and evolution of grounded theory. We then outline the principles underlying the grounded theory approach and the procedures for doing a grounded theory study, illustrating these elements with real examples. Next, we address key critiques of grounded theory, which continue to shape how the method is perceived and used. Finally, pitfalls and controversies in grounded theory research are examined to provide a balanced view of both the potential and the challenges of this approach. This Guide aims to assist researchers new to grounded theory to approach their studies in a disciplined and rigorous fashion, to challenge experienced researchers to reflect on their assumptions, and to arm readers of medical education research with an approach to critically appraising the quality of grounded theory studies.

Six key questions will help readers to assess qualitative research