Human factors
impacted through reduced team efficiency, miscommunication, and lower standards of care. Delays, avoidable complications, and near misses are more likely in environments where team members are not aligned or respectful of each other’s contributions. Moreover, patient trust can be eroded if staff behaviour reflects internal conflict or visible tension. Addressing toxicity in the operating theatre
requires both cultural and structural change. This change must not only start in leadership but also in mentorship, where models of behaviour are passed on to healthcare workers. From the senior staff model, respectful, inclusive behaviour sets a powerful standard and footprint. Implementation of zero-tolerance policies for bullying and creation of clear, confidential reporting pathways, supporting whistleblowers, could support the change so much needed in healthcare. By fostering psychological safety, confidentiality, well-being and openness for wrongdoing should not be ignored. By acknowledging the problem, promoting respectful behaviours, and investing in non-technical skill development, healthcare institutions can move toward safer, more supportive, and high-functioning surgical teams. Non-technical skills are often developed
by training and consistent reinforcement to bring fundamentals to the service. Those skills can help build trust and collaboration in the operating theatres. (See Table 1) The incorporation of non-technical skills as a foundation for enhancing culture and teamwork in the operating theatre is not merely an addition to clinical training – it is essential. These skills transform a group of highly skilled individuals into a high-performing, adaptive team capable of delivering safe, efficient, and patient-centred care. Through cultural education, embracing differences, supportive leadership, structured communication, and an
Promote psychological safety
Create an environment where every team member feels safe to speak up, ask questions, highlight admin mistakes, and offer suggestions without fear, blame or humiliation. This can be fostered by encouraging open communication, regardless of hierarchy.
Training in non-technical skills
Incorporate regular training in communication, leadership, situational awareness, decision-making and teamwork. Frameworks like NOTSS (Non-Technical Skills for Surgeons); ANTS (for anaesthetists); and SPLINTS (for scrub practitioners) provide structure. - Conduct multidisciplinary simulation training - Provide feedback on both technical and non-technical performance.
Address incivility and bullying
Toxic behaviour must be addressed with clear policies and support mechanisms. - Implement and enforce anti-bullying policies - Provide confidential reporting systems - Support victims and hold offenders accountable
Use pre- and post-operative briefings
Structured team briefings before a procedure and debriefings
after enhance coordination. - Address anticipated challenges, patient specific risks, and team responsibilities
- Debrief to discuss what went well and what to improve Leadership development
Leaders set the tone. Train senior staff to lead with emotional intelligence, humility and clarity. - Promote ‘servant’ leadership and role modelling - Encourage mentors and coaching relationships
Celebrate team success and growth
Recognise collective achievements, milestones and use constructively.
- Use 360-degree feedback - Encourage peer reviews and reflective practice - Continuously review systems and processes, not just qualifications
Focus on staff wellbeing Support the physical and emotional wellbeing of all team members Table 2: Guide on the key actions to improve culture in operating theatres
unwavering commitment to team development, operating theatres can evolve into environments where excellence is a shared, ongoing pursuit. In doing so, the culture of the surgical workplace becomes not only safer but also more humane
and fulfilling for all involved. There is a very long path to embrace for a safety culture in the healthcare professional environment for learning, providing a safe culture place where the team is encouraged to prevent bullying or a toxic situation. That can be improved by encouraging individuals in surgical teams and other healthcare settings to lead change, while being open to talk about the existing problem. The ‘power’ of words and gestures can be very influential, especially for those who are new in the operating theatre setting and learning. It is everyone’s responsibility to make sure that medical and nursing students take away from theatres an inclusive culture where, above the pressure, all staff are valued equally, irrespective of background, past history of education, lived experience or professional grade. This ensures the best patient care, with full team effort. If we put patient care, safety, and great teamworking at the heart of what we do, we cannot go wrong.
CSJ July 2025 I
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