TABLE 2.

Teamwork Themes and Subthemes Identified Using Framework Analysis

Theme	Subtheme	Description of behavior marker	Example
Backup behavior	Offer and/or ask for help	Recognized when assistance was needed and asked other team members for support.	A Medical Trainee needs saline, but the Scrub Nurses are busy counting, so the Circulating Nurse says: “Here, here, I’ve got it.”
Coordination	Check-back	Closed-loop communication used (ie, when a message was sent, the receiver acknowledged it was heard and repeated it back; the sender confirmed it was heard correctly and clarified if it was not).	Surgeon asks: “Cautery up to 80 spray.” Circulating Nurse confirms: “80?” Surgeon responds: “Yeah.”
	Precise communication	Message was communicated with all relevant details.	Surgeon asks: “Can I get a stapler—60 Purple?” as opposed to simply stating: “Can I get a stapler.”
Psychological safety (PS)	Admit mistakes	Openly described errors committed.	Surgeon has made an error and is tracing steps back “Ok, let’s see what I did here. Lots of bleeding, great. Where did we say I put a hole into… there, right?”
	Speak up	Verbalized a personal or team safety concern.	The patient has a latex allergy. A Nurse stops the Medical Trainee from scrubbing in wearing normal gloves and says: “The patient has a latex allergy.”
	Be solution-oriented	Provided a message focused on problem-solving and avoided assigning blame to the operator.	A Medical Trainee is putting the drape on the patient incorrectly. The Circulating Nurses steps in and says “OK, so let’s throw this out. You can’t put this drape on [correctly] by yourself” and gets another drape to start again together.
Situation assessment and shared mental models (SASMMs)	Give updates	Communicated the status of activities or responsibilities to team.	Surgeon has successfully retrieved the gastric band and notifies the OR team that: “It’ll be coming out in two pieces.”
	Conduct briefs	Instructed or informed team about the operative plan.	Surgeon says: “So we’re gonna continue this side and immobilize as much as you can. And then we’ll start stapling….just immobilize the whole line down all the way to the sigmoid.”
	Huddle to problem solve	Brought team together to problem solve.	There’s a lot more bleeding than the Surgeon expected so they ask the OR team for the status on the patient’s blood consent and for input. The Nurse confirms blood consent, Anesthesia asks: “Are you encountering some bleeding? Do you want 1-2 units ready?” The Surgeon confirms this would be good and the Nurse dials the phone and confirms 2 units are available.
Team decision-making and planning (TDMP)	Open to feedback	Asked for suggestions and constructive feedback.	Medical Trainee is stapling the bowel and asks the Surgeon: “are you happy with my position?” The Surgeon is not, so Surgeon guides the Trainee to the right spot.
	Encourage participation	Encouraged team members to acknowledge other team members’ opinions.	Surgeon and Medical Trainee discuss how they want to complete the transection. After the Trainee provides a suggestion by “thinking out loud,” the Surgeon says, “that’s a good idea.”
	Ask others for input	Prompted team members to contribute by asking for their insights or ideas on the plan.	Surgeon asks the OR team’s opinion on whether they need to do a cross stitch to prevent anastomotic leaking: “I don’t know. Do you think we need it?”
Team leadership (TL)	Guidance	Supported others by providing direction and coaching.	Surgeon tells Medical Trainee “This is a good place to use a sponge. You don’t have to, but it’ll stop the bleeding.”
	Delegate tasks	Assigned tasks based on role and workload.	OR team is moving patient from surgical table to postop bed. Anesthesiologist asks the Circulating Nurse to move the bed down so they can focus on patient’s head positioning.
	Give feedback	Provided information about reactions to a situation or team member performance of a task.	While the Surgeon directs the Medical Trainee on how to use the harmonic they say “Your left hand goes in there now. Perfect. No no, with your right hand, push some of these things down. Correct, like that. And this hand you want it to be… nope. Right there to the bottom.”
	Informal leadership	Took initiative or provided direction if the task required action.	The Medical Trainee asks for an instrument, but there are none in the OR, so the Nurse goes to retrieve one from inventory.