Ethnography of Operating Room Culture and Team Dynamics

Introduction

The cultural scene explored in this ethnography is an operating room. The individual participants in a typical operating room setting are: primary surgeon, second surgeon, surgical assistant, surgical technician, anesthesiologist, nurse anesthetist, scrub nurse, and a circulating nurse. There is also a holding room nurse and a recovery nurse — not specifically inside the operating room but involved nonetheless in the surgery and recovery. The participants require highly specialized training to be able to perform their chosen roles successfully. The common goal of all these individuals is the successful performance of an invasive medical procedure, generally for the purposes of improving or even saving a life. The patient is, for the duration of the procedure, the total focus of every person in that room — years of experience and dedication devoted to those hours in which a human life is genuinely and quite literally in their hands.

Throughout the course of this paper, I hope to elucidate not only the specific function of the aforementioned individuals but also the value they have ascribed to their individual roles. Through firsthand observation, I had the unique privilege of observing two surgical procedures, one of which is used as a vignette below. I also had the chance to meet and interview several of the regular participants in my chosen cultural scene, which provided invaluable information in truly understanding what I was experiencing as a member of the scene. Retrospectively, I am able to look back on the experience and consider what I might have done differently, as well as what factors may have influenced not only the data but the experience itself. Finally, I hope to reflect on this learning experience, appraising the social, cultural, and psychological value of my newly acquired knowledge.

Cultural Description of the Operating Room

The best and most succinct description of my chosen scene was offered by the surgical technologist I had occasion to speak with: "In the OR, we're like a single organism, all connected, working towards one goal — the successful completion of which is central to our continued existence." Initially I did not understand how that could be true when the diverse and complex roles of each participant demanded autonomy and expertise in their own right. However, after observing a procedure, the analogy made perfect sense. Once in the midst of a procedure, it is as though each participant is anticipating the needs and actions of every other participant. They are prepared for the best, worst, and most likely scenario, and act as a single-minded, flawless, and precise unit.

The most striking aspect of this whole event is that these teams are not always assembled from the same people. Nurses, anesthesiologists, and surgeons are all interchangeable depending on the procedure, the day, the time, and the relative urgency of the situation. Essentially, each individual must know their role in any procedure so thoroughly that, regardless of who comprises the rest of the team, they are able to function with the same level of confidence and expertise. Understanding how operating rooms are organized helps illustrate why this adaptability is so critical to patient safety.

A day in the life of an operating room is not terribly indicative of the social scene in which I am interested. The room is simply a sterile space with technical equipment until it is in use. Then, as though elevated to something more than floor, walls, and a ceiling, it takes on a surreal energy — alive with the hurried, hushed movements that will decide a patient's longevity. An operating room will see several surgical procedures on a given day, nearly analogous to a revolving door, holding a diversity of procedures as well as outcomes. In the quiet between procedures, it is simply a room.

In this setting, categories are predetermined and very clearly defined, organized according to job and tenure within that field. As I had anticipated, it was the primary surgeon who led the carefully choreographed procedure — conducting, if you will, a multipart orchestra in which all players have vital roles. The primary surgeon was responsible not only for successfully achieving the surgical goals but also for assessing the relative efficacy of the anesthesia, the patient's vital statistics, and directing the secondary surgeon, surgical assistant, surgical technologist, anesthesiologists, nurse anesthetist, and scrub nurse. This included determining what order to utilize chemical agents, when to retrieve sterile instruments, and requesting additional materials as well as the removal of waste materials and no-longer-needed instruments.

With that level of control comes the heavy responsibility of being largely accountable for the success of the procedure and the life of the patient. Though it was undoubtedly the primary surgeon who held the role of leader during the procedure, without the careful preparation of the surgical technician and the dedication of every other person in that room, no successful surgical procedure would be possible. The primary surgeon is in charge and will ultimately be the first held to account if something goes wrong, but his actions are very nearly of equivalent value to those of the other individuals physically acting upon the patient.