ABSTRACT
This chapter describes patterns of silence in the operating room (OR), considers the actions and relations that the silences embody and discusses their implications for sophisticated evaluation of the communicative behaviour of OR teams. Many in the domain of surgical performance research have developed tools to objectively evaluate team communication. Researchers studying OR team performance have sought to address the deficit by developing tools that include in their purview the objective evaluation of team communication. ‘Counting silence’ is a complicated but necessary business for performance evaluation for safer surgery: silence can promote safety when team members ‘count to ten’ and think before acting, and it can undermine safety when team members fail to cross-check and respond to one another’s questions. Assessing the effectiveness of educational interventions requires appropriate measures of team communication. The challenge in creating such measures is to provide analytical traction while continuing to reflect the complex, often subtle and evolving nature of team communication.
