Surgical teamwork: systemic functional linguistics and the analysis of verbal and non verbal meaning in surgery

Purpose: Surgeons rely on teamwork, yet beyond an appreciation that some teams are more enjoyable to work in than others, or more effective, there is little understanding of the myriad complex interactions that make teamwork possible. Techniques of systemic functional linguistics permit objective analysis of behaviour (often subtle or subliminal) that carries meaning; these techniques can be applied to surgical teamwork. Methodology: Linguists came into the operating room initially for unobtrusive note taking and sketching. Increasing familiarity over several months allowed detailed audio visual analysis of surgery. Surgical sequences were recorded and analysed using Elan software. Recurring patterns of meaning were identified and catalogued. Results: The techniques surgeons and their team members use to exchange meaning is made explicit in this study, which brings out the systemic character of the options for meaning available to surgical team members. A grammar, albeit one that encompasses meaning through gesture, touch, body position and gaze, as well as speech, is presented. This grammar captures not only the conventions, rules and consistencies of the surgical ensemble, it also brings out the rhythm, tone, and nuance of the teamwork interactions. Conclusion: It is possible to analyze the subtle nuances of interaction that constitute teamwork during surgery. We hope that this work will help demystify the operating room and make it easier for junior staff to understand what is being “said” while making it possible for more experienced staff to recognize and optimise the teamwork so essential for the realization of a complex modern operation.