Facilitators of and barriers to teamwork between operating room nurses and other practitioners: a meta-synthesis of qualitative studies
Clinical Snapshot
PICO Framework
| P — Population | Operating room nurses and other healthcare practitioners in surgical settings |
| I — Intervention | Qualitative exploration of teamwork dynamics |
| C — Comparator | Not applicable (qualitative synthesis) |
| O — Outcomes | Facilitators and barriers to effective teamwork in operating rooms |
Bottom Line
This comprehensive meta-synthesis of 29 qualitative studies provides robust evidence for improving operating room teamwork. The research identifies five key facilitators (professional skills, role awareness, team familiarity, patient-centred culture, effective leadership) and five major barriers (individualistic behaviours, punitive management, hierarchical culture, environmental constraints, insufficient resources) operating across individual, interpersonal, and systemic levels. The findings offer a practical framework for perioperative leaders to enhance team collaboration through targeted interventions. While the study's strength lies in its international scope and comprehensive search strategy, the lack of explicit quality assessment methodology limits confidence in findings. Nevertheless, the consistent themes across diverse healthcare contexts suggest broad applicability. For Australian practice, these insights align well with existing perioperative standards and could inform quality improvement initiatives, particularly in implementing team-based safety protocols and addressing hierarchical barriers that may impede effective communication and patient safety.
Key Findings
P Value: Not applicable for qualitative synthesis
Effect Size: Not applicable for qualitative synthesis
Primary Outcome: Five key facilitators identified: professional skills, role awareness, team familiarity, patient-centred culture, effective leadership
Nnt Or Sensitivity: Five major barriers: individualistic behaviours, punitive management, hierarchical culture, environmental constraints, insufficient resources
Confidence Interval: Not applicable for qualitative synthesis
Clinical Application
Highly feasible - interventions target modifiable factors at individual, team, and organisational levels Highly relevant to Australian ORs. Aligns with ACORN standards and ACSQHC perioperative care standards. Could inform implementation of WHO surgical safety checklist and team-based care models under Activity Based Funding Operating room nurses, surgeons, anaesthetists, and other perioperative team members in acute care hospitals
Abstract
OBJECTIVES: Seamless collaboration in the operating room is the critical foundation for patient safety and successful outcomes. This synergy enhances efficiency, minimises errors and is a key determinant of the final surgical quality. The objective of this study is to synthesise qualitative studies on facilitators of and barriers to teamwork between operating room nurses (ORNs) and other practitioners. DESIGN: Systematic review and meta-synthesis of qualitative studies. DATA SOURCES: A systematic search was conducted across nine electronic databases: PubMed, Embase, Scopus, Web of Science (Core Collection), CINAHL, PsycINFO, CNKI, WanFang and Vip. The search covered the period from 1 January 2014 to 30 September 2025. The search strategy used both medical subject headings and free-text terms, supplemented by the snowball method and grey literature. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Qualitative studies exploring teamwork involving ORNs were included. Of 4839 initially retrieved records, 29 studies finally met the inclusion criteria. DATA EXTRACTION AND SYNTHESIS: Two researchers independently extracted data, including the author, year of publication, country, study design, study objective, interview location, number of participants, age, methods of data collection and analysis and duration of interviews. The key findings were synthesised into two overarching themes: facilitators (eg, professional skills, role awareness, team familiarity, patient-centred culture, effective leadership) of and barriers (eg, individualistic behaviour, hierarchical culture, insufficient resources, punitive management, environmental constraints) to teamwork between ORNs and other practitioners. A meta-synthesis was conducted to synthesise study results from different groups and countries. NVivo 15 was used for data management. RESULTS: A total of 29 qualitative studies (published between 2014 and 2025) were included in this study. Key facilitators of teamwork included professional skills, role awareness, team familiarity, patient-centred culture and effective leadership. Major barriers encompassed individualistic behaviours, punitive management, hierarchical culture, environmental constraints and insufficient resources. These factors worked across individual, interpersonal and systemic levels to shape OR teamwork. CONCLUSION: Optimising OR teamwork requires a multifaceted approach simultaneously addressing these facilitators and barriers. Interventions should simultaneously cultivate individual competencies (eg, skills, role awareness), foster positive team dynamics (eg, familiarity, psychological safety, inclusive leadership), and rectify systemic issues (eg, hierarchical culture, resource constraints, punitive management). In this way, teamwork between ORNs and other practitioners can be enhanced, thereby contributing to improved perioperative safety and outcomes. PROSPERO REGISTRATION NUMBER: CRD42024506414.
References
- 1.Chen, Y., Zhang, Y., Zhang, J., & Luo, J. (2026). Facilitators of and barriers to teamwork between operating room nurses and other practitioners: a meta-synthesis of qualitative studies. BMJ Open. https://doi.org/10.1136/bmjopen-2024-098386
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