Creating safe atmospheres in surgery: experience one, create one, teach one

INTRODUCTION This study extends previous work on psychological safety in surgical multidisciplinary teams (MDTs) by analysing the ways that leaders try to create or maintain a ‘safe atmosphere’: one in which team members feel that they can talk about issues that cause them concern. METHODS For this qualitative study of atmospheric work in MDTs, semi-structured interviews were carried out with 53 clinical and 7 non-clinical staff who work in NHS hospitals. They related their experiences of surgical team leadership between the 1980s and 2022. RESULTS Our findings reveal how surgical leaders’ atmospheric work involves the use of bundles of activities designed to encourage people to speak up, particularly during operating lists. These activity bundles can also be used as a training tool to prepare others to recognise and participate in a safe atmosphere. The leadership activities can be used by team members individually and collectively across MDTs’ different roles, and not just by the most senior surgeons. CONCLUSIONS Participants identified that atmospheric work can create a safe atmosphere and improve patient safety, a process we term ‘templating’. Currently, however, there are only limited attempts to build on this potential of atmospheric work in NHS hospitals.