title: Foundations for teaching surgeons to address the contributions of systems to operating room team conflict.
abstract: BACKGROUND
  Prior research has shown that surgeons who effectively manage operating room conflict engage in a problem-solving stage devoted to modifying systems that contribute to team conflict. The purpose of this study was to clarify how systems contributed to operating room team conflict and clarify what surgeons do to modify them.
  
  
  METHODS
  Focus groups of circulating nurses and surgeons were conducted at 5 academic medical centers. Narratives describing the contributions of systems to operating room conflict and behaviors used by surgeons to address those systems were analyzed using the constant comparative approach associated with a constructivist grounded theory approach.
  
  
  RESULTS
  Operating room team conflict was affected by 4 systems-related factors: team features, procedural-specific staff training, equipment management systems, and the administrative leadership itself. Effective systems problem solving included advocating for change based on patient safety concerns.
  
  
  CONCLUSIONS
  The results of this study provide clarity about how systems contribute to operating room conflict and what surgeons can do to effectively modify these systems. This information is foundational material for a conflict management educational program for surgeons.
authors.affiliation: Department of Surgery, University of Alabama at Birmingham, 35294, USA. darogers@uab.edu
authors.forename: David A
authors.initials: DA
authors.lastname: Rogers
authors.forename: Lorelei
authors.initials: L
authors.lastname: Lingard
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Boehler
authors.forename: Sherry
authors.initials: S
authors.lastname: Espin
authors.forename: Nancy
authors.initials: N
authors.lastname: Schindler
authors.forename: Mary
authors.initials: M
authors.lastname: Klingensmith
authors.forename: John D
authors.initials: JD
authors.lastname: Mellinger
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D005260:Female; D017144:Focus Groups; D013502:General Surgery / Q000193:education*; D006801:Humans; D007857:Leadership; D008297:Male; D017008:Negotiating; D009726:Nurses / Q000523:psychology; D009873:Operating Rooms / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration*; D010820:Physicians / Q000523:psychology; D011340:Problem Solving
keywords: Conflict management education; Operating room conflict; Systems contributions