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The quality of teamwork among health care professionals is known to affect patient outcomes. In the OR, surgeons report more favorable perceptions of communication during procedures and of teamwork effectiveness than do nurses. We undertook a quality improvement project in the Veterans Health Administration to confirm reported teamwork differences between perioperative nurses and surgeons and to examine the implications of these differences for improving practice patterns in the OR. The Safety Attitudes Questionnaire, which measures safety culture, including the quality of communication and collaboration among health care providers who routinely work together, was administered in 34 hospitals. Perioperative nurses who participated in the survey rated teamwork higher with other nurses than with surgeons, but surgeons rated teamwork high with each other and with nurses. On five of six communication and collaboration items, surgeons had a significantly more favorable perception than did perioperative nurses. To increase the likelihood of success when implementing the use of checklist-based crew resource management tools, such as the World Health Organization's Surgical Safety Checklist, project leaders should anticipate differences in perception between members of the different professions that must be overcome if teamwork is to be improved.

DVERSE EVENTS RELATED TOsurgery continue to occur despite the best efforts of clinicians. 1 Teamwork and effective communication are known determinates of surgical safety. [2][3][4][5][6] Previous efforts at demonstrating the efficacy of patient safety initiatives have been limited because of the inability to study a control group. 7 For example, the use of the World Health Organization Safe Surgery checklist has been evaluated, but its overall efficacy remains uncertain because no control group was studied to clearly demonstrate this instrument's effectiveness. 6 The Veterans Health Administration (VHA) is the largest national integrated health care system in the United States, with 153 hospitals, 130 of which provide surgical services. The VHA implemented a national team training program and studied the program's effect on patient outcomes. The VHA began piloting team training that

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