Table 2 Coding system for interview analysis

Task management (k = .88)*

Planning

It’s more that you see, in patients who are at a certain age and have comorbidities, that you really consider how far you can go in a procedure, what their limitation is, as far as one can gauge this, with respect to operative time, with respect to blood loss, regarding pain level… So that you anticipate, so that that one defines clear parameters. [S12]

Task distribution

Well, that someone does not possess the skills for the task at that moment. (…) That we swap with each other, so that the distribution of tasks works again and we can carry on. [N04]

Prioritisation

It also depends on the importance because if there are problems with the patient, then of course I’m first going to call on one of the anaesthesia consultants, before I unpack any material. [N04]

Delegation

Or I realise, I need something really urgently, then I know I can send someone outside, and then it will be brought. [N01]

Clarification of task

For example, if there is nothing mentioned on the list of split-skin grafting, if you cannot quite close the wound, then I can ask, don’t you need split-skin, can you close the wound like this and so on. [N06]

Assistance

The scrub nurse in the sense that when I realise that she can’t really reach over to the surgical field, that I lend her a hand so to speak. [S02]

Team and process monitoring (incl. routine checks)

In the beginning, before the operation starts, there are checklists (…). We have also, in my opinion a very efficient and good checklist, it also gives a lot of security and confidence that you really think of things that are important. Everyone needs to be involved; the anaesthetist, the surgeon and the nurses. [N11]

Information management (k = .85)*

Procedure and patient related information

When intraoperatively some bullshit happens, when you cut into some vessel and then it bleeds or some such thing, any unforeseen events (…) that has to be communicated immediately. [S09]

Situation assessment

I must have a willingness not to rush through this procedure as a lone fighter, but keep eyes and ears open, around me. When I hear in the background, the patient, the sound of the monitor there behind the green cloth is getting slower, there sits an inexperienced anaesthesia trainee. (…) This requires attention from all team members to the other team members, what do they need, what do they want. [S08]

Team member information

I need to know basically what the other person knows. If I do not know (…) I have to check. [N05]

Decision making

If I notice surgically for example, that’s not what we expected, then you have to discuss the plan anew (…) and that is only possible as a team. This requires communication to come to a joint decision on the onward progress of the operation. I think it is wrong for one to then decide alone. [S08]

Teaching (k = .94)*

Explanation/guidance

There may be an intern for example, who is allowed to do something in the OR, for example sew up a wound, and he doesn’t do terribly well or has not often sewn, then you can teach him or help him. [S10]

Balancing teaching and other tasks

But there are those [procedures] that are more difficult, or the doctors are nervous, or it bleeds, then you have really no time, you have to concentrate on the operation. (…) Then you cannot look after anyone in addition. But most often this phase is over quickly, and then you can concentrate on the trainee on top of everything. [N07]

Leadership (k = 1)*

Leadership role

But I think it’s a co-dominance there, because everyone has his own specialty and for his specialty the ultimate authority. [S02]

Change of leader

That perhaps the surgeon has the lead, but the anaesthetist says, hey, now you have to stop the patient is in pain, you have to wait now. [N07]

Challenging moments (k = .71)*

Unexpected situations

If it’s a big case, then the surgeons can choose a completely different approach intraoperatively. Simply because vessels are not such as one had hoped, or because it bleeds more or because there is an infection, you have not seen from the outside, that can alter a procedural step considerably. [N13]

Anticipated challenges

If an intricate step of the operation (…) where they have sewn small vessels under the microscope, which simply must be done well, quickly and cleanly, which is a step where everyone knows this is not the time to just ask some questions about something else, it takes maximum concentration. [S14]

Climate (k = 1)*

Communication openness/work atmosphere

But the nursing assistant, I find, also has the right, if she sees something, if what I do is not good, that she tells me that, that’s something I expect. [N16]