BMJ Qual Saf 20:237-242 doi:10.1136/bmjqs.2009.039008
  • Original research

The relationship of the emotional climate of work and threat to patient outcome in a high-volume thoracic surgery operating room team

  1. Allan Frankel6
  1. 1Department of Anesthesiology, Hospital for Special Surgery, New York, USA
  2. 2Brigham and Women's Hospital, Boston, Massachusetts, USA
  3. 3Division of General Internal Medicine and Center for Surgery and Public Health, at Brigham and Women's Hospital, Harvard Medical School and School of Public Health, Boston, Massachusetts, USA
  4. 4Department of Anesthesiology, Newton-Wellesley Hospital, Massachusetts, USA
  5. 5Clinical Director of Perioperative Services, Boston Medical Center, Massachusetts, USA
  6. 6Pascal Metrics Inc, Sudbury, Massachusetts, USA
  1. Correspondence to Michael Nurok, 535 East 70th Street, New York, 10021, USA; nurokm{at}
  1. Contributors Michael Nurok, MD, PhD, Stuart Lipsitz, ScD, Andrea Kelly, RN, and Allan Frankel, MD, designed and implemented the study. Stuart Lipsitz, ScD and Linda Evans, RN, MSN, CNOR, performed statistical analyses. Michael Nurok, MD, PhD, Linda Evans, RN, MSN, CNOR, Stuart Lipsitz, ScD, and Allan Frankel, MD, analyzed data and prepared the manuscript. Raphael Bueno, MD, Margaret Doyle, RN, Philip Hartigan, MD, David Sugarbaker, MD, and their respective nursing, anaesthesia, and surgery teams facilitated and participated in this study as subjects. Richard Adamski, RRT MBA designed the data sheets. Richard Adamski, RRT MBA, Erin Graydon-Baker, RRT, Linda Evans, RN, MSN, CNOR, Michael Nurok, MD, PhD, Andrea Kelly, RN, Allan Frankel, MD, and Paul Satwicz, MD, participated in observations. Funding was provided by Partners Healthcare.

    At the time of this research, Michael Nurok was employed by the Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, MA and Allan Frankel and Andrea Kelly were employed by Partners Healthcare, Boston, MA.

  • Accepted 30 July 2010
  • Published Online First 5 January 2011


Context It is widely believed that the emotional climate of surgical team's work may affect patient outcome.

Objective To analyse the relationship between the emotional climate of work and indices of threat to patient outcome.

Design Interventional study.

Setting Operating rooms in a high-volume thoracic surgery centre from September 2007 to June 2008.

Participants Thoracic surgery operating room teams.

Intervention Two 90 min team-skills training sessions focused on findings from a standardised safety-culture survey administered to all participants and highlighting positive and problematic aspects of team skills, communication and leadership.

Main Outcome Measures Relationship of functional or less functional emotional climates of work to indices of threat to patient outcome.

Results A less functional emotional climate corresponded to more threat to outcome in the sterile surgical environment in the pre-intervention period (p<0.05), but not in the post-intervention or sustaining period of this study. This relationship did not exist in the anaesthesia or circulating environments of the operating room.

Conclusions The emotional climate of work in the sterile surgical environment appeared to be related to threat to patient outcome prior to, but not after, a team-training intervention. Further study of the relationship between the emotional climate of work and threat to patient outcome using reproducible methods is required.


  • Funding Partners HealthCare Inc., Boston, Massachusetts.

  • Competing interests During the period of this study, Allan Frankel was Director of Patient Safety at Partners Healthcare. He is currently a Principal at Pascal Metrics however the methods used in the study are unlike any that are currently being used and have no bearing on Pascal activity.

  • Ethics approval This study was conducted with the approval of the Partners Human Research Committee, Brigham and Women's Hospital/Massachusetts General Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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