Absence or presence: Silent discourse in the operating room and impact on surgical team action

Our objective was to examine the influence of silence on team action in the operating room. We conducted a constructed grounded theory study with semi-structured interviews with 25 interprofessional surgical team members. Using a framework of silence as communication and performance, transcripts were iteratively team-coded to develop themes and a conceptual model. OR silence is expressed verbally and nonverbally. Two contexts of silence were identified: homogenous as collective action, and disparate, as disengagement. Complex and dynamic, two primary themes emerged, Power that often shuts down communication, and Focus during critical moments. Five additional sub-themes included critical moments, respect, self-reflection, personal preference, and, bad mood. OR silence is not an absence of communication and requires a response. Whether homogenous through cohesiveness, or desperate as a solitary act, OR silence is a call to action. Examining silence as a part discourse has important implications on surgical team function. •Silence is an important part of communication.•In the operating room silence is complex and contains meaning.•During surgery silence can alter team perceptions of time and space.•Operating room silences require a response and inform team member action.•Silence as discourse during surgery has multiple purposes and interpretations.