Methods and Frameworks to Assess Operating Team Resilience: A Scoping Review

The operating room (OR) is a complex environment where errors significantly impact patient outcomes, and the ability of surgical teams to adapt and recover from unexpected disruptions-defined as resilience-is paramount. Frameworks offer structured approaches for analyzing resilience yet are variably applied throughout the relevant literature. This review aims to characterize how frameworks are used to study OR team resilience and examines the implications of inconsistent approaches.

After the Arksey & O'Malley framework, EMBASE, CINAHL, and MEDLINE were searched for studies published up to July 29, 2024. The search included keywords such as 'surgery' and 'resilience'. The included studies' reference lists were also manually searched. Studies focusing on the OR, examining the influence of human factors on team function and recovery, and reporting metrics for patient safety were included. Data extraction and content analysis were conducted independently by 2 reviewers, with results summarized narratively.

Of 3165 studies identified, 9 met the inclusion criteria. Two utilized the systems engineering initiative for patient safety framework, and 2 incorporated the Oxford non-technical skills tool, whereas the remaining 5 developed an ad hoc approach to study operating team resilience. Notably, only 2 studies classified themselves as part of the resilience literature.

This review demonstrates inconsistent framework application in surgical resilience research, resulting in methodological variability and limited cross-study synthesis. Developing frameworks specific to the OR is essential for advancing this field and improving study classification. Expanding search strategies to include resilience-adjacent terms will further enhance research visibility.