Viewing patient safety in surgery through the lens of a theatrical performance: a narrative review.

Abstract

Background: In the high-stakes environment of the operating room (OR), patient safety depends not only on technical expertise but also on seamless communication, clear roles, and coordinated teamwork. Traditional approaches often overlook the relational and performative dimensions of surgical care.

Methods: This narrative article proposes a metaphorical framework that compares surgical practice to live theater, where each team member plays a rehearsed role, and protocols act as scripts. The study explores key themes such as preparation (rehearsals), intraoperative coordination (live performance), and structured debriefing (curtain call). The aim is to synthesize knowledge from clinical literature and human factors theory to provide a novel interpretive framework for improving patient safety in the operating room (OR). A selective literature review was conducted focusing on peer-reviewed publications related to surgical teamwork, communication, safety checklists, and non-technical skills. Sources were identified through PubMed and Google Scholar using relevant terms such as "surgical safety," "human factors in surgery," and "team communication."

Results: The metaphorical framework reveals that each member of the OR team-from the surgeon to the scrub nurse-is reimagined as a theatrical role, with their contribution being essential to the surgical outcome. Key concepts such as simulation training, checklists, psychological safety, and mutual accountability are highlighted as critical tools for enhancing performance and reducing preventable harm. The study emphasizes the importance of clear role definitions, team coordination, and continuous learning, similar to a theater production's preparation, performance, and reflection stages.

Conclusion: Viewing the OR through the lens of theater offers a novel, human-centered model for improving surgical safety. This conceptual framework promotes structured teamwork, shared mental models, and a culture where every action is intentional and every role is respected ensuring that each surgical performance prioritizes the patient's well-being above all.