Rethinking safety culture assessment in the operating room: From crew resource management to the Safety Attitudes Questionnaire – Operating Room Version (SAQ-OR)

Background: Patient safety in the operating room (OR) and perioperative settings relies on effective teamwork, communication, and safety culture. Over the past three decades, human factors research has contributed to the development of tools to assess safety attitudes; however, their ability to capture the unique characteristics of OR environments remains unclear. Objective: This scoping review aimed to examine the evolution of safety culture assessment in the OR, identify key trends, and explore limitations of existing approaches. Methods: A literature-informed narrative overview was conducted focusing on studies assessing safety culture in OR teams, particularly those using the Safety Attitudes Questionnaire (SAQ), its operating room version (SAQ-OR), and related instruments. Results: Nineteen studies were included. Most employed cross-sectional designs, while a limited number evaluated interventions such as surgical safety checklists and team training programmes. SAQ-based instruments were the most commonly used. Most studies originated from Europe and North America, with few from Asian health care settings. Conclusions: Safety culture research in the OR has primarily focused on measurement rather than intervention. Existing tools may not fully reflect the context-specific characteristics of OR environments. Future research should develop approaches that better reflect communication and role-related dynamics to support teamwork and safety in perioperative practice.