A Methodological Approach to Assessing Closed-Loop Communication in the Operating Room.

OCCUPATIONAL APPLICATIONSClosed-loop communication (CLC) is widely used to support teamwork in high-risk settings; however, current approaches do not fully capture the complex and dynamic nature of communication in surgical practice. This study presents a practical method for coding and measuring CLC that better reflects real operating room interactions. The proposed approach captures both verbal and functionally equivalent non-verbal responses, as well as multi-party communication patterns. New breakdown and performance measures identify where coordination fails and quantify how reliably communication is completed across roles. For ergonomics and human factors practitioners, this approach provides systematic methods and metrics to assess teamwork quality in high-stakes environments. The method can be used to identify where coordination problems occur across different roles and support targeted communication training. These measures are also applicable to other high-stakes environments, such as aviation and emergency response, where reliable communication is essential for safety and performance.