Scholars taking a functional perspective assume that groups are goal-oriented and that inputs (e.g., the group task) and/or processes (e.g., communication) influence group performance (e.g., productivity, effectiveness, satisfaction) as well as external factors (e.g., organizational structures, regulations), all of which can be evaluated (Poole et al., 2004; Hollingshead et al., 2005). Their research goal is to identify relevant group features and behaviors (such as certain communication or coordination patterns) that promote or hinder group performance (Fernandez Castelao et al., 2011; Kolbe et al., 2014; Willmes et al., 2022). For example, one result obtained by taking this perspective is that closed-loop-communication (CLC), where a command is followed by a checkback and closing the loop (Härgestam et al., 2013; El-Shafy et al., 2018), correlates with higher task performance (e.g., lower hands-off time in resuscitation, better adherence to guidelines) and thus higher patient safety (Salas et al., 2008). Research from a functional perspective is suited to inform the testing of certain interventions (e.g., checklists)(Lingard et al., 2008; Russ et al., 2015), the development of interventions to improve team performance, such as crisis resource management principles (Oberfrank et al., 2019), different mnemonics to help teams quickly organize themselves (e.g., 10 s for 10 min) (Rall et al., 2008) and briefing and debriefing interventions (Lingard et al., 2008, 2011; Russ et al., 2015).

Consider the episode in lines 19–21, where the surgeon asked the scrub nurse to get the clamp and the nurse acknowledges it. Instruction-reaction episodes such as this one may be analyzed in terms of their completeness by comparing them to the “ideal” CLC cycle (Tschan, 1995, 2002). Additionally, one could check which internal and external factors prevent the correct implementation of the CLC cycles. This analysis could reveal the proportion of standard vs. non-standard forms of CLC and relate it to outcome measures such as the number of followed instructions or patient survival (Marzuki et al., 2019).

Another functional approach to the excerpt would be to code the content of utterances with an established coding scheme (i.e., assign pre-defined behavior and communication codes to sequences of the interaction). For example, researchers may code case-relevant communication (CRC) such as ‘instructions’, versus case-irrelevant communication (CIC) such as chitchatting (Seelandt et al., 2014; Lehrke et al., 2022). The proportions and patterns of CRC to CIC episodes could then be set in relation to outcome variables such as satisfaction with teamwork or team effectiveness [e.g., surgical site infections (Widmer et al., 2018)].

In sum, researchers interested in crucial inputs and processes influencing team performance outcomes are advised to adopt this perspective. Exemplary research questions as well as recommendations for data sources are highlighted in Table 2. However, focus on the functional perspective is often limited to “team performance,” disregarding other important outcomes such as well-being or system maintenance.

Scholars taking a conflict-power-status perspective assume that resources, status, and power are unequally distributed within groups (Poole et al., 2004; Sell et al., 2004). Their research goal is to understand how these inequalities, social relationships and associated group structures develop and change, and how they influence group processes (e.g., conflict management) and outcomes [e.g., member satisfaction (Poole et al., 2004)] Healthcare teams seem to be a logical place for adopting the conflict-power-status perspective (Janss et al., 2012) given that differences in (legitimate) power and occupational status are paramount (Hollenbeck et al., 2012). In our operating room team example, surgeons, anesthesiologists, perfusionists and nurses may each have certain explicit positional status and power, yet also have implicit, subtle and relational status and power based on experience, tenure and relationships (Yule et al., 2006; Gardezi et al., 2009).

Consider the episode in lines 30–37, where we witness how the surgeon expressed his dissatisfaction with the nurse, whereupon the nurse offered to be substituted by another nurse. While the surgeon agreed with this suggestion, instructing another nurse to enter, the circulating nurse overtly objected, instructing the first nurse to stay. Applying the conflict-power-status perspective to analyzing the excerpt offers the possibility to study how power is explicitly and implicitly enacted (e.g., by examining who instructs whom), how open (vs. subtle) conflicts are enacted, or which coalitions exist. Assumptions and discussion about responsibilities, performance or authority are a frequent source of tension in the operating room (Lingard et al., 2002, 2004). Tension, frustration and conflict influence the quality of team interactions. For example, while observing disrespectful behavior may cause team members to speak up with a concern, a general lack of psychological safety or of inclusive language may impede live-saving speaking up (Edmondson, 2003; Raemer et al., 2016; Weiss et al., 2018; Krenz et al., 2020; Vauk et al., 2022).

As healthcare is more and more provided by multidisciplinary teams whose professional members each have a unique identity with potentially differing priorities, roles and expectations of how care should be delivered, micropolitical interests have to be negotiated (Taplin et al., 2015; Kolbe et al., 2019). Politics refers to the use of power, authority and influence and is a relational process between people and within teams (Rogers et al., 2020). This excerpt also gives rise to the possibility to assess emotional reactions to and satisfaction with the manner in which hierarchy is acted out and which role sarcasm, humor and irony play in such power games (Krenz et al., 2019; Long et al., 2020; Koopman et al., 2023; Weiss et al., 2023).

In sum, researchers interested in understanding status and power inequalities, group structures and their impact on team performance outcomes are directed to this approach. However, research strongly following the conflict-power-status perspective may require high levels of reflexivity from researchers who have their own personal views on conflict, power and status dynamics.

Scholars taking a psychodynamic perspective assume that emotional and nonconscious processes exist within all human groups which impact their interactions and task performance (Mcleod and Kettner-Polley, 2004). Their research goal is to understand emotions and unconscious patterns of behavior (Mcleod and Kettner-Polley, 2004). To increase team performance, these nonconscious processes have to be brought to team members’ conscious awareness (Mcleod and Kettner-Polley, 2004). One of these nonconscious processes is humor (Newirth, 2006).

Humor can have different functions. On the one hand, humor takes on a conducive role and positive humor has many benefits. It may alleviate tension, fatigue, and improve work relationships (Crowe et al., 2016). Humor also has a relaxing function and can buffer the negative effects of stress on health and well-being (Martin, 1996; Karl et al., 2007). In addition, humor reduces perceived stress and the likelihood of burnout and strengthens resilience (Murden et al., 2018; Rose et al., 2021). On the other hand, humor and jokes can serve as a gateway for prejudices or to devalue other individuals (Prusaczyk and Hodson, 2020). Humor can be employed to define the status quo of a group or to maintain and consolidate the hierarchy within a team (Hodson and Prusaczyk, 2021). Interestingly, gender often plays a role regarding the negative form of humor, with women being the target of sexualized humor (Tabassum and Karakowsky, 2022).

Consider the episode in lines 33–49, where two female nurses and a male surgeon were part of what appears to be a humorous interaction. The surgeon questioned the performance of one nurse and made it sound as if she could not do her job and did not feel like doing it. He used a very colloquial formulation (“She does not feel like it anymore”) and this humorous interaction contains an ambiguity (which is typical for humor). He may have used humor to “soften” his message and to offer a more or less suitable excuse for what could otherwise be perceived as rude (Ringblom, 2022). Or, he may have used humor to put women (the nurses) in an inferior position and to maintain a gender- and/or status-based ingroup-outgroup distinction (Ringblom, 2022).

In this episode, it would be also interesting to examine the speaking up behavior of the participants. One might explore to what extent negative humor influences the speaking up behavior of the ironized group (the nurses) or the whole group and to clarify whether this behavior could be a hindrance or even beneficial for further speaking up (Parsons et al., 2001; Vauk et al., 2022).

Numerous studies on emotions, stress management, and burnout among health-care workers exist (e.g., during COVID-19 emergency (Di Giuseppe et al., 2021)) with only few studies on humor and well-being (e.g., effect of humor on nursing professionals’ well-being (Navarro-Carrillo et al., 2020)), albeit unrelated to healthcare teams. Therefore, investigating the role of humor in healthcare teams and its relation to well-being and speaking-up could not only be promising but applying the psychodynamic perspective may provide desired guidance for researchers who wish to identify emotional and nonconscious processes within teams and their impact on further interactions and performance. However, team research mainly following the psychodynamic perspective may struggle with the multiple and even conflicting socio-emotional processes, e.g., humor may have both a beneficial and obstructive impact (Tschan et al., 2015).

Scholars taking a temporal perspective assume that groups are systems that evolve over time and in which change is generic and arises across multiple time scales (Arrow et al., 2004). Their research goal is to discriminate changes that are systematic or even regular from changes that are episodic and particular. They also aim to understand how groups systematically change over time and how this group development can be described, explained and modeled (Harvey et al., 2023). On the micro level, the patterning of interaction in groups comes into focus and how these dynamics relate to relevant other factors like group performance, team member satisfaction etc.

Healthcare teams exhibit dynamics on both levels, the meso level of the dynamics of the team as a whole as well as the micro level of interaction patterns. For example, guideline-oriented teamwork as it is prevalent in resuscitation teams entrains the dynamics of the group as a whole, measurable by the degree of guideline adherence (Fernandez Castelao et al., 2015). Another example is an interaction pattern on the micro level who assumed that groups shift from behaviors focused primarily on the task to behaviors relating to the socio-emotional requirements of the group (Bales, 1950). This can be explained by Bales’ equilibrium model (Bales et al., 1953), which claims that a group must keep a balance between task-oriented and socio-emotional needs, in order to be successful. However, socio-emotional behavior might merge into CIC which, at some point, might cause distractions for team members and impair surgical outcomes (Tschan et al., 2015; Wheelock et al., 2015). Other temporal patterns found in healthcare teams are adaptation processes where implicit vs. explicit coordination mechanisms are situationally adapted to routine vs. non-routine requirements of the task (Burtscher et al., 2011; Riethmüller et al., 2012).

Consider the episode in lines 19 to 45, where we can apply the basic distinction between CRC and CIR outlined previously in the functional perspective. From the temporal perspective, we can state that this episode is composed of different micro episodes swaying from CRC and CIC communication. This shift back and forth between CRC and CIC creates a non-random interaction pattern relating systematically to task performance and well-being functions of the team. It would also be interesting to explore whether the CIC utterances in this group serve the tension-reduction function assumed in the equilibrium model (Bales, 1950) or – on the contrary – induce interpersonal conflict and thus impair team performance. Thus, researchers aiming at detecting and describing dynamic patterns in teams and relating these patterns to diverse functions of a team are recommended to apply the temporal perspective. However, research mainly driven by the temporal perspective may involve risks that such too fine-grained analyses of micro processes leaving out structural conditions on the meso (team as a whole) and macro (embedding organization, socio-political system) levels.

Scholars taking the social identity perspective assume that relations between large-scale social categories as nations, cultural groups etc. exist and analyze the cognitive aspects of self- and other-classifications of social groups and group membership (Hogg et al., 2004). Social identity is “the individual’s knowledge that he belongs to certain social groups together with some emotional and value significance to him of this group membership” (Tajfel, 1972, p. 292). These scholars’ research goal is to describe how the categorization of self and others define group memberships, the construction of group norms and the enactment of these norms in group and intergroup behavior (Turner, 1985; Turner et al., 1987; Hogg et al., 2004). For example, belonging to different professional groups impacts how healthcare team members react to inclusive language and speak up (Weller et al., 2014; Weiss et al., 2018). Even more, gender stereotypes woefully impact team interaction in the OR (Pattni et al., 2017; Minehart et al., 2020). That means, in a given situation a specific social category – in our example physician or nurse – might be salient due to the context, here the heart surgery in the operating theatre.

Consider the episode in lines 30–37, one could describe the interaction between the surgeon and the nurse(s) as an intergroup situation, primarily on the interprofessional dimension physician versus nurse. In the surgeon’s utterance “this nurse …,” the (scrub) nurse Xenia is addressed as a member of her social category. The physician addresses her not as an individual, but through the lens of the stereotype “nurse” which means the person become depersonalized. Although the nurse is present in the situation and working at the operating desk with the surgeon, she is addressed in the third person, not with her name but with her professional classification. Her colleague, the circulating nurse, immediately comes to her defense, says her name (“Xenia”) and provides cover. One could even go thus far that the circulating nurse tries to annulate the relational communication on the collective level (differentiating “we” from “them”) by trying to get back to the interpersonal level of “Xenia” interacting with the other team members. Applying the social identity perspective to analyze the excerpt, we could identify which social categories are salient in this team. Besides the interprofessional categorization – physician vs. nurse – there is also the gender-dimension, man versus women. In the ironic, sarcastic or even aggressive way the surgeon comments on the competencies of the nurse, one could even see a categorization on the dimension of hierarchy which parallels the other two dimensions. Thus, the social identity perspective provides theoretical guidance if research questions focus on the conditions and effects of identification with the team, with subteams or the discrimination or even competition toward other teams or larger social units and categories. However, research mainly based on the social identity perspective risks overlooking the variety and creativity of the behavior of team members as individual persons (rather than as members of social categories).

What is the problem that matters? Exposure to disrespectful team members? Impeded patient safety when team members do not share or listen to safety concerns? Lack of clarity on whether or how heart team meetings work? Precisely identifying the problem at hand is important because it will guide which theoretical lens(es) may fit best for studying it. For example, if in our heart surgery example (Table 1) the perceived stress and reduced well-being of the operating room team were problematic, applying not only the functional but also the conflict/power/status and psychodynamic perspectives might be fruitful and direct researchers to studying the tensions, potential toxic functions of humor and other forms of disrespectful communication in the OR (Lingard et al., 2004). Notably, the problem is not the same as the research gap.

What is already known about the problem and what is the current gap in the research, precisely? From our experience, a research review beyond the scope of one discipline and one theoretical perspective typically reveals plenty of existing research that will help sharpen the research question and methods. For example, when studying voice in healthcare teams, reviewing the voice literature in organizational behavior and psychology yields a variety of concepts, methods and results applicable to healthcare teams (Heaphy et al., 2022; Li and Tangirala, 2022). For broadening the research beyond healthcare, the dimensional model of Hagemann allows for identifying similarities, differences, and application (Hagemann et al., 2011). Notably, identifying the research gap can be a challenging step as research from different theoretical lenses and disciplines is frequently published in different kinds of journals; researchers may benefit from leaving the comfort zones of their field’s journals.

Why does the research gap and the chosen approach to closing it matter? The team research perspectives described in this article can be a considerable hook (Figure 1): A problem may be studied from a different perspective. For example, while voice in healthcare teams has typically been studied from the conflict/status/power perspective, applying a psychodynamic perspective may discover unconscious voice/silence patterns (Foulk et al., 2016). Alternatively, a problem may be studied combining different theoretical perspectives. For example, knowledge on facilitating voice in healthcare teams may be enhanced by combining the conflict/status/power with the psychodynamic perspective, linking power, status, patterns and voice communication (Weiss et al., 2017, 2018, 2023; Lemke et al., 2021). As another example, a behavioral observation study on teamwork and communication within surgical teams has shown that more case-irrelevant communication including humor during wound closure is related to worse patient outcomes, whereas case-relevant communication during the whole surgery seems to be a protective factor against surgical site infections (Tschan et al., 2015). This impressive study evolved through combining the psychodynamic, the temporal, and the functional perspectives. Further combinations of theoretical perspectives are conceivable: combining the functional with the conflict-power-status perspective may enrich our understanding of crucial relational aspects improving or undermining team effectiveness (Janss et al., 2012; Weiss et al., 2023). Combining the functional with the temporal perspective (Fernandez Castelao et al., 2015) to find out how effective and less effective behavioral patterns emerge and can be supported or avoided may be fruitful, e.g., by training or intervention. Similarly, the social identity perspective may fit well to the conflict-power-status and functional perspectives for exploring the effects of stereotyping on team and leadership effectiveness as well as on patient safety (Weller et al., 2014; Pattni et al., 2017; Minehart et al., 2020).