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Background: In an era where team communication and patient safety are paramount, standardized tools have been deemed critical to safe, efficient practice. In some cases—perhaps most notably in the surgical safety checklist (SSC)—these tools have been elevated as the key to safe patient care. However, effects of the SSC on patient safety in practice remain mixed. We explore the role and impact of the surgeon leader in the use of structured communication tools to understand how surgeon engagement impacts intraoperative teamwork.