Teamwork and communication issues continue to present significant challenges in healthcare. Such challenges reflect a system that is vulnerable to error and adverse patient outcomes. This paper describes an effort to address team communication and coordination challenges - and ultimately improve patient safety - in the general surgery operative unit at a large university-affiliated teaching hospital. The research team consisted of cognitive and human factors scientists, in addition to patient safety and quality personnel from the hospital. A primary goal of this effort was to study and describe team functioning in the OR, and develop a tailored intervention that would address the unique needs and challenges faced by the surgical teams studied. An additional goal was to demonstrate that improvements in team coordination and communication positively impact patient care and safety outcomes in the OR. Using Cognitive Task Analysis methods, we conducted fourteen in-depth interviews with members of the general surgery team and direct observations of three surgical procedures. We identified several areas where teams are functioning well - including shared goals and commitment to safe and high quality care. We also identified several factors that constrain teamwork and effective information flow among the OR team. Based on the findings, we developed a set of recommendations for addressing the challenges identified. Members of the OR leadership group elected to implement and evaluate a preoperative briefing intervention. To ensure that the preoperative briefing was not an off-the-shelf solution, but one that was customized for the teams we studied, we facilitated a cocreative preoperative briefing development workshop with key stakeholders. The workshop enabled representatives of the surgical team to create and adapt content and structure for the briefing. We describe the process used for developing the preoperative briefing, along with metrics for assessing the impact of the briefing on teamwork, communication, and patient safety.