Safe and efficient surgical operations depend on a work environment larger than the individual operating room (OR) and on communications at different levels of the hospital organization. Extensive communication is needed before and during surgery to ensure that surgical rooms, equipment, and supplies; patients; surgeons; supporting personnel; and accompanying documentation are all ready at the appropriate times. In this article, we compile the results of three of our studies of communication activities outside ORs, with the goal of identifying opportunities and challenges in the workflow of surgery. The first study demonstrates the amount of communication work performed by OR coordinators. The second study demonstrates the potential functions of a whiteboard in communication. The third study describes an organizational learning strategy of proactive event reporting. We apply computer-supported cooperative work and organizational learning concepts to the findings and suggest ways in which information technology may improve surgical workflow. © 2007 Springer-Verlag London Limited.