Vast majority of ‘disruptive behaviour’ in ORs goes unreported: study

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This article was published 16/01/2020 (2137 days ago), so information in it may no longer be current.

Surgeons, anesthesiologists, nurses and others who work in surgery tend to avoid reporting any bad behaviour around the operating table to their bosses, concludes a new study from University of Manitoba researchers.

The paper, published in the Canadian Journal of Anesthesia, didn’t specifically examine operating rooms in Manitoba. It analyzed a major survey of clinicians in seven countries, including Canada, the United States and United Kingdom, that asked whether those medical professionals reported “disruptive behaviour” to management and how they rated management’s response.

Disruptive behaviour could range from rudeness to outright abuse, explained study co-author Alex Villafranca, a PhD candidate in bioethics at U of M.

“Examples of mild incivility would be someone using hurtful sarcasm in their communications with you, someone taking some subtle actions to undermine your work,” he said. “Whereas on the egregious side, we get things like verbal threats and even physical assault.”

Such behaviour can lead to unhappy staff, absenteeism and high turnover, said co-author Dr. Eric Jacobsohn, a professor of anesthesia and an associate dean of professionalism with the university’s Max Rady College of Medicine.

Research suggests “when bad things happen in a clinical area, often it’s not the technical aspect which is the root cause… Often, communication between members of the team has a big part to play,” Jacobsohn said.

“And frankly, if people are being uncivil, not communicating well, et cetera, it is conceivable that that may in fact lead to deleterious patient care.”

Of the 4,775 clinicians who responded to the survey questions, about 97 per cent under-reported disruptive behaviour, with 74 per cent reporting less than one-fifth of the bad behaviour they had witnessed.

Roughly 30 per cent never reported any disruptive behaviour at all, and only 21 per cent of respondents said they were satisfied with management’s response to a report.

“I think it tells us that we need to make changes to the reporting systems that exist, because people are not making frequent enough use of them,” said Villafranca.

To illustrate the problem, Villafranca offered an anecdote he’d heard from an anesthesiologist in the U.S.

“This anesthesiologist was in the operating room, and a nurse he was working with accidentally passed the wrong tool to the surgeon. In response to this, the surgeon got angry, picked up a bonesaw and threw it between a few peoples’ heads, across the room where it hit the wall and bent,” Villafranca said.

The incident was reported to the hospital’s head of surgery.

“In response to it, he did not reprimand the surgeon, but instead he encased the bone saw in glass and hung it on his wall above his desk… If I’m a clinician, and I have a disruptive behaviour to report, there’s no way I’m going to be reporting it to that manager.”

Jacobsohn said addressing the issue of under-reported malfeasance in the operating room requires cultural changes at multiple levels, from medical schools to hospitals. An accompanying editorial in the Canadian Journal of Anesthesia advises hospital leaders to pay attention to the study’s findings and start investigating why staff might not want to report disruptive behaviour to management.

Despite the study’s findings, Jacobsohn said Manitobans preparing to undergo surgery shouldn’t be alarmed.

“If you’re going into the hospital and you’re having surgery, I don’t think that should be the focus of your worry,” he said. “I think by and large, the vast majority of teams work well.”

solomon.israel@freepress.mb.ca

Twitter: @sol_israel