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Research Committee Article Abstract Disruptive Behavior in the Perioperative Arena
A Wall Street Journal quoted by Rosenstein & O’Daniel (2006, p. 100) states that, “There is growing evidence that poor communication between hospital support staff and surgeons is the leading cause of avoidable surgical error.” The JCAHO estimates that 60% of all medical errors can be traced to some form of communication breakdown. There has been increasing study of the effect of human factors on patient safety and outcomes. This article lends little scientific evidence to the debate but it does bring the issue and some additional evidence to a wider audience. Every perioperative nurse has witnessed and probably experienced disruptive behavior in the operating room. Some examples of this type of behavior have achieved legendary status and are frequently re-told as part of the culture and history of a facility. This behavior has the potential to negatively affect communication flow and team dynamics. Rosenstein & O’Daniel cite the example of the assessment of one large urban teaching facility to center a discussion of disruptive behavior in the operating room. These authors do not define disruptive behavior but they do give examples from the staff of this facility. Example include yelling, abusive language, the berating of staff, condescending remarks and insults as examples of behavior. This phenomenon, although certainly widespread, has not been extensively studied. This article reports the perceptions and beliefs of staff but provides no theoretical framework regarding causation nor do they offer suggestions for methods for further study. In this descriptive article perceptions are given and compared to previously gathered data but no conclusions are offered. In this study 94% of the respondents believed that disruptive behavior could have a negative effect on patient outcomes, 19% could relate a specific adverse event linked to such behavior and 80% believed these adverse events were preventable. Attending surgeons were cited as the most frequent perpetrators but all healthcare disciplines were guilty to some extent. The greatest frequency of disruptive behavior cited was that of general surgeons, cardiovascular surgeons, orthopods and neurosurgeons in order of frequency. The causation of disruptive behavior has not been determined but it is almost certainly multi-factorial. These authors speculate that contributing factors include home life issues, work problems, cultural and ethnic factors, generational issues, gender bias and hierarchy and role perceptions as all having some part. Factors supporting disruptive behavior include traditional avoidance or reluctance to counsel surgeons and the fact that disruptive behavior often gets rewarded. The authors do finish with a hopeful note. They assert that it is possible to decrease disruptive behavior and improve teamwork and communication. Possible solutions that may be tried include communication and teamwork training including techniques learned from the aviation safety community. There have been recent reports of the use of multi-disciplinary codes of conduct to regulate behavior. Although initial reports are promising the long-term effects of such codes has not been studied. The study of disruptive behavior will increase, as its effects on communication and patient outcomes becomes clear. Rosenstein & O’Daniel (p. 105) sound the clarion call on the issue with their closing statement, “Given the growing concerns about accountability for providing high-quality outcomes and patient safety, workforce shortages, reputation, and liability, hospitals can no longer afford to take a passive approach and tolerate disruptive behavior.” James
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