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Observational Study
. 2019 Dec 12;14(12):e0226437.
doi: 10.1371/journal.pone.0226437. eCollection 2019.

"Disruptive behavior" in the operating room: A prospective observational study of triggers and effects of tense communication episodes in surgical teams

Sandra Keller  1   2 , Franziska Tschan  1 , Norbert K Semmer  3 , Eliane Timm-Holzer  1 , Jasmin Zimmermann  1 , Daniel Candinas  4 , Nicolas Demartines  5 , Martin Hübner  5 , Guido Beldi  4
Affiliations
Observational Study

"Disruptive behavior" in the operating room: A prospective observational study of triggers and effects of tense communication episodes in surgical teams

Sandra Keller et al. PLoS One. .

Abstract

Background: Tense communication and disruptive behaviors during surgery have often been attributed to surgeons' personality or hierarchies, while situational triggers for tense communication were neglected. Goals of this study were to assess situational triggers of tense communication in the operating room and to assess its impact on collaboration quality within the surgical team.

Methods and findings: The prospective observational study was performed in two university hospitals in Europe. Trained external observers assessed communication in 137 elective abdominal operations led by 30 different main surgeons. Objective observations were related to perceived collaboration quality by all members of the surgical team. A total of 340 tense communication episodes were observed (= 0.57 per hour); mean tensions in surgeries with tensions was 1.21 per hour. Individual surgeons accounted for 24% of the variation in tensions, while situational aspects accounted for 76% of variation. A total of 72% of tensions were triggered by coordination problems; 21.2% by task-related problems and 9.1% by other issues. More tensions were related to lower perceived teamwork quality for all team members except main surgeons. Coordination-triggered tensions significantly lowered teamwork quality for second surgeons, scrub technicians and circulators.

Conclusions: Although individual surgeons differ in their tense communication, situational aspects during the operation had a much more important influence on the occurrence of tensions, mostly triggered by coordination problems. Because tensions negatively impact team collaboration, surgical teams may profit from improving collaboration, for instance through training, or through reflexivity.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Mean tensions per hour across all 30 participating surgeons.
Fig 2
Fig 2. Illustration of perceived teamwork quality by the different professions for surgeries with no tensions as compared to surgeries with the mean level of tensions (in surgeries with tensions).
Fig 3
Fig 3. Illustration of effect of task-triggered and coordination-triggered tensions on teamwork quality for surgeons, anesthetists and scrub nurses.
See this image and copyright information in PMC

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Publication types

Grants and funding

This work was supported by a grant from the Swiss National Science Foundation (grant number 156882) to FT, GB, and DC. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.