Abstract
BackgroundTense 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 findingsThe 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.ConclusionsAlthough 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.
Highlights
The picture of the cursing surgeon that throws instruments across the operating room (OR) is still present in many minds
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
Consent of surgical team members to be observed was assured by an opt-out procedure–participants could at any time refuse the presence of the observer in the operating room
Summary
The picture of the cursing surgeon that throws instruments across the operating room (OR) is still present in many minds. Such extreme events are nowadays rare [1], tense communication has not disappeared from modern ORs [2,3]. A characteristic of these behaviors is that they do not necessarily imply an intent to harm: the instigator may even be unaware of potential harm caused [8] Note that this definition is broader than definitions that limit disruptive behavior as socially and professionally inappropriate conduct [9]. 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
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