Women Surgeons’ Experiences of Interprofessional Workplace Conflict

Lesly A Dossett,Reshma Jagsi,Kerry Lindquist,C Ann Vitous,Dana A Telem

doi:10.1001/jamanetworkopen.2020.19843

Lesly A Dossett, Reshma Jagsi + Show 3 more

Open Access

https://doi.org/10.1001/jamanetworkopen.2020.19843

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Abstract

Gender differences in interprofessional conflict may exist and precipitate differential achievement, wellness, and attrition in medicine. Although substantial attention and research has been directed toward improving gender equity in surgery and addressing overall physician wellness, research on the role of interprofessional conflict has been limited. The objective of this study was to understand scenarios driving interprofessional conflict involving women surgeons, the implications of the conflict on personal, professional, and patient outcomes, and how women surgeons navigate conflict adjudication. A qualitative approach was used to explore the nature, implications, and ways of navigating interprofessional workplace conflict experienced by women surgeons. The setting was a national sample of US women surgeons. Purposive and snowball sampling were used to recruit women surgeons in training or practice from annual surgical society meetings. Participants were eligible if they were currently in a surgical training program or surgical practice. Nearly all participants had experienced at least 1 workplace conflict with a nonphysician staff member resulting in a formal write-up. A workplace conflict was defined as any conflict resulting in the nonphysician staff member taking action such as confronting the woman surgeon, reporting the event to supervisors, or filing a formal report. Interviews were conducted between February 19, 2019, and June 21, 2019. Recordings were transcribed and deidentified. Inductive thematic analysis was used to examine data in relation to the research questions. Thirty US women surgeons (8 [27%] age 25-34 years, 16 [53%] age 35-44 years, 5 [17%] age 45-54 years, and 1 [3%] age 55-64 years) of varying surgical specialties were interviewed. Conflicts were often reported as due to a breakdown in communication or from performance-related disputes. Participants perceived personal and professional implications including self-doubt, depression, frustration, anxiety, loss of sleep, reputational harms, and delays to advancement. Participants also described potential patient safety implications primarily due to decreased communication resulting from some surgeons being hesitant to engage in subsequent interactions. Participants described a variety of navigation strategies including relationship management, rapport building, and social capital. The success of these processes tended to vary by individual circumstances, including the details of the conflict, practice setting, level of support of leadership, and individual personality of the surgeon. This qualitative study highlights women surgeons' experiences with interprofessional workplace conflict. Interprofessional culture building, broader dissemination of implicit bias training, and transparent and equitable adjudication systems are potential strategies for avoiding or mitigating the implications of these conflicts.

Highlights

Women surgeons perceived (1) a double standard related to these conflicts, (2) the expectation that they conform to gender over professional norms, and (3) that these conflicts have negative consequences on their personal wellbeing and professional reputation
Inductive thematic analysis of the narratives of the women surgeons in this study revealed 3 major themes in relation to circumstances of interprofessional workplace conflict: 1. Circumstances of reported conflicts: the context surrounding the conflict events 2
Circumstances of Reported Conflicts Circumstances leading to reported interprofessional conflicts were described by the participants as due to (1) the surgeon’s response to perceived performance-related issues on behalf of the staff member, (2) the interprofessional staff perceiving the women surgeons as unprofessional, (3) breaches of protocols, or (4) a combination of these circumstances (Table 2)

Summary

Introduction

Interprofessional teamwork is critical to success in medicine, in intense work environments such as the operating room, trauma resuscitation bay, and critical care units.[9,10] Interprofessional conflict is known to contribute to workplace dissatisfaction and stress, and existing data suggest women are more likely to experience these conflicts.[11] For example, surgical technologists file complaints against women more than men and exhibit sex-based discrimination.[12] a study of operating room behaviors demonstrated complex differences related not to the sex of the attending surgeon and the sex of others present, including greater cooperation when the attending surgeon’s sex differed from the majority of other team members. These gender-based differences in interprofessional conflict in surgical settings may partially explain why women surgeons experience a higher stress index.[13,14]

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