Abusive, disruptive behaviour common in operating rooms, University of Manitoba studies suggest

Recent survey results suggest health-care staff working in operating rooms may be exposed to high levels of disruptive and abusive behaviour.

The findings come from a pair of studies by researchers with the University of Manitoba, who distributed two surveys to clinicians that work in operating rooms, including anesthesiologists, nurses, surgeons and senior medical students.

The first survey found 97 per cent of respondents reported being exposed to disruptive behaviour, defined by researchers as behaviour being directed toward others or in the presence of others that “results in a perceived threat to victims or witnesses, and violates a reasonable person’s standard of respectful behavior.” Between July 2012 and August 2014 researchers sent the survey to 101,624 clinicians in Canada, Australia, New Zealand, Brazil, India, the United States and the UK, and received 7,391 responses.

“In medicine, the disruptive behaviour, the person that potentially is most profoundly affected is the patient,” said Dr. Eric Jacobsohn, the lead researcher and a professor in the University of Manitoba Rady Faculty of Health Sciences, who said anecdotal evidence suggested the behaviour was common in the high-stress environment of an operating room.

“The environment is right, and the stakes are very high, so we wanted to look at that,” he said, adding that 25 per cent of physicians who responded reported being bullied in the previous week.

The second survey focused on abusive behaviour, defined as disruptive behaviour that “includes physical and psychological abuse, such as using force against another person or using words or actions to control, frighten, isolate or devalue another person.” It went out to 22,177 clinicians in the United States and Canada over the same time period and of the 7,391 who responded, 23.2 per cent reported experiencing abuse personally and 39 per cent reported witnessing abuse against colleagues.

“Many of the previous studies had assumed the doctors were the perpetrators,” said Jacobsohn. “But when you started scratching – the little literature there was – it suggested that it’s many of the workers in the O.R.”

Researchers included a note of caution over the survey’s low response rate, saying it’s possible the incidence rate could be inflated because those with personal experiences may have been more motivated to respond.

But Jacobsohn said the findings should not be dismissed.

“The data shows that disruptive clinicians are a medical-legal liability to the institution. Even if they’re fantastic docs, fantastic nurses, in the end the medical-legal cost to the institution exceeds their perceived clinical worth.”

He said the study also asked if management takes the issues seriously, and the majority reported they were not.

“I think what’s going to change this is black boxes in the operating room,” he said, referring to a system of recording what takes place in operating rooms.

In the meantime, he said, “Management has to take this seriously.”

The studies were published in the Canadian Journal of Anesthesia.

-With files from CTV’s Michelle Gerwing