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 "Hopefully our findings can be used to inform interprofessional
training," Dr. Laura K. Jones from Emory University, Atlanta,
Georgia told Reuters Health by email.
Jones's team used careful observation techniques to evaluate 6,348
social interactions and nontechnical communications among at least
400 different operating room team members during a variety of
surgical procedures.
By far, cooperative behaviors were most common, representing 59
percent of all communications, and conflicts were rare, accounting
for only 2.8 percent of communications, the researchers reported in
the Proceedings of the National Academy of Sciences.
The primary surgeon was the most common source of communications and
of cooperative communications, and the surgeon in training was the
most common recipient.
The primary surgeon was also the most common source of conflict
communications, but these were most commonly directed at the
circulating nurse. In fact, most conflict communications were
directed down the social hierarchy, mainly targeting individuals
several ranks apart.
The likelihood of cooperation decreased with an increasing
percentage of males in the room, but it depended on the surgeon's
gender.
When the surgeon's gender differed from the main gender makeup of
the rest of the surgical team, cooperation was higher and conflict
was lower. When the genders were alike, though, cooperation was
lower and conflict was higher. These effects seemed stronger for
male surgeons than for female surgeons.
Teams with male surgeons and mostly male other members were about
twice as likely to have at least one conflict as teams with male
surgeons and mostly female other members.
"I found the main finding about gender dynamics most
interesting--that male (surgeons') rooms were more cooperative when
the majority of the other clinicians were female, and the inverse of
that," Jones said. "We weren't looking for that specifically, but it
showed up and it rang very true to clinicians in my family who
prefer to work with the opposite sex."
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"Creating all mixed gender teams is not feasible, but having a
better understanding how and why they work would be helpful," Jones
said.
Dr. David A. Rogers from the University of Alabama in Birmingham,
who has studied operating room conflict management, told Reuters
Health by email, "The findings in this present study that the
conflict type language tended to flow down the hierarchy is contrary
to our goal of creating a safe working environment where all team
members are free to speak up."
"(The public) should be confident that the vast majority of
operations are performed by teams of committed individuals who work
well together," he said. "There is a substantially diminishing
tolerance for the most egregious behaviors . . . (but) their study
draws attention to the fact that we have still not reached our goal
of eliminating it altogether."
Dr. Cindy M. Clark from ATI Nursing Education, Leawood, Kansas
specializes in fostering civility and creating and sustaining
healthy work environments. She told Reuters Health by email that
intense conflict in the operating room, while uncommon, "can have
significant and detrimental impact on patient outcomes."
She added, "While we can emphasize that conflict occurs less
frequently than cooperative interactions, both matter and require
our attention to deliver safe patient care."
"Emphasizing the importance of effective and respectful
communication in all patient care areas (and in life) will have an
impact on achieving optimal patient outcomes," she said.
SOURCE: http://bit.ly/2MVxwUQ Proceedings of the National Academy of
Sciences USA, online July 2, 2018.
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