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

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 ope...

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Main Authors: Sandra Keller, Franziska Tschan, Norbert K Semmer, Eliane Timm-Holzer, Jasmin Zimmermann, Daniel Candinas, Nicolas Demartines, Martin Hübner, Guido Beldi
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2019-01-01
Series:PLoS ONE
Online Access:https://doi.org/10.1371/journal.pone.0226437
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author Sandra Keller
Franziska Tschan
Norbert K Semmer
Eliane Timm-Holzer
Jasmin Zimmermann
Daniel Candinas
Nicolas Demartines
Martin Hübner
Guido Beldi
author_facet Sandra Keller
Franziska Tschan
Norbert K Semmer
Eliane Timm-Holzer
Jasmin Zimmermann
Daniel Candinas
Nicolas Demartines
Martin Hübner
Guido Beldi
author_sort Sandra Keller
collection DOAJ
description 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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spelling doaj.art-f746c107014945c89e5b4bf8c383f64c2022-12-21T18:26:07ZengPublic Library of Science (PLoS)PLoS ONE1932-62032019-01-011412e022643710.1371/journal.pone.0226437"Disruptive behavior" in the operating room: A prospective observational study of triggers and effects of tense communication episodes in surgical teams.Sandra KellerFranziska TschanNorbert K SemmerEliane Timm-HolzerJasmin ZimmermannDaniel CandinasNicolas DemartinesMartin HübnerGuido BeldiBACKGROUND: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.https://doi.org/10.1371/journal.pone.0226437
spellingShingle Sandra Keller
Franziska Tschan
Norbert K Semmer
Eliane Timm-Holzer
Jasmin Zimmermann
Daniel Candinas
Nicolas Demartines
Martin Hübner
Guido Beldi
"Disruptive behavior" in the operating room: A prospective observational study of triggers and effects of tense communication episodes in surgical teams.
PLoS ONE
title "Disruptive behavior" in the operating room: A prospective observational study of triggers and effects of tense communication episodes in surgical teams.
title_full "Disruptive behavior" in the operating room: A prospective observational study of triggers and effects of tense communication episodes in surgical teams.
title_fullStr "Disruptive behavior" in the operating room: A prospective observational study of triggers and effects of tense communication episodes in surgical teams.
title_full_unstemmed "Disruptive behavior" in the operating room: A prospective observational study of triggers and effects of tense communication episodes in surgical teams.
title_short "Disruptive behavior" in the operating room: A prospective observational study of triggers and effects of tense communication episodes in surgical teams.
title_sort disruptive behavior in the operating room a prospective observational study of triggers and effects of tense communication episodes in surgical teams
url https://doi.org/10.1371/journal.pone.0226437
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