VHA Research Finds Disruptive Behavior Common in Operating Rooms; Behavior Linked to Adverse Events, Medical Errors, and Mortality

IRVING, Texas -- New research conducted by VHA Inc., a national healthcare alliance, has found that disruptive behavior between surgeons, nurses, and anesthesiologists occurs frequently in hospital operating rooms and can negatively affect patient outcomes. Of those surveyed, 94 percent said this behavior needlessly contributes to adverse events, medical errors, compromises in patient safety, impairs quality and can affect patient mortality. 

The study described disruptive behavior as any inappropriate behavior, confrontation or conflict, ranging from verbal abuse to physical and sexual harassment. 

Clinical staff are not communicating well in the operating room and important information is not being exchanged, said Alan H. Rosenstein, MD, MBA, vice president and medical director at VHA and co-author of the study. Lack of respect between staff and clarity of roles are jeopardizing patient care. Disruptive behavior provokes stress, frustration and loss of concentration, which can impede transfer of vital information and can compromise patient safety and quality of care.

Respondents linked disruptive behavior to the occurrence of adverse events (67 percent), medical errors (67 percent), compromises in patient safety (58 percent), impaired quality (68 percent) and patient mortality (28 percent). Almost half of respondents (46 percent) said they were aware of an event that could have occurred because of disruptive behavior and 19 percent said they knew of an adverse event that occurred as a direct result of disruptive behavior.

Attending surgeons, anesthesiologists and nurses showed the greatest concerns about the seriousness of disruptive behaviors:

-- 22 percent of attending surgeons and 12 percent of anesthesiologists have witnessed disruptive behavior in other physicians on a weekly basis.

-- 21 percent of nurses have witnessed disruptive behavior in other nurses on a weekly basis.

We have been exploring and researching the issue of disruptive behavior in health care for more than five years and have found that negative behavior appears most prominent in high stress areas, such as the perioperative arena or operating room, said Michelle ODaniel, MHA, MSG, director of member relations for VHA and co-author of the study. In the OR, disruptive behavior compounds threefold because there are multiple people working in a small room, focused on one object and fully interdependent on each other a very stressful situation in and of itself.

Respondent comments were collected to help define the issue and are revealing. Comments included:

-- Poor communication postoperatively because of disruptive reputation resulted in delayed treatment, aspiration and eventual demise.

-- The RN did not call the MD about change in patient condition because he had a history of being abusive when called. Patient suffered because of this.

-- MD became angry when RN reported decline in patients conditionpatient required emergency intubation and transfer to the ICUcausing the family much unnecessary heartache and disruption in grieving process.

-- MD was told twice that sponge count was off. She said they will find it later. Patient had to be reopened.

VHA has provided counsel to more than 50 hospitals across the country on how to address disruptive behavior issues, including recognizing the problem, conducting assessments and implementing solutions. To address this issue, Rosenstein and ODaniel believe it takes: organizational commitment, recognition and awareness of the problem, face-to-face meetings with OR team members, clear policies about acceptable behavior, procedural changes, intervention strategies, focused education on communication and team collaboration.

Source: VHA Inc.