Triggers and Enablers of Disruptive Behavior in Operating Room Staff: A District-Level Investigation
DOI:
https://doi.org/10.70749/ijbr.v3i3.815Keywords:
Disruptive Behavior, Operating Theatre, Triggers, Enablers, Workload, Team Communication, Resource Constraints, EMR (Electronic Medical Record)Abstract
Background: Disruptive behavior in operating theatres (OTs) poses critical risks to patient safety and team efficacy, exacerbated by hierarchical dynamics, resource constraints, and high-pressure workflows. This study investigates triggers and enablers of such behavior among OT staff in district-level tertiary care settings. Methodology: A descriptive cross-sectional study was conducted across three hospitals in District Vehari, Pakistan. Using simple random sampling, 165 OT staff (surgeons, nurses, technologists) with ≥1 year of experience completed a structured questionnaire. Data were analyzed via SPSS (v29), with frequencies and percentages calculated for categorical variables. Results: Verbal abuse (18.8%) and refusal to cooperate (15.8%) were the most frequent disruptive behaviors, while 46.1% of incidents involved overlapping behaviors (e.g., verbal abuse + physical aggression). Key triggers included high workload (14.5% reported often/always), insufficient resources (15.7%), surgeon temperament (11.5%), and scheduling issues (11.5%). Systemic inefficiencies like unclear policies (9.1%) and inadequate ancillary support (13.3%) further aggravated tensions. Hierarchical conflicts and interpersonal friction were prominent, with poor teamwork (9.7%) and personality clashes (11.5%) frequently cited. Conclusion: Disruptive behavior in Operation Theatres stems from multifactorial triggers, including organizational deficits, power asymmetries, and individual stressors. Mitigation requires protocol standardization, resource optimization, and interdisciplinary training to enhance communication and resilience. Addressing hierarchical imbalances and equipment reliability is critical for fostering safer, collaborative OT environments.
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Vaseghi F, Rarani MA, Raeisi AR, Moravveji A. Content analysis of family physician plan using social marketing approach: Qualitative-document analysis. Journal of Education and Health Promotion. 2023 Nov 1;12(1):393. https://doi.org/10.4103/jehp.jehp_1017_22
Morey NJ, Morey TE. Quality and Safety in Anesthesia and Perioperative Care. Anesthesia & Analgesia. 2017 Sep 1;125(3):1070-1. https://doi.org/10.1213/ane.0000000000002302
Yule S, Flin R, Paterson-Brown S, Maran N. Non-technical skills for surgeons in the operating room: a review of the literature. Surgery. 2006 1;139(2):140-9. https://doi.org/10.1016/j.surg.2005.06.017
Pfifferling JH. Physicians'“disruptive” behavior: consequences for medical quality and safety. American Journal of Medical Quality. 2008 May;23(3):165-7. https://doi.org/10.1177/1062860608315338
Heslin MJ, Singletary BA, Benos KC, Lee LR, Fry C, Lindeman B. Is Disruptive Behavior Inherent to the Surgeon or the Environment? Analysis of 314 Events at a Single Academic Medical Center. Ann Surg. 2019 1;270(3):463–72. https://doi.org/10.1097/sla.0000000000003469
Villafranca A, Hiebert B, Hamlin C, Young A, Parveen D, Arora RC, et al. Prevalence and predictors of exposure to disruptive behaviour in the operating room. Canadian Journal of Anesthesia. 2019 15;66(7):781–94. https://doi.org/10.1007/s12630-019-01333-8
Al-Khaldi MH, Irtemah H, Alhawari SF. The Impact of Transformational Leadership on Organizational Identification in Kuwaiti Islamic Banks. Modern Applied Science. 2020;14(7):111. https://doi.org/10.5539/mas.v14n7p111
Keller S, Tschan F, Semmer NK, Timm-Holzer E, Zimmermann J, Candinas D, et al. “Disruptive behavior” in the operating room: A prospective observational study of triggers and effects of tense communication episodes in surgical teams. PLoS One. 2019 1;14(12);783-92 https://doi.org/10.1371/journal.pone.0226437
Mirzaei S, Pazokian M, Atashzadeh-Shoorideh F, Amir S, Pishgooie H. The Limbo Atmosphere in operating room settings Caused by Disruptive Behaviors: A Qualitative Study. Ann Surg. 2020 1;270(3):463–72. https://doi.org/10.21203/rs.3.rs-28425/v1
Heslin MJ, Singletary BA, Benos KC, Lee LR, Fry C, Lindeman B. Is Disruptive Behavior Inherent to the Surgeon or the Environment? Analysis of 314 Events at a Single Academic Medical Center. Ann Surg. 2019 Sep 1;270(3):463–72. https://doi.org/10.1097/sla.0000000000003469
Rosenstein AH, O’daniel M. Managing disruptive physician behavior Impact on staff relationships and patient care. J Surg Educ 2008. 1;270(3):63–70. https://doi.org/10.1212/01.wnl.0000310641.26223.82
Rosenstein AH, O’Daniel M. Impact and Implications of Disruptive Behavior in the Perioperative Arena. J Am Coll Surg. 2006 203(1):96–105. https://doi.org/10.1016/j.jamcollsurg.2006.03.027
Campos M, Lira MJ, Mery P, Calderón M, Sepúlveda M, Pimentel F, et al. Disruptive behavior in the operating room: Systemic over individual determinants. International Journal of Surgery Open. 2022 1(2);43-46 https://doi.org/10.1016/j.ijso.2022.100492
Chrouser KL, Partin MR. Intraoperative Disruptive Behavior: The Medical Student’s Perspective. J Surg Educ. 2019 1;76(5):1231–40. https://doi.org/10.1016/j.jsurg.2019.04.002
Villafranca A, Fast I, Jacobsohn E. Disruptive behavior in the operating room: Prevalence, consequences, prevention, and management. Vol. 31, Current Opinion in Anaesthesiology. Lippincott Williams and Wilkins; 2018. 2;5(2);366–74. https://doi.org/10.1097/aco.0000000000000592
Attri JP, Sandhu GK, Mohan B, Bala N, Sandhu KS, Bansal L. Conflicts in operating room: Focus on causes and resolution. Vol. 9, Saudi Journal of Anaesthesia. Wolters Kluwer Medknow Publications; 2015 1;270(3):457–63. https://doi.org/10.4103/1658-354x.159476
A Survey of the Impact of Disruptive Behaviors and Communication Defects on Patient Safety Article. Surgmed Jr Afriqa. 2008 1;70(3):463–72. https://doi.org/10.1016/s1553-7250(08)34058-6
Cochran A, Elder WB. A model of disruptive surgeon behavior in the perioperative environment. J Am Coll Surg. 2014 219(3):390–8. https://doi.org/10.1016/j.jamcollsurg.2014.05.011
Oliveira RM, da Silva LMS, Guedes MVC, Oliveira AC de S, Sánchez RG, Torres RAM. Analyzing the concept of disruptive behavior in healthcare work: An integrative review. Afiqan jr Surgery 2016. 1;20(4): 690–9. https://doi.org/10.1590/s0080-623420160000500021
Sevdalis N, Forrest D, Undre S, Darzi A, Vincent C. Annoyances, disruptions, and interruptions in surgery: The Disruptions in Surgery Index. World J Surg. 2008 ;32(8):1643–50. https://doi.org/10.1007/s00268-008-9624-7
Smith, J. P., & Jones, A. L. Stress and burnout in the operating room: A review of the literature. Journal of Surgery. 2018;45(3): 210-215.
Brown, K. M., & Clark, S. E. Communication barriers and conflict resolution in the operating room. Anesthesia & Analgesia. 2019;129(2): 497-504.
Davis, R. L., & Thomas, H. G. Hierarchical dynamics and disruptive behavior in surgical teams. The Journal of Clinical Anesthesia. 2020;32(1): 23-28
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