Australian researchers have successfully trialled a novel experiment to address offensive and rude comments in operating theatres by placing ‘eye’ signage in surgical rooms.
The eye images, attached to the walls of an Adelaide orthopaedic hospital’s operating theatre without any explanation, had the desired effect in markedly reducing poor behaviour among surgical teams – a result they attributed to the perception of being “watched,” even though the eyes were not real.
Lead researcher, University of South Australia’s Professor Cheri Ostroff said that the three-month experiment was undertaken to address a widespread culture of bullying and poor behaviour in surgical theatres.
“Rude and offensive remarks don’t just affect staff morale, wellbeing, and productivity; they can also have a negative impact on patients,” she said.
“Yet teamwork is critical during surgery. When incivility contributes to poor communication in the operating theatre, worse outcomes can result.”
‘Incivility’ is prevalent in many industries, including the healthcare sector and particularly in high-stress and high-pressure environments such as operating theatres and the consequences are far reaching, leading to high staff turnover, low job satisfaction, a drop in productivity and less compliance with infection control and medication protocols.
Several interventions have been trialled internationally to address the poor behaviour in surgical teams, including workshops and training sessions, but with limited success.
In the Adelaide study, an initial survey was sent out to 74 staff at a private hospital – including surgeons, trainees, nurses, anaesthetists, and technicians – asking people to report incidents of bad behaviour in the operating theatre.
A month later, the eye signs were placed and seven weeks later, a follow up survey was undertaken – which showed a marked drop in the number of theatre nurses in particular experiencing offensive and rude remarks.
Surgeon Dr Nicholas Wallwork, who took part in the study, noted that rudeness and bullying could occur in operating theatres because the stakes were high.
“There are at least six people working as a team in a confined space, under time pressures and with risks involved. A high-functioning stable team delivers better performance, but due to numerous factors this is sometimes difficult to achieve,” he said.
“Poor communication is a recognised problem in our industry, and it is not always from the top down, but across teams. Complex leadership structures, where surgeons have direct clinical control of the staff during a shift, but are not line managers outside the operating theatre, lead to conflict.
The study identified four critical areas for organisational and cultural change:
- a need for senior management to be role models and emphasise respect in the workplace;
- appreciation and acknowledgement of employees’ value;
- more open communication within teams and between staff and management;
- more clarity in respect to roles
“Changing the workplace culture is important. In many healthcare settings, management are far removed from the day-to-day workplace stressors, creating a disconnect and lack of understanding,” Professor Ostroff concluded.
“Unless we change this structure, which is leading to high burnout and frequent staff turnover, we will face a crisis in the industry.”