Is disruptive behavior inherent to the surgeon or environment?

Editor's Note

Unclear policies and urgent competing responsibilities in the OR create stress, suggesting that the environment is the primary contributor to disruptive behavior by the surgeon, this study finds.

Of 314 reports of disruptive behavior from surgical, medical, and other specialties, which included both the reporter account and involved party responses, high-intensity environments (OR, ICU, etc) made up 56% of the reports.

There was a significant direct relationship between the stress of the clinical situation and the egregiousness of the behavior. Perceived unprofessional or lack of communication was present in 70% and 44% of events, respectively.

Logistic regression analysis found that unclear hospital policies, the involved party being a surgeon, and urgent competing responsibilities were associated with potential patient harm.

Tactics to improve stressful environments and clearly communicated policies may be more effective and sustainable than targeted interventions to enhance patient safety, the authors say.