Authors

1 Deputy of Research and Technology

2 Department of Midwifery, Nursing and Midwifery Faculty, North Khorasn University of Medical sciences, Bojnurd, Iran

Abstract

INTRODUCTION: Understanding the development and distribution of disruptive behaviour among
members of a health‑care team is critical to the safety and quality of patient care in high‑risk
environments such as operating rooms. The present study identified disruptive behaviour and its
effect on the treatment of patients in the operating room environment.
SUBJECTS AND METHODS: This cross‑sectional study used the convenience sampling method to
select 144 operating room physicians and nurses (91 women and 53 men). The study was conducted
in the operating rooms of four academic hospitals with different specialties in North Khorasan province
in Iran from December 2013 to September 2014. The data were collected using a translated, modified,
and validated questionnaire to investigate the prevalence and consequences of disruptive behaviour,
the response of the health care system to the behaviour, factors affecting the creation of conflict and
the spread of disruptive behaviour. Statistical analysis of the data was performed using SPSS 18.
RESULTS: Disruptive behaviour was reported by 82.95% physicians and nurses. On average, 39%
of physicians and 21% of operating room nurses exhibited disruptive behaviour. Disruptive behaviour
is associated with psychological and clinical consequences. Factors such as fear of retaliation (8%),
lack of change (43.8%), lack of security (18.1%) and attitude of the organization (14.6%) are significant
reasons for the failure to report these behaviours.
CONCLUSIONS: The findings suggest that disruptive behaviour occurs and affects treatment and
workflow of treatment teams in the operating room. Interpersonal conflict contributes to the growth
of such behaviour; thus, more research should focus on this subject in the future.

Keywords

1. Shokri A, Yazdan Panah A, Vahdat Sh. The professional
relationship between the nurses and physicians from their own
point of view. Iran J Health and Care 2013;15:69-76.
2. Mahmoodian F, Seyed Jafari SM, Keshmiri M, Azimi A,
Vosoughi M. Nurses’ experiences about the challenges of nursephysician professional relationships, in 1390. Sadra Med Scie J
2014;2:31-42.
3. Bakhtiari S, Mehrabi T, Hasanzadeh A. An investigation on
occupational stress of the operating room staffs in hospitals
affiliated to Isfahan University of Medical Sciences and its
association with some factors. Iran J Nurs Midwifery Res
2013;18:101-4.
4. Azizpour Y, Shohani M, Sayehmiri K, Kikhavani S. A survey on
the associated factors of stress among operating room personnel.
Thrita 2013;2:19-23.
5. Booij LH. Conflicts in the operating theatre. Curr Opin
Anaesthesiol 2007;20:152-6.
6. Grogan MJ, Knechtges P. The disruptive physician: A legal
perspective. Academic radiology 2013;20:1069-73.
7. Cochran A, Elder WB. A model of disruptive surgeon behavior
in the perioperative environment. J Am Coll Surg 2014;219:390-8.
8. Rosenstein AH, O'Daniel M. Impact and implications of
disruptive behavior in the perioperative arena. J Am Coll Surg
2006;203:96-105.
9. Veltman LL. Disruptive behavior in obstetrics: A hidden threat
to patient safety. Am J Obstet Gynecol 2007;196:587 e1-4.
10. Stecker M, Epstein N, Stecker MM. Analysis of inter-provider
conflicts among healthcare providers. Surg Neurol Int
2013;4:S375-82.
11. Wachs JP, Frenkel B, Dori D. Operation room tool handling and
miscommunication scenarios: An object-process methodology
conceptual model. Artif Intell Med 2014;62:153-63.
12. Cochran A, Elder WB. Effects of disruptive surgeon behavior in
the operating room. Am J Surg 2015;209:65-70.
13. Small CR, Porterfield S, Gordon G. Disruptive behavior within
the workplace. Applied Nursing Research 2015;28:67-71.
14. Katz JD. Conflict and its resolution in the operating room. J Clin
Anesth 2007;19:152-8. [Epub 2007 Mar 24].
15. de Vries EN, Prins HA, Crolla RM, den Outer AJ, van Andel G,
van Helden SH, et al. Effect of a comprehensive surgical safety
system on patient outcomes. N Engl J Med 2010;363:1928-37.
16. Rogers DA, Lingard L, Boehler ML, Espin S, Mellinger JD,
Schindler N, et al. Surgeons managing conflict in the operating
room: Defining the educational need and identifying effective
behaviors. Am J Surg 2013;205:125-30.
17. Stella C. Conflict in the operating room: Fight and flight or growth
and communication. Can Oper Room Nurs J 2010;28:7-8, 13-6, 8.
18. Patel P, Robinson BS, Novicoff WM, Dunnington GL, Brenner MJ,
Saleh KJ. The disruptive orthopaedic surgeon: Implications for
patient safety and malpractice liability. J Bone Joint Surg Am
2011;93:e1261-6.
19. Hu YY, Arriaga AF, Peyre SE, Corso KA, Roth EM, Greenberg CC.
Deconstructing intraoperative communication failures. J Surg Res
2012;177:37-42.
20. Antoniadis S, Passauer-Baierl S, Baschnegger H, Weigl M.
Identification and interference of intraoperative distractions and
interruptions in operating rooms. J Surg Res 2014;188:21-9.
21. Rogers DA, Lingard L, Boehler ML, Espin S, Schindler N,
Klingensmith M, et al. Foundations for teaching surgeons to
address the contributions of systems to operating room team
conflict. Am J Surg 2013;206:428-32.