By Will Boggs MD

(Reuters Health) – Social behavior in the operating room is significantly affected by the mix of professional roles and the surgeon’s gender, according to researchers who observed 200 surgical procedures.

“Hopefully our findings can be used to inform interprofessional training,” Dr. Laura K. Jones from Emory University, Atlanta, Georgia told Reuters Health by email.

Jones’s team used careful observation techniques to evaluate 6,348 social interactions and nontechnical communications among at least 400 different operating room team members during a variety of surgical procedures.

By far, cooperative behaviors were most common, representing 59 percent of all communications, and conflicts were rare, accounting for only 2.8 percent of communications, the researchers reported in the Proceedings of the National Academy of Sciences.

The primary surgeon was the most common source of communications and of cooperative communications, and the surgeon in training was the most common recipient.

The primary surgeon was also the most common source of conflict communications, but these were most commonly directed at the circulating nurse. In fact, most conflict communications were directed down the social hierarchy, mainly targeting individuals several ranks apart.

The likelihood of cooperation decreased with an increasing percentage of males in the room, but it depended on the surgeon’s gender.

When the surgeon’s gender differed from the main gender makeup of the rest of the surgical team, cooperation was higher and conflict was lower. When the genders were alike, though, cooperation was lower and conflict was higher. These effects seemed stronger for male surgeons than for female surgeons.

Teams with male surgeons and mostly male other members were about twice as likely to have at least one conflict as teams with male surgeons and mostly female other members.

“I found the main finding about gender dynamics most interesting–that male (surgeons’) rooms were more cooperative when the majority of the other clinicians were female, and the inverse of that,” Jones said. “We weren’t looking for that specifically, but it showed up and it rang very true to clinicians in my family who prefer to work with the opposite sex.”

“Creating all mixed gender teams is not feasible, but having a better understanding how and why they work would be helpful,” Jones said.

Dr. David A. Rogers from the University of Alabama in Birmingham, who has studied operating room conflict management, told Reuters Health by email, “The findings in this present study that the conflict type language tended to flow down the hierarchy is contrary to our goal of creating a safe working environment where all team members are free to speak up.”

“(The public) should be confident that the vast majority of operations are performed by teams of committed individuals who work well together,” he said. “There is a substantially diminishing tolerance for the most egregious behaviors . . . (but) their study draws attention to the fact that we have still not reached our goal of eliminating it altogether.”

Dr. Cindy M. Clark from ATI Nursing Education, Leawood, Kansas specializes in fostering civility and creating and sustaining healthy work environments. She told Reuters Health by email that intense conflict in the operating room, while uncommon, “can have significant and detrimental impact on patient outcomes.”

She added, “While we can emphasize that conflict occurs less frequently than cooperative interactions, both matter and require our attention to deliver safe patient care.”

“Emphasizing the importance of effective and respectful communication in all patient care areas (and in life) will have an impact on achieving optimal patient outcomes,” she said.

SOURCE: Proceedings of the National Academy of Sciences USA, online July 2, 2018.