Disruptive behavior in the operating room: Systemic over individual determinants

Background: The operating room (OR) environment presents specific conditions that put stress on work dynamics. Disruptive behavior among members of the health team is recognized to affect work dynamics and patient outcomes. As surgeons have been syndicated as frequent disruptors, the objective was to explore their perceptions about OR working dynamics and the occurrence of disruptive behavior. Study design: Qualitative exploratory study, based on semi-structured individual interviews. Twenty participants were sampled until data saturation. For better context, we also included in the sample anesthesiologists, nurses, and technicians, among others. Using grounded theory framework, investigators extracted data from verbatim transcriptions with qualitative software. Results: Problems of infrastructure, interpersonal relationships, and organizational failures had most density of citations and trigger the most disruptive behavior narrated events. Although personality traits were noted to promote some disruptive behavior occurrence, systemic determinants were critical, such as poorly defined working roles and a plethora of personal ways to cope or avoid disruptive behavior. Conclusion: Our results suggest that disruptive behavior events are not just a matter of a surgeon's personality traits but also substantiated by systemic normalization, informal communication strategies, and undefined roles, making teams less resilient to unexpected events.