Ethological observations of social behavior in the operating room

Abstract

Operating rooms (ORs) are inhabited by hierarchical, mixed-gender clinical teams that are often prone to conflict. In evolutionary terms, one expects more within- than between-gender rivalries, especially since the OR is a place where all sorts of social interactions occur, not merely technical communications. To document the full range of behavior, the present study used ethological observation techniques, recording live all social behavior by the team. Using an ethogram, 6,348 spontaneous social interactions and nontechnical communications were timestamped during 200 surgical procedures. Cooperation sequences (59.0%) were more frequent than conflict sequences (2.8%), which ranged from constructive differences of opinion to discord and distraction that could jeopardize patient safety. Behavior varied by clinical role and with the gender composition in the OR. Conflict was initiated mostly down the hierarchy between individuals several ranks apart. Cooperation tended to increase with a rising proportion of females in the OR, but the most pronounced effect concerned the interaction between both genders. If the attending surgeon's gender differed from that of the majority of other personnel in the OR, cooperation was significantly more common.

Keywords: conflict; gender; human behavior; medical; operating room.

Fig. 1.

Initiated interpersonal conflicts as percent of all communications up or down the social hierarchy in the OR. The hierarchy has been set as attending surgeon > surgical fellow/resident > anesthesia provider > circulating nurse > scrub person. The bars give the overall unadjusted data (conflict as percent of all communications) for individuals one to four rank positions apart in the role hierarchy. Black bars show conflict directed at individuals ranking below the source; gray bars show conflict directed at higher-ranking individuals.

Fig. 2.

Mean (± SE) overall cooperative behavior as a percentage of all communications in the OR by gender composition of the team.

Fig. 3.

The gender interaction for cooperation illustrated with unadjusted aggregated data at the surgery level for all 200 surgeries. The graph compares the mean (± SD) percentage of cooperation in the OR by attending surgeon’s gender and the gender of his or her male- or female-prevalent OR team.