Disruptive behaviour in the operating room is under-reported: an international survey

  • Ian Fast
  • Alexander Villafranca
  • Bernadette Henrichs
  • Kirby Magid
  • Chris Christodoulou
  • Eric JacobsohnEmail author
Reports of Original Investigations



The purpose of this study was to investigate the reporting habits of clinicians who have been exposed to disruptive behaviour in the operating room (OR) and assess their satisfaction with management’s responses to this issue.


Ethics committee approval was obtained. This was a pre-specified sub-study of a larger survey examining disruptive behaviour, which was distributed to OR clinicians in seven countries. Using Likert-style questions, this study ascertained the proportion of disruptive intraoperative behaviour that clinicians reported to management, as well as their degree of satisfaction with management’s responses. Binomial logistic regression identified socio-demographic, exposure-related, and behavioural predictors that a clinician would never report disruptive behaviour.


Four thousand, seven hundred and seventy-five respondents were part of the sub-study. Disruptive behaviour was under-reported by 96.5% (95% confidence interval [CI], 95.9 to 97.0) of respondents, and never reported by 30.9% (95% CI, 29.6 to 32.2) of respondents. Only 21.0% (95% CI, 19.8 to 22.2) of respondents expressed satisfaction with management’s responses. Numerous socio-demographic, exposure-related, and behavioural predictors of reporting habits were identified. Socio-demographic groups who had higher odds of never reporting disruptive behaviour included younger clinicians, clinicians without management responsibilities, both anesthesiologists and surgeons (compared with nurses), biological females, and heterosexuals (all P < 0.05).


Disruptive behaviour was under-reported by nearly all clinicians surveyed, and only one in five were satisfied with management’s responses. For healthcare systems to meaningfully address the issue of disruptive behaviour, management must create reporting systems that clinicians will use. They must also respond in ways that clinicians can rely on to affect necessary change.

Les comportements perturbateurs en salle d’opération sont sous-rapportés : un sondage international



L’objectif de cette étude était d’examiner les pratiques de signalements des cliniciens exposés à des comportements perturbateurs en salle d’opération (SOP) et d’évaluer leur satisfaction vis-à-vis des réactions de la direction à ce problème.


Nous avons obtenu le consentement du comité d’éthique. Il s’agissait d’une sous-étude pré-spécifiée d’un plus grand sondage portant sur les comportements perturbateurs, distribué aux cliniciens de SOP dans sept pays. À l’aide de questions de style Likert, cette étude a déterminé la proportion de comportements perturbateurs peropératoires rapportés par les cliniciens à la direction, ainsi que leur degré de satisfaction vis-à-vis de la réponse de la direction. Une régression logistique binomiale a permis d’identifier les prédicteurs sociodémographiques, ainsi que les prédicteurs liés à l’exposition et comportementaux indiquant qu’un clinicien ne rapporterait jamais un comportement perturbateur.


Quatre mille sept cent soixante-quinze répondants ont été inclus dans cette sous-étude. Les comportements perturbateurs étaient sous-rapportés par 96,5 % (intervalle de confiance [IC] 95 %, 95,9 à 97,0) des répondants, et jamais rapportés par 30,9 % (IC 95 %, 29,6 à 32,2) des répondants. Seuls 21,0 % (IC 95 %, 19,8 à 22,2) des répondants ont exprimé être satisfaits des réactions de la direction. De nombreux prédicteurs sociodémographiques, liés à l’exposition et comportementaux des habitudes de communication ont été identifiés. Les groupes sociodémographiques affichant une probabilité plus élevée de ne jamais rapporter les comportements perturbateurs comprenaient les cliniciens plus jeunes, les cliniciens sans responsabilités de direction, les anesthésiologistes et les chirurgiens (par rapport au personnel infirmier), les femmes biologiques et les hétérosexuels (tous P < 0,05).


Les comportements perturbateurs étaient sous-rapportés par la quasi-totalité des cliniciens interrogés, et seul un clinicien sur cinq s’estimait satisfait des réponses de la direction. Si les systèmes de soins de santé veulent véritablement régler le problème des comportements perturbateurs, les directions des établissements doivent créer des systèmes de communication des incidents qui seront utilisés par les cliniciens. Elles doivent également réagir de manière à ce que les cliniciens puissent avoir confiance que les changements nécessaires seront apportés.


Author contributions

Ian Fast contributed to all aspects of this study, including conception and design of the study; analysis and interpretation of the data, and drafting of the manuscript. Alexander Villafranca contributed to all aspects of this study, including conception and design of the study; acquisition, analysis, and interpretation of the data, and drafting of the manuscript. Bernadette Henrichs contributed to the conception and design of the study, acquisition of the data, and editing of the manuscript. Kirby Magid contributed to the interpretation of the data, data analysis, and drafting of the manuscript. Chris Christodoulou and Eric Jacobsohn contributed to the conception and design of the study, interpretation of the data, and drafting of the manuscript.


We would like to thank the Academic Oversight Committee of the Department of Anesthesia, Perioperative and Pain Medicine at the University of Manitoba (Winnipeg, MB, Canada) for providing financial support of this project. We also appreciate the help of the 23 organizations who distributed the survey and the time and effort of all respondents.

Conflicts of interest


Funding statement

The Academic Oversight Committee of the Department of Anesthesia, Perioperative and Pain Medicine at the University of Manitoba (Winnipeg, MB, Canada), Max Rady College of Medicine provided financial support for this project.

Editorial responsibility

This submission was handled by Dr. Philip M. Jones, Associate Editor, Canadian Journal of Anesthesia.


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Copyright information

© Canadian Anesthesiologists' Society 2019

Authors and Affiliations

  • Ian Fast
    • 1
  • Alexander Villafranca
    • 1
  • Bernadette Henrichs
    • 2
    • 3
  • Kirby Magid
    • 1
  • Chris Christodoulou
    • 1
  • Eric Jacobsohn
    • 1
    Email author
  1. 1.Department of Anesthesia, Perioperative and Pain MedicineUniversity of ManitobaWinnipegCanada
  2. 2.Goldfarb School of NursingBarnes Jewish CollegeSt. LouisUSA
  3. 3.Department of AnesthesiologyWashington University in St. LouisSt. LouisUSA

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