Researchers have found a unique way to tackle “sexist” and “humiliating” behaviour by surgeons in operating rooms across Australia.
It is “not uncommon” for surgeons to describe fellow medical staff in the operating theatre as “incompetent”, to roughly grab surgical instruments or to discredit nurses, says Rose Petrohilos, a junior doctor and intern representative for Bairnsdale Regional Health Service.
Petrohilos says she witnessed such incidents when she was completing her training. She also says “gossip in the operating theatre is also very common”.
“Some surgeons talk disparagingly about other surgeons while they’re not in the room,” Petroholis said. “Jokes made in the operating room can also be quite sexist. I’ve also been in an operating theatre where the surgeon has asked me to stand in a specific way which meant his elbow was digging into my breast.
“It is all behaviour that creates an anxiety in the room, it is often directed at nurses, and it is just not good for team dynamics.”
Studies suggest that the majority of healthcare workers have experienced incidents of incivility such as rudeness, derision, insulting remarks, humiliation and being ignored.
In an effort to address the issue, the University of South Australia professor of management and organisational behaviour, Cheri Ostroff, came up with a novel but simple intervention: printing images of eyes, and placing them on the walls of operating theatres.
The eye images were attached to the walls of an Adelaide orthopaedic hospital without any explanation to staff, with some of the images including a slogan underneath that read: “operate with respect”.
Staff including 74 surgeons, trainees, nurses, anaesthetists and technicians were surveyed prior to the images being placed on the walls, and asked about their experiences of incivility such as hurtful sarcasm, being purposefully ignored or insulted, and other behaviours.
“There is evidence from other studies that incivility impacts how long the operation takes, and some complications that might occur,” Ostroff said.
“The other way incivility has an effect is it impacts the mood of staff, and how stressed people become, whether they get burned out, their job satisfaction, and whether they want to leave the organisation or healthcare.”
One month after the survey, the eye signs were placed in five operating theatres, and in surgical hallways, of the hospital. Seven weeks after the signs appeared, the same staff were again surveyed about their experiences of incivility.
The impact was marked, Ostroff said. After 93% of participants reported experiencing or observing incivility in first survey, it fell to 86% in the second study. Theatre nurses in particular reported a significant drop in experiencing offensive and rude remarks, the study published in the journal PLOS One on Thursday found.
The study concluded it is unlikely the eye signs alone will lead to long-lasting cultural change, with further measures needed. But as an initial intervention, Ostroff said the signs had the benefit of being cheap and easy to adopt.
Dr Christine Lai, the Royal Australasian College of Surgeons (Racs) chair of professional standards, said: “I think the eye posters are great and have excellent positive messaging aimed at the team and focusing on improving culture for better patient care.
“Cultural change is complicated and takes time – that’s why the Racs is in this for the long haul.”
In 2022 the Racs launched a report on building a culture of respect in surgery, including a plan for addressing cultural issues.
“We are redoubling our efforts to foster a more diverse and inclusive workforce that reflects the communities we serve,” Lai said.
She said nearly all surgeons had completed “operating with respect” training, and that the Racs had found high levels of awareness, above 90%, among surgeons in regards to the links between unprofessional conduct and patient safety.
“We encourage employers to provide workplaces that are safe to work and learn in, making it safe for healthcare teams and individuals to speak up for the culture they want to be part of,” Lai said.
Information and support for anyone affected by rape or sexual abuse issues is available in Australia at 1800Respect (1800 737 732). In the UK, Rape Crisis offers support on 0808 500 2222. In the US, Rainn offers support on 800-656-4673. Other international helplines can be found at ibiblio.org/rcip/internl.html
