Teaching Operating Room Conflict
Management to Surgeons: Defining
the Educational Need and
Identifying Effective Behaviors
Association for Surgical Education
March 24, 2012
Acknowledgements
• Collaborators
– Lorelei Lingard, PhD, University of Western Ontario
– Sherry Espin, PhD, Ryerson University
– Maggie Boehler, MS, Southern Illinois University
– John Mellinger, MD, Georgia Health Sciences
University
– Nancy Schindler, MD, MHPE, University of Chicago
– Mary Klingensmith, MD, Washington University
– Jessica Davis, Southern Illinois University
• Study participants
Acknowledgements
Funded by an Association for Surgical
Education Foundation Center for
Excellence in Surgical Education and
Training grant
Background
Interpersonal conflict exists in the
operating room and has consequences
for team members and patients.
Rogers DA, Lingard L. Surgeons managing conflict: A framework for
understanding the challenge. J Am Coll of Surg 2006;203:568-74.
Limitations
• Research focused on communication,
patient safety, human factors
• Extent of and pathway to consequences
not developed
Rogers DA, Lingard L. Surgeons managing conflict: A framework for
understanding the challenge. J Am Coll of Surg 2006;203:568-74.
Study Goal
• Clarify the specific educational need
–Prior training
–Conflict consequences
• Identify effective behaviors
–Allows an instructional target
–Informs the development of
assessment tools
Data Collection and Analysis
•
•
•
•
Five centers (IRB approved)
Focus groups of OR nurses and surgeons
Transcripts served as the data set
Constructivist grounded theory processes
Charmaz K. Constructing Grounded Theory: A Practical Guide
Through Qualitative analysis 2006. Sage.
Results
• Thirty-one circulating room nurses in six
focus groups
• Thirty-five surgeons in six focus groups
• Two hundred and twenty page transcript
Needs Assessment
• No formal educational preparation
• Surgeons used trial and error of observed
behaviors
• Conflict and conflict management has
consequences for surgeons, staff and
patients
Inadequate Training
“I think the days of ‘I’m the surgeon...it’s
my way and the rest of you be damned’
are gone. As the new younger people
come out, while you may wish it may still
be that way, you realize that it’s not.”
(Surgeon, Institution B, 400.)
Consequences for Team Members
“You have a delicate, complicated
operation you have to do and, you know,
you have to focus all your concentration
on that and you know if you have had a
tussle with somebody it may make it
difficult to do that.” (Surgeon, Institution
E, 157.)
Effective Behaviors
Behavior
Endorsed by
both groups
Forcing
No
Consistent with
social science
research
Yes
Maintaining calm
Yes
Yes
Focused
problem-solving
Confronting
Yes
Yes
Yes
Yes
Enhanced
communication
Yes
Partially
Forceful Responses
“If I think that this person is not paying
attention, I may have to raise my voice. I
will later regret it. I will apologize and
will later have counseling about it. But at
the moment it was to save the patient.”
(Surgeon, Institution E, 75.)
Rogers DA, Lingard L, Boehler ML, Espin S, Klingensmith M, Mellinger
JD, Schindler N. Teaching operating room conflict management to
surgeons: clarifying the optimal approach. Med Educ 2011;45:939-45.
Maintaining Calm
“I guess one would be that if there is
conflict that they are able to take control
and put a hold on it…they are calmer and
they are able to prioritize and rationalize
important things instead of just flying off
the handle.” (Nurse, Institution D, 83).
Focused Problem-Solving
• Concentrate on the immediate patient
concern
• Demonstrate flexibility about solutions
• Appeal to administration about systems
issues later
Confronting
“Well, I’ve confronted them before….I’ve had
doctors and they come in carrying on ….and
I’m looking at them and I just say, “We’re
trying our best to do what we can do and
some of the things are out of our control, but
the things we can control, we’re taking care
of.” (Nurse, Institution B, 239).
Enhanced Communication
“….if you slow things down and say ‘This is
what you need to do, this is what is
happening and this is what I want to do.
Sometimes this helps.’” (Surgeon,
Institution B, 242).
Listening?
“…I think as long as both people involved
kind of acknowledge the option or input
of the other person, sort of give them
credit for saying like, oh that’s a good
idea, or I see your point but this is my
rationale for doing it this way…”(Nurse,
Institution D, 176).
Limitation
• Hesitancy in sharing opinions
• No follow-up sessions
Summary
• Compelling evidence of a specific
educational need
• Effective behaviors identified that inform
development of a curriculum
• Identified areas for future research
Thanks Again!
Funded by an ASE Foundation CESERT grant