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The Impact of Disruptive Behavior in the OR

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The Impact of Disruptive Behavior in the OR

By Missy Padoll, CRICO

Related to: Communication, Emergency Medicine, Surgery, Teamwork Training

Over the years, clinicians working in a surgical environment have become inured to poor communication and behavior from their surgical colleagues. Beyond the destructive impact these interactions can have on professional relationships, they may also lead to medical error resulting from breakdowns in the flow of communication within the clinical team.

In Malpractice Risks in Communication Failures, a review of 1,959 surgery cases from 2009–2013 showed that surgical patients are vulnerable to communication failures from the pre-operative consent process though post-op recovery and discharge. Of these, 19 percent reported “miscommunication among providers regarding the patient’s condition” as a contributing factor. An “unsympathetic response to patient complaints” was cited in 13 percent of cases. To further illustrate the impact, 48 percent of these surgery cases resulted in a high-severity injury, or death.

A culture that tolerates impatience, dogmatism, and a reluctance to express a safety concern leaves patients more susceptible to preventable injuries, and exposes all providers on the care team to allegations of malpractice. Surgical teams that master the ability to respectfully convey and receive information with patients before surgery, team members during surgery, and subsequent providers after surgery establish a model for colleagues from all disciplines.

In our current environment, previously tolerated misbehavior on the part of surgeons is no longer acceptable. Speaking up and challenging the status quo has become a rally call across all industries, including health care. Savvy leaders are making the connection between communication failures as a root cause of adverse events and malpractice suits in their hospitals. The challenge is how to shift this legacy behavior by surgeons.

To address the issues head on, a team of researchers at Ariadne Labs collaborated with four academic surgery departments in the Boston area, leveraging medical malpractice data from CRICO Strategies’ national Comparative Benchmarking System (CBS). Together, they led a first-of-its kind Harvard research study that sheds new light on the serious effects of negative surgeon behavior on their interactions with colleagues, malpractice risk, and potentially even patient care.

The study collected de-identified data on 264 surgeons who received 360-degree reviews between the years 2012 and 2013. Researchers then merged this 360-degree review data with malpractice claims data from CBS. Their findings emphasize the importance of respectful communication and teamwork and show that surgery needs a culture change.

Key Findings

  • Close to half of all surgeons in the group had been named in at least one claim
  • Multiple positive behaviors were significantly associated with lower instances of malpractice claims (e.g., open to feedback, respectful of team members)
  • Negative behaviors were significantly associated with risk of having malpractice claims (e.g., snapping out in frustration, talking down to others)

In a recent blog post describing the study, author Janaka Lagoo MD, MPH, shared the following summary:


To capitalize on the key findings of this work, we encourage our surgical colleagues to consider the following as we all work to improve the quality and safety of surgical care for all patients:

  • More widespread use of the 360-degree reviews to identify areas of improvement and action planning to make those improvements.
  • Comprehensive and scalable programs to address potential underlying issues like substance abuse or anger management, that can be associated with negative performance reviews.
  • Improved focus on physician/patient relationship building through all levels of training and practice.

Additional Material


August 28, 2018
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