Implementation of Civility Saves Lives in the Neurosurgical Theatre Department

ABSTRACT

Introduction: Incivility is defined as rude behaviour or rude remarks[1]. It comes from the Latin incivilis meaning 'not of a citizen' and includes belittling, sarcastic comments, ignoring, rebuking and embarrassing colleagues as well as non-verbal behaviours such as eye rolling. External stressors combined with a permissive environment allow this behaviour to occur. Stressors are personal and work-related stress, feeling rushed, over-worked, having low morale or suffering exhaustion[2]. Many of these are commonplace within the healthcare system, particularly during the last two years with the COVID-19 pandemic. Healthcare workplace incivility is common, reported up to 97% in the operating room[2] with a resultant impact on staff and presenting a patient safety risk. Katz et al[3] described significant differences in performance of anaesthetic trainees exposed to a polite or rude surgeon during a simulated intra-operative haemorrhage (91.2% vs. 63.6% (P=0.007) performing at expected level). 25% of staff who experienced incivility take this out on service users. 75% of service users who witness it are less enthusiastic about the organisation [4]. Reducing workplace incivility is part of the NHS Long-term Plan[5] and NHS People Plan[6]. Our primary objective was to determine prevalence of perceived disruptive behaviours within the operating room at a single-specialty neurosciences centre. Secondary objectives were to identify the most frequent types of disruptive behaviours and implement changes to reduce incivility. Methodology: This survey is locally registered (ref 10-202122-SE). An anonymous, electronic survey, using Google Forms, was disseminated to healthcare staff working in the neurosurgical operating rooms over 1-month (July 2021) using email cascades and established staff WhatsApp groups. Reminders were sent at week 2 and 3. The survey was previously validated [2] and consisted of two sections exposure (14-items in 4 categories personal;in-group;out-group;undirected and directed at patients) and responses (14-items) to disruptive behaviours. Data collected included staff demographics. Data was analysed using Microsoft Excel. Result(s) The survey response rate was 49% (n=92;Table 1). 85% of responders perceived experiencing or witnessing disruptive behaviour, most frequently undirected (85%), and mostly a few times a year (personal 70%;patient-directed 67%;in-group 65%;out-group 68%;undirected 56%). A few respondents personally experienced disruptive behaviours on a monthly (4%), weekly (1%) or daily basis (1%). 'Having work obstructed' was the most frequently perceived personal (62%) or out-group (62%) disruptive behaviour, 'sarcasm' most common in-group (63%) and 'speaking ill of others' (85%) most common undirected behaviour. Response to perceived disruptive behaviours was assertive (68%), rarely malicious or manipulative (<1%). 47% accepted the behaviours as a part of normal operating room culture. Further subgroup analysis was not conducted due to small numbers. In response to our survey, we have taken the following actions (1) Raising awareness We have presented the results at multidisciplinary staff forums;including Hospital, Neuroanaesthetic and Neurosurgical Department Safety Forums and Operating Department teaching sessions. (2) Further education and awareness Posters and infographics are displayed from the Civility Saves Lives movement[7], AAGBI #knockitout[8] and of survey results. (3) Staff encouraged to attend further training Active Bystander, to develop tools to manage disruptive behaviours. Conclusion(s) Perceived disruptive behaviours may be common within the neurosurgical operating room environment. Our results are in keeping with published literature[2] and highlight an important patient safety risk. Encouraging staff to overcome incivility can improve team performance and reduce errors[3], creating a more supportive working environment, safeguarding patients and improving experience. Staff may be empowered to speak up when they see something that potentially jeopardises patient safety. We plan to resurvey once changes have been fully implemented for a period of 6 months to see whether greater awareness and empowerment of staff has made a difference. (Table Presented).