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. 2023 Nov 30;18(11):e0295271.
doi: 10.1371/journal.pone.0295271. eCollection 2023.

Eyes on incivility in surgical teams: Teamwork, well-being, and an intervention

Cheri Ostroff  1 , Chelsea Benincasa  2 , Belinda Rae  1 , Douglas Fahlbusch  3 , Nicholas Wallwork  4
Affiliations

Eyes on incivility in surgical teams: Teamwork, well-being, and an intervention

Cheri Ostroff et al. PLoS One. .

Abstract

Incivility in surgery is prevalent and negatively impacts effectiveness and staff well-being. The purpose of this study was to a) examine relationships between incivility, team dynamics, and well-being outcomes, and b) explore a low-cost intervention of 'eye' signage in operating theater areas to reduce incivility in surgical teams. A mixed methods design was used in an orthopedic hospital. Surveys of incivility, teamwork, and well-being were administered three months apart in a small private hospital. An intervention of signage with eyes was placed in the theater area after administration of the first survey, using a pretest-posttest design. Participants also responded to an open-ended question about suggestions for improvements at the end of the survey which was then thematically analyzed. At the individual level (n = 74), incivility was statistically significantly related to team dynamics which in turn was significantly related to burnout, stress, and job attitudes. At the aggregate level, reported incivility was statistically significantly lower after the 'eye' sign intervention. Thematic analysis identified core issues of management behaviors, employee appreciation, communication, and work practices. Incivility in surgical teams has significant detrimental associations with burnout, stress, and job attitudes, which occurs through its impact on decreased team dynamics and communication. A simple intervention that evokes perceptions of being observed, such as signage of eyes in theater areas, has the potential to decrease incivility at least in the short term, demonstrating that incivility is amenable to being modified. Additional research on targeted interventions to address incivility are needed to improve teamwork and staff well-being.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Examples of eye intervention signs.
Fig 2
Fig 2. Relationship between incivility and outcomes mediated by team dynamics.
Fig 3
Fig 3. Pre- and post-intervention incivility by job roles.
See this image and copyright information in PMC

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References

    1. Riskin A, Bamberger P, Erez A, Zeiger A. Discrete incivility events and team performance: A cognitive perspective on a pervasive human resource (HR) issue. Res Pers Human Resour. 2020. Jul 24;38:223–58.
    1. Cortina LM, Hershcovis SM, Clancy KB. The embodiment of insult: A theory of biobehavioral response to workplace incivility. J Manage. 2022. Mar;48(3):38–763. doi: 10.1177/0149206321989798 - DOI - PMC - PubMed
    1. Villafranca A, Hiebert B, Hamlin C, Young A, Parveen D, Arora RC, et al.. Prevalence and predictors of exposure to disruptive behaviour in the operating room. Can J Anaesth. 2019. Jul 1:66(7):781–94. - PubMed
    1. Westbrook J, Sunderland N, Li L, Koyama A, McMullan R, Urwin R, et al.. The prevalence and impact of unprofessional behaviour among hospital workers: a survey in seven Australian hospitals. MJA. 2021. Jan;214(1):31–37. doi: 10.5694/mja2.50849 - DOI - PubMed
    1. Santosa KB, Kayward L, Matusko N, Jagsi R, Audu CO, Kwakye G, et al.. Incivility, work withdrawal, and organizational commitment among US surgeons. Ann Surg. 2023. Mar 1;277(3):416–422. doi: 10.1097/SLA.0000000000005186 - DOI - PubMed

Grants and funding

This project was supported by the Australian Research Council Grant, Project DP160101313 (CO received the award). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.