“Don’t Yell at Me!” Disruptive Behavior in the OR

Disruptive behavior in the operating room can manifest in many forms, from overt verbal abuse to passive-aggressive avoidance behaviors. Disruptive behavior can be caused by team and institutional culture, technical and situational factors, distractions, poor communication, and surgeon personality. As leaders of the operating team, it is essential that surgeons do not contribute to disruptive behavior, either in individual conduct or in perpetuation of a complicit culture. Moreover, as a leader, a surgeon should be setting the tone and leading by example, as well as demanding professional behavior from the entire team. Disruptive behavior in the operating room ultimately leads to decreased individual and team performance, increased stress, increased employee attrition, decreased learning, increased communication errors and litigation, and poor patient outcomes. Understanding how to recognize, address, manage, and prevent disruptive behavior in the operating room is of utter importance, given that disruptive behavior has negative effects on the surgeon, surgical teams, learners, and—most importantly—patients and perioperative safety. In this chapter, the effects of disruptive behavior in the operating room on perioperative safety will be discussed, as well as individual-, team-, and systems-level solutions.