title: Impact and implications of disruptive behavior in the perioperative arena.
abstract: BACKGROUND
  There is a growing concern about the role of human factor issues and their effect on patient safety and clinical outcomes of care. Problems with disruptive behaviors negatively affect communication flow and team dynamics, which can lead to adverse events and poor quality outcomes.
  
  
  METHODS
  A 25-question survey tool was used to assess the status and significance of disruptive behaviors around perioperative services in a large metropolitan academic medical center. Results were analyzed and compared with those from a national databank to identify areas of concern and opportunities for improvement.
  
  
  RESULTS
  Disruptive behaviors were a common occurrence in the perioperative setting. These types of behaviors were most prevalent in attending surgeons. Disruptive behaviors increased levels of stress and frustration, which impaired concentration, impeded communication flow, and adversely affected staff relationships and team collaboration. These events were perceived to increase the likelihood of medical errors and adverse events and to compromise patient safety and quality of care.
  
  
  CONCLUSIONS
  Disruptive behaviors in the perioperative arena have a significant impact on team dynamics and communication flow, which can have a negative impact on patient care. Organizations need to recognize the prevalence and significance of disruptive behaviors and develop policies and processes to address the issue. Key areas of focus include recognition and awareness, organizational and cultural commitment, implementation of appropriate codes of behavior policies and procedures, and provision of education and training programs to discuss contributing factors and tools to build effective communication and team collaboration skills.
authors.affiliation: VHA West Coast, Pleasanton, CA 94588, USA. arosenst@vha.com
authors.forename: Alan H
authors.initials: AH
authors.lastname: Rosenstein
authors.forename: Michelle
authors.initials: M
authors.lastname: O'Daniel
mesh_terms: D000046:Academic Medical Centers; D000378:Agonistic Behavior; D001291:Attitude of Health Personnel; D003142:Communication; D003625:Data Collection; D034462:Dissent and Disputes; D006801:Humans; D007400:Interprofessional Relations; D017063:Outcome Assessment, Health Care; D019990:Perioperative Care; D014481:United States