School of Health, Northwestern Polytechnic, K220, 10726 106 Ave., Grande Prairie, AB, T8V 4C4, Canada.
Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada.
Can J Anaesth. 2024 Apr;71(4):490-502. doi: 10.1007/s12630-023-02670-5. Epub 2023 Dec 21.
Disruptive intraoperative behaviour can have detrimental consequences for clinicians, institutions, and patients. The way victims and witnesses respond to disruptive behaviour can ameliorate or exacerbate consequences. Nevertheless, previous research has neither described the responses of a multinational sample of clinicians nor developed tools to recognize and evaluate responses.
After obtaining ethics committee approval, 23 perioperative organizations distributed a survey evaluating clinician responses to disruptive behaviour. We grouped responses into four response strategies: passive, assertive, manipulative, and malicious. Thereafter, we derived norms (i.e., percentile distributions) for each response strategy using empirical distribution functions. Latent profile analysis identified groups of clinicians balancing their use of the four response strategies differently (i.e., response pattern groups). We used Chi square tests to examine associations between response pattern groups and respondent demographics.
We analyzed 4,789 complete responses. In response to disruptive behaviour, 33.7% of clinicians altered medical care in ways that were unindicated, 54.6% avoided communication with team members, and 12.1% misled the offender. Profile analysis identified five response pattern groups: extreme passive-predominant (30.5% of clinicians), extreme assertive-predominant (20.5%), moderate passive-predominant (18.9%), moderate assertive-predominant (26.5%), and a disparate pattern (greater use of manipulative and malicious responses) (3.5%). Profession, sex, management responsibilities, and sexual orientation predicted the response pattern group (all, P < 0.001).
The responses of thousands of clinicians involved passivity, manipulativeness, or maliciousness. We present norms and a response pattern classification to help organizations evaluate responses, recognize response patterns, and provide tailored support to victims and witnesses.
术中的破坏性行为可能会给临床医生、医疗机构和患者带来不利后果。受害者和证人对破坏性行为的反应方式可以减轻或加剧后果。然而，以前的研究既没有描述来自多个国家的临床医生的反应，也没有开发出识别和评估反应的工具。
在获得伦理委员会批准后，23 个围手术期组织分发了一份评估临床医生对破坏性行为反应的调查问卷。我们将反应分为四种反应策略：被动、果断、操纵和恶意。然后，我们使用经验分布函数为每种反应策略得出规范（即百分位分布）。潜在剖面分析确定了不同程度地平衡使用四种反应策略的临床医生群体（即反应模式群体）。我们使用卡方检验来检验反应模式群体与受访者人口统计学特征之间的关联。
我们分析了 4789 份完整的回复。对于破坏性行为，33.7%的临床医生以未经指示的方式改变了医疗护理，54.6%避免与团队成员沟通，12.1%误导了肇事者。分析确定了五种反应模式群体：极端被动占主导地位（30.5%的临床医生）、极端果断占主导地位（20.5%）、中度被动占主导地位（18.9%）、中度果断占主导地位（26.5%）和不同模式（更多使用操纵和恶意反应）（3.5%）。职业、性别、管理职责和性取向预测了反应模式群体（均 P<0.001）。
数千名临床医生的反应表现为被动、操纵或恶意。我们提供规范和反应模式分类，以帮助组织评估反应、识别反应模式，并为受害者和证人提供有针对性的支持。
