An innovative approach to managing behaviour in the operating room (OR) using posters with eye symbols has seen positive results.
A team of Australian researchers conducted a successful trial to address offensive and impolite remarks within ORs by implementing ‘eye’ signage in surgical rooms.
These posters, placed on the walls of an Adelaide orthopaedic hospital’s operating theatre without explanation, effectively reduced poor behaviour among surgical teams.
The lead researcher, Professor Cheri Ostroff from the University of South Australia, attributed this outcome to a sense of being ‘watched’, even though the eyes are not real.
The three-month experiment targeted a prevalent culture of bullying and misconduct in surgical settings, a problem pervasive not only in healthcare but across various high-stress industries.
Professor Ostroff emphasised that besides affecting staff morale and productivity, rude behaviour also has a detrimental impact on patients, particularly in compromising teamwork and communication during surgery, potentially leading to poorer outcomes.
The consequences of such behaviour include high turnover rates, decreased job satisfaction, reduced productivity and non-compliance with crucial protocols like infection control and medication procedures.
Despite attempts with workshops and training sessions internationally, addressing this behaviour has proven challenging.
In the Adelaide study, an initial survey involving 74 staff members at a private hospital – including surgeons, nurses, trainees, anaesthetists and technicians – documented incidents of misconduct in the operating theatre.
Subsequently, the eye signs were introduced, and a follow-up survey conducted seven weeks later revealed a significant impact.
Theatre nurses notably reported a substantial decrease in witnessing or experiencing offensive behaviour.
Surgeon Dr Nicholas Wallwork, who was involved in the study, highlighted the experiment’s indication that people alter their behaviour, even subconsciously, when they sense being observed.
He emphasised the challenges in surgical settings due to the high stakes, teamwork demands, time pressures, and risks involved, underscoring the necessity of fostering high-functioning, stable teams.
Dr Wallwork addressed the communication challenges within teams, attributing them not only to hierarchical structures but also to the competitive and intense nature of the field.
He suggested that modifying leadership structures could alleviate burnout and staff turnover, averting an impending crisis in the industry.
Professor Ostroff emphasised the potential for change through straightforward interventions, stressing the importance of altering workplace culture.
The study identified critical areas for improvement, including setting role model examples among senior management, recognising employee value, promoting open communication within teams and with management and establishing more explicit role definitions.
The findings of this research have been published in PLOS ONE under the title: ‘Eyes on incivility in surgical teams: teamwork, wellbeing, and an intervention’.
Photo caption: An eye sign is used in an Adelaide hospital's operating rooms to improve the culture among medical staff. Photograph: Ostroff
