Development of Survey Scales for Measuring Exposure and Behavioral Responses to Disruptive Intraoperative Behavior

Abstract

Objectives: Disruptive intraoperative behavior has detrimental effects to clinicians, institutions, and patients. How clinicians respond to this behavior can either exacerbate or attenuate its effects. Previous investigations of disruptive behavior have used survey scales with significant limitations. The study objective was to develop appropriate scales to measure exposure and responses to disruptive behavior. Methods:We obtained ethics approval. The scales were developed in a sequence of steps. They were pretested using expert reviews, computational linguistic analysis, and cognitive interviews. The scales were then piloted on Canadian operating room clinicians. Factor analysis was applied to half of the data set for question reduction and grouping. Item response analysis and theoretical reviews ensured that important questions were not eliminated. Internal consistency was evaluated using Cronbach α. Model fit was examined on the second half of the data set using confirmatory factor analysis. Content validity of the final scales was re-evaluated. Consistency between observed relationships and theoretical predictions was assessed. Temporal stability was evaluated on a subsample of 38 respondents.Results: A total of 1433 and 746 clinicians completed the exposure and response scales, respectively. Content validity indices were excellent (exposure = 0.96, responses = 1.0). Internal consistency was good (exposure = 0.93, responses = 0.87). Correlations between the exposure scale and secondary measures were consistent with expectations based on theory. Temporal stability was acceptable (exposure = 0.77, responses = 0.73). Conclusions:We have developed scales measuring exposure and responses to disruptive behavior. They generate valid and reliable scores when surveying operating room clinicians, and they overcome the limitations of previous tools. These survey scales are freely available.

Prevalence and predictors of exposure to disruptive behaviour in the operating room

“…The Ethics Boards at the University of Manitoba, Washington University School of Medicine in St Louis and the University of Michigan approved this study. We distributed our previously developed scale 25 to 134 perioperative associations in Canada, Australia, New Zealand, Brazil, India, the USA, and the UK. The scale quantifies how often clinicians perceive themselves as having experienced and/or witnessed 14 examples of disruptive behaviour in the preceding year (see Fig.…”

“…7 To develop strategies to reduce disruptive behaviour in the OR, it is important to establish the scope of the problem and to ascertain who is at higher risk of being exposed. Previous investigations in the OR have had methodological limitations relating to sampling frames, survey tool development, and statistical methodology.. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Appropriate tools to measure exposure to disruptive behaviour have only recently been created 21,24,25 and previous studies have not examined disruptive behaviour in a large international cohort of OR clinicians. There is also limited data on the socio-demographic predictors of exposure to disruptive behaviour.…”

Abusive behaviour in Canadian and US operating rooms

“…In the first stage, two scales were developed to measure exposure and responses to disruptive behaviour. 24 From July 2012 to August 2014, these scales were distributed to 23 perioperative associations in seven countries. Then, in the second stage, we evaluated the prevalence and predictors of exposure to disruptive behaviour, as well as how people respond to disruptive behaviour.…”

Conquering the silence: reporting disruptive behaviour

“…5 Les auteurs ont défini un comportement perturbateur comme possédant quatre composantes : 1) étant de nature interpersonnelle; 2) survenant dans le contexte opératoire; 3) résultant en une menace perçue par les victimes et/ou les témoins; et 4) portant atteinte à la perception raisonnable de ce qui constitue un comportement respectueux envers une personne tel qu'ancré dans la Déclaration universelle des droits de l'homme. 6 Le premier manuscrit révélait que 97 % des répondants avaient rapporté avoir été exposés à des comportements perturbateurs au cours de la dernière année, une plus grande exposition étant rapportée par les personnes occupant une position de pouvoir moins traditionnelle (c.-à-d. des cliniciens plus jeunes, avec moins d'expérience, de sexe féminin, non hétérosexuels, des infirmières ou travaillant dans des cliniques privées). 5 Le deuxième manuscrit avait examiné un sous-groupe spécifié au préalable de 2875 cliniciens de SOP canadiens et américains qui ont répondu à des questions liées aux comportements abusifs -dans ce cas, l'agression physique, les menaces verbales, ou l'invasion intimidante de l'espace personnel.…”

“…5 The authors defined disruptive behaviour as having four components: 1) being interpersonal in nature, 2) occurring in the operative context, 3) resulting in a perceived threat to victims and/or witnesses, and 4) violating a reasonable person's standard of respectful behaviour as rooted in the Universal Declaration of Human Rights. 6 The first manuscript revealed that 97% of respondents reported exposure to disruptive behaviour in the past year and that higher exposure was reported by those in a lesser traditional position of power (i.e., clinicians who were younger, inexperienced, female, non-heterosexual, nurses, or working in privately funded clinics). 5 The second manuscript examined a pre-specified subgroup of 2,875 Canadian and US OR clinicians who answered questions related to abusive behaviour; in this instance, physical assault, verbal threats, or intimidating invasion of personal space.…”