Article Review and Commentary
Every Operating Room case has an average of 4 conflicts. Those conflicts have the potential to affect safety , patient care and efficiency.
This paper, which collected conflict stories from operating room personnel in a Swiss teaching hospital, found that 4 out of ten of the episodes of conflict experienced by OR staff had an impact on providing timely, patient-centered and efficient care.
There are several aspects of this study which are worth noting.
- The paper discussed the direct and indirect effects of conflict in the patient care realm. Direct effects of conflict relate to patient care delays and the quality of care. Indirect effects include the mental distraction of staff from clinical duties and impact on their mental health. Conflict during work hours can directly contribute to burnout.
- Surveyed participants were classified by teams with the same specialty or job (intraprofessional) , different specialty or job (interprofessional) and by hierarchy (nurse manager/ nurse, chief resident/ resident). Patient-centered consequences were more associated with intraprofessional conflicts. Interprofessional conflicts, in which different groups or specialties may be in disagreement, would be more likely to result in delay of care.
- The conflict stories were coded and the participants were asked to comment on whether they felt that the conflict impacted patient safety. The six dimensions of quality cited by the Institute of Medicine, timeliness, patient-centeredness, efficiency, effectiveness, safety and equity were used. The most common associated outcomes of conflict cited were failure to provide timely, patient-centered, and less efficient care.
This paper suggests that, in assessing Operating Room efficiency, conflict must be considered and assessed. Use of semistructured interviews is a powerful tool to assess the presence of conflict in the perioperative setting. These stories can be coded and stratified to assess intraprofessional, interprofessional and hierarchical conflict.
Conflict, once recognized and assessed, serves as a platform to improve efficiency, patient care, and the mental health of all staff. Strategies for conflict recognition and processing can be employed.