Archive June 2017 XVIII, No. 6

The Courage to Speak Up

Will your staff stick up for your patients when they sense trouble in the OR?

Bill Donahue, Senior Editor

courage to speak up NO FEAR Do your nurses and techs have the courage to speak up in the OR?

Even the tiniest course correction in the OR could mean the difference between getting an a.m. patient home safe by lunchtime and having him endure an extended stay in the ICU. In some cases, it could also mean the difference between life and death.

Alex B. Haynes, MD, MPH, FACS, sees these kinds of course corrections daily in his OR: slight adjustments he agrees to after members of his surgical team speak up to make him aware of situations — most of them minor — that could cause an infection or otherwise affect a patient's surgical outcome.

"A lot of things can change between the time we do the booking sheet to the moment we head into the OR," says Dr. Haynes, a surgical oncologist with Massachusetts General Hospital in Boston. "Once we conclude the time out, I always say, 'At any point during the surgery, if anyone sees anything they think is not right or if they're unclear about what we're doing, please speak up.'"

And they do — every day. Usually it's the little things: "You might want an extra drape here or there because it's not quite as covered as we'd like" or "Someone's glove touched an unsterile part of the field."

In all too many ORs, though, potential red flags are noted but not spoken aloud. Dr. Haynes ascribes this silence to entrenched behaviors rooted in the traditional surgeon-first hierarchy, or simply the fear of being wrong and then chastised for interrupting the workflow. He's been heartened by a shift away from this archaic OR culture, even though it's happening more slowly than he would like.

"We should have an environment in the OR where it's not considered a courageous thing to say, 'I think you contaminated yourself,'" he says. "As a surgeon, I would be mortified if someone felt they were in any way not brave enough to say something like that. It's about members of a team working together, not the surgeon who believes others should speak only when spoken to. That's an absurd concept."

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