Silence, Power and Communication in the Operating Room

Abstract

This paper is a review of the article, “Silence, Power and Communication in the Operating Room” by Gardezi et al. (2009). The article’s major points are summarized and highlights of how the findings could be applied in practice are given. A retrospective study was conducted by the authors in general surgery at three of Toronto’s tertiary-care hospitals and the participants were 11 general surgeons, 74 anesthesiologists, and116 operation room (OR) nurses.

The aim of the study was to establish whether preoperative inter-professional team briefing would be a good way of improving communication among different healthcare professionals in ORs. The findings showed that silence and communication in OR set-ups involve nuances and complexities that could not be understood and addressed through a short preoperative briefing of OR teams using a checklist. The involved individuals should learn how to interpret the strategies and modalities of communication that occur in ORs as a way of addressing the silence problem successfully.

Introduction

Inadequate communication is one of the major causes of medical errors in operating rooms (OR), and thus it is a critical patient safety issue that should be addressed comprehensively. Nurses report that they feel constrained in what they can say or do in operating rooms, and thus they are seen as a passive audience for other professionals, such as physicians, in such set-ups. Therefore, Gardezi et al. (2009) conducted a study to explore whether having a short preoperative inter-professional team briefing using a structured checklist would be an effective way of improving communication in ORs. This paper summarizes the main points of the article “Silence, Power and Communication in the Operating Room” and highlights how the finding could be applied in practice.

Summary of Main Points

The authors focused on silence resulting from constrained communication specifically why OR professionals decide not to say anything even when something of concern occurs. The findings of the study showed that problematic silences in OR exist in multiple forms including “the absence of communication, non-response to a colleague’s question or request, and quiet or hesitant speech” (Gardezi et al., 2009, p. 1398). The authors established that while silence may point to powerlessness, at times it may be used as a way of expression to accomplish certain objectives. Additionally, silence may reflect individual behaviors or internalized aspects coming from institutionalized power relations.

Absence of Communication

The absence of communication occurs in situational scenarios especially when staff members fail to “seek clarification, ask follow-up questions, or communicate immediately relevant information” (Gardezi et al., 2009, p. 1393). One probable motivation for this problem is the fear to expose one’s lack of knowledge. Nurses are more likely to talk to their colleagues when seeking clarification on an issue instead of approaching surgeons, even when the latter would address the problem directly and sufficiently. Professionals in the OR also project a lack of communication by failing to share information that other individuals do not have. However, professionals in the OR have developed certain strategies to overcome this problem such as using laconic style and reticent tone to communicate.

Failure to Respond to Questions or Requests

Gardezi et al. (2009) observed that silence occurred through the failure to respond to direct questions or requests, especially from nurses. This form of silence could occur due to the surgeons’ resistance to institutional protocols or an averment of traditional surgical power. One of the participating surgeons argued that this behavior is defensive as opposed to assertive, whereby surgeons are silently resisting the erosion of their autonomy and insisting that they become part of a team in ORs. This assertion highlights the underlying power struggles between nurses and surgeons because the former is perceived as the approved supervisors of institutional rules.

Speaking Quietly

Some of the nurse participants spoke quietly thus hindering successful communication, which is another form of silence. The authors argued that such behavior could be motivated by the traditional view that nurses are a passive audience to surgeons in ORs. Nurses are required to show competence by anticipating the surgeons’ needs and preferences, and this aspect often impedes inter-professional communication.

Application in Practice

One of the important issues that I have learned from this ethnographic study is that lack of communication contributes significantly to the lack of patient safety, which leads to poor care outcomes. First, I will always speak up when something of concern needs to be said. For instance, if a surgeon asks me to insufflate a patient’s abdomen and I am not sure which controls to use, I will ask for clarification.

Additionally, I will ensure that I respond to all questions and queries from all people that I work with at any given time. I will also communicate loudly enough to ensure that being heard clearly to avoid miscommunication or poor communication. If I do not get a response to my queries, I will be patient and wait for an answer until I act. Above all, I will endeavor to educate my colleagues on the importance of effective communication as a way of ensuring patient safety and quality care.

Conclusion

Lack of effective communication is a common problem among healthcare professionals working together, and it affects the quality of care services delivered to patients. The authors of this article observed three forms of silence – speaking quietly, failure to respond to questions, and absence of communication. Healthcare professionals should be encouraged to communicate effectively. However, the complexity of silence and speech should not be overlooked through the assumption that communication occurs only through cross-checking explicit speech. Understanding the subtleties and complexities of communication will help healthcare professionals to interpret the different modalities and strategies of speech that play out in different care settings.

Reference

Gardezi, F., Lingard, L., Espin, S., Whyte, S., Orser, B., & Baker, G. R. (2009). Silence, power and communication in the operating room. Journal of Advanced Nursing, 65(7), 1390-1399. Web.