IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0295271.html

Eyes on incivility in surgical teams: Teamwork, well-being, and an intervention

Author

Listed:
  • Cheri Ostroff
  • Chelsea Benincasa
  • Belinda Rae
  • Douglas Fahlbusch
  • Nicholas Wallwork

Abstract

Incivility in surgery is prevalent and negatively impacts effectiveness and staff well-being. The purpose of this study was to a) examine relationships between incivility, team dynamics, and well-being outcomes, and b) explore a low-cost intervention of ‘eye’ signage in operating theater areas to reduce incivility in surgical teams. A mixed methods design was used in an orthopedic hospital. Surveys of incivility, teamwork, and well-being were administered three months apart in a small private hospital. An intervention of signage with eyes was placed in the theater area after administration of the first survey, using a pretest-posttest design. Participants also responded to an open-ended question about suggestions for improvements at the end of the survey which was then thematically analyzed. At the individual level (n = 74), incivility was statistically significantly related to team dynamics which in turn was significantly related to burnout, stress, and job attitudes. At the aggregate level, reported incivility was statistically significantly lower after the ‘eye’ sign intervention. Thematic analysis identified core issues of management behaviors, employee appreciation, communication, and work practices. Incivility in surgical teams has significant detrimental associations with burnout, stress, and job attitudes, which occurs through its impact on decreased team dynamics and communication. A simple intervention that evokes perceptions of being observed, such as signage of eyes in theater areas, has the potential to decrease incivility at least in the short term, demonstrating that incivility is amenable to being modified. Additional research on targeted interventions to address incivility are needed to improve teamwork and staff well-being.

Suggested Citation

  • Cheri Ostroff & Chelsea Benincasa & Belinda Rae & Douglas Fahlbusch & Nicholas Wallwork, 2023. "Eyes on incivility in surgical teams: Teamwork, well-being, and an intervention," PLOS ONE, Public Library of Science, vol. 18(11), pages 1-12, November.
    • Handle: RePEc:plo:pone00:0295271
    DOI: 10.1371/journal.pone.0295271
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0295271
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0295271&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0295271?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Mathias Ekström, 2012. "Do watching eyes affect charitable giving? Evidence from a field experiment," Experimental Economics, Springer;Economic Science Association, vol. 15(3), pages 530-546, September.
    2. Melissa Bateson & Daniel Nettle & Gilbert Roberts, 2006. "Cues of being watched enhance cooperation in a real-world setting," Natural Field Experiments 00214, The Field Experiments Website.
    3. Amy C. Edmondson, 2003. "Speaking Up in the Operating Room: How Team Leaders Promote Learning in Interdisciplinary Action Teams," Journal of Management Studies, Wiley Blackwell, vol. 40(6), pages 1419-1452, September.
    4. Martin A. Nowak & Karl Sigmund, 1998. "Evolution of indirect reciprocity by image scoring," Nature, Nature, vol. 393(6685), pages 573-577, June.
    5. M.A. Nowak & K. Sigmund, 1998. "Evolution of Indirect Reciprocity by Image Scoring/ The Dynamics of Indirect Reciprocity," Working Papers ir98040, International Institute for Applied Systems Analysis.
    6. Bart Blackburn & Tiffany Chan & Elizabeth Cherot & Richard B. Freeman & Xi Hu & Eric Matt & C. Aubrey Rhodes, 2023. "Beyond Burnout: from Measuring to Forecasting," NBER Working Papers 30895, National Bureau of Economic Research, Inc.
    7. repec:feb:natura:0059 is not listed on IDEAS
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Jan Krátký & John J McGraw & Dimitris Xygalatas & Panagiotis Mitkidis & Paul Reddish, 2016. "It Depends Who Is Watching You: 3-D Agent Cues Increase Fairness," PLOS ONE, Public Library of Science, vol. 11(2), pages 1-11, February.
    2. De Cremer, David & Dijk, Eric van, 2009. "Paying for sanctions in social dilemmas: The effects of endowment asymmetry and accountability," Organizational Behavior and Human Decision Processes, Elsevier, vol. 109(1), pages 45-55, May.
    3. Axel Franzen & Sonja Pointner, 2013. "Giving according to preferences: Decision-making in the group dictator game," University of Bern Social Sciences Working Papers 2, University of Bern, Department of Social Sciences, revised 24 Jan 2014.
    4. Damien Francey & Ralph Bergmüller, 2012. "Images of Eyes Enhance Investments in a Real-Life Public Good," PLOS ONE, Public Library of Science, vol. 7(5), pages 1-7, May.
    5. Boero, Riccardo & Bravo, Giangiacomo & Castellani, Marco & Squazzoni, Flaminio, 2009. "Reputational cues in repeated trust games," Journal of Behavioral and Experimental Economics (formerly The Journal of Socio-Economics), Elsevier, vol. 38(6), pages 871-877, December.
    6. Mullins, Daniel A. & Whitehouse, Harvey & Atkinson, Quentin D., 2013. "The role of writing and recordkeeping in the cultural evolution of human cooperation," Journal of Economic Behavior & Organization, Elsevier, vol. 90(S), pages 141-151.
    7. María Pereda & Daniele Vilone, 2017. "Social Pressure and Environmental Effects on Networks: A Path to Cooperation," Games, MDPI, vol. 8(1), pages 1-13, January.
    8. Valerio Capraro & Francesca Giardini & Daniele Vilone & Mario Paolucci, 2016. "Partner selection supported by opaque reputation promotes cooperative behavior," Judgment and Decision Making, Society for Judgment and Decision Making, vol. 11(6), pages 589-600, November.
    9. Jeffrey Winking, 2014. "Anonymity versus Privacy in the Dictator Game: Revealing Donor Decisions to Recipients Does Not Substantially Impact Donor Behavior," PLOS ONE, Public Library of Science, vol. 9(12), pages 1-11, December.
    10. Gary Bolton & Eugen Dimant & Ulrich Schmidt, 2018. "When a Nudge Backfires. Using Observation with Social and Economic Incentives to Promote Pro-Social Behavior," PPE Working Papers 0017, Philosophy, Politics and Economics, University of Pennsylvania.
    11. Wang, Xiaofeng & Chen, Xiaojie & Gao, Jia & Wang, Long, 2013. "Reputation-based mutual selection rule promotes cooperation in spatial threshold public goods games," Chaos, Solitons & Fractals, Elsevier, vol. 56(C), pages 181-187.
    12. Wang, Chengjiang & Wang, Li & Wang, Juan & Sun, Shiwen & Xia, Chengyi, 2017. "Inferring the reputation enhances the cooperation in the public goods game on interdependent lattices," Applied Mathematics and Computation, Elsevier, vol. 293(C), pages 18-29.
    13. Frauke von Bieberstein & Andrea Essl & Kathrin Friedrich, 2021. "Empathy: A clue for prosocialty and driver of indirect reciprocity," PLOS ONE, Public Library of Science, vol. 16(8), pages 1-15, August.
    14. Charness, Gary & Du, Ninghua & Yang, Chun-Lei, 2011. "Trust and trustworthiness reputations in an investment game," Games and Economic Behavior, Elsevier, vol. 72(2), pages 361-375, June.
    15. Ge, Xin & Yang, Jian & He, Xi & Liu, Yue & Zhao, YiXiang & Li, Lili, 2025. "Effects of third-order reputation mechanism on the dynamic evolution of cooperation in mixed-games," Physica A: Statistical Mechanics and its Applications, Elsevier, vol. 660(C).
    16. Cubitt, Robin P. & Drouvelis, Michalis & Gächter, Simon & Kabalin, Ruslan, 2011. "Moral judgments in social dilemmas: How bad is free riding?," Journal of Public Economics, Elsevier, vol. 95(3), pages 253-264.
    17. Deng, Zhenghong & Wang, Shengnan & Gu, Zhiyang & Xu, Juwei & Song, Qun, 2017. "Heterogeneous preference selection promotes cooperation in spatial prisoners’ dilemma game," Chaos, Solitons & Fractals, Elsevier, vol. 100(C), pages 20-23.
    18. Gaudeul, Alexia & Keser, Claudia & Müller, Stephan, 2021. "The evolution of morals under indirect reciprocity," Games and Economic Behavior, Elsevier, vol. 126(C), pages 251-277.
    19. Ben-Ner, Avner & Putterman, Louis & Kong, Fanmin & Magan, Dan, 2004. "Reciprocity in a two-part dictator game," Journal of Economic Behavior & Organization, Elsevier, vol. 53(3), pages 333-352, March.
    20. Andrew W. Bausch, 2014. "Evolving intergroup cooperation," Computational and Mathematical Organization Theory, Springer, vol. 20(4), pages 369-393, December.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0295271. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.