Plays well with others (?)

Had an interesting conversation with an OR nurse earlier this week. She was upset about something that had happened in the theatre she was working in. (Not my theatre, but it easily could have been.) In addition to the planned major surgery, the patient unexpectedly required an additional minor procedure done that was within the general ability of the surgeon, but not within his area of expertise. When that additional procedure didn't seem to be going well (and eventually required calling in another surgeon), she was at a loss over how to suggest that the attempts be stopped and the other surgeon be called in sooner. There was some minor injury from the attempts, but that should heal without ill effect.

So, why couldn't she just speak up and voice her concern for the safety of the patient?

It's because the OR culture won out.

There is a definite hierarchy in health care generally, but it is very rigid in the operating room. From the top down: Doctor (surgeon slightly edges out anaesthetist), nurse, patient. Orders flow one direction. Suggestions coming up the other way are not always well-received. The nurse didn't feel safe in making a comment because she was afraid of being verbally abused in return.

Sometimes, the surgeon needs to overrule everyone else, based on his/her training, experience and ultimate responsibility for the patient's outcome. But there are many times where other OR staff's judgement and experience make them aware of risks to patient safety. If they are afraid to speak up, patients suffer harm. The silent staff will be upset and feel guilty that they didn't advocate on behalf of their patient.

Solutions?

Educate OR staff (?role-playing, ?simulations) how to tactfully (yet firmly) express a safety concern to the surgeon

Convince surgeons that their patients may have a better outcome if everyone on the OR team is welcomed as an active participant in patient safety and quality improvement initiatives

Let all the crotchety old surgeons retire and train the new ones to play well with others

Any suggestions?