Promoting a culture of respect in cardiothoracic surgery: navigating challenges in understanding unethical behaviour

A.Yu. Sydorenko; H.  Spindler

doi:10.26641/2307-0404.2024.3.313484

Authors

A.Yu. Sydorenko Aarhus University, Bartholins Allé, 11, Aarhus C, DK-8000, Denmark; Bogomolets National Medical University, Shevchenko blvd, 13, Kyiv, 01004, Ukraine https://orcid.org/0000-0002-1650-126X
H. Spindler Aarhus University, Bartholins Allé, 11, Aarhus C, DK-8000, Denmark https://orcid.org/0000-0002-7098-5699

DOI:

https://doi.org/10.26641/2307-0404.2024.3.313484

Keywords:

bullying, discrimination, harassment, cardiothoracic surgery

Abstract

Unprofessional behaviour in the workplace, such as bullying, harassment, and discrimination, remains common in the cardiothoracic surgery unit. Despite its prevalence, there is little consensus on what constitutes unprofessional behaviour in the workplace of a cardiothoracic surgeon. In this review, we aim to narrow down the definition of unprofessional behaviour among cardiothoracic surgeons, identify its prevalence and the factors contributing to it, as well as explore potential preventive and support measures. We searched the MEDLINE and Web of Science databases (2000-2022), focusing on publications within psychology, medicine, general surgery, and cardiothoracic surgery for inclusion in a focused review. The current review identified 89 papers that highlight the complexity of defining unprofessional behaviour and its prevalence in cardiothoracic surgery units. Psychosocial professional challenges, hierarchical relationships within the medical team, and a high-stress environment may prompt unprofessional behaviour, which can manifest in both overt and covert actions. Such behaviour negatively mpacts medical services for patients, the psycho-emotional state of employees, and the overall functioning of the medical institution. The most effective support measures are characterized by being proactive, anticipating potential problems before they occur. Unprofessional behaviour should be considered an organizational concern, not merely an issue between individual team members. This perspective is essential for fostering a healthy work environment. The leaders of cardiothoracic surgery, given their high status and authority, play a pivotal role in this regard; their focus on inclusiveness of employees with lower status or responsibility is crucial for promoting a culture of psychosocial safety. This culture should be characterized by trust, honesty, and mutual respect, ensuring that every team member feels valued and respected. By prioritizing these values, leaders can minimize the risk of unprofessional behaviour, ultimately leading to an improvement in the quality of medical services for patients, an improvement in the psycho-emotional state of employees and the functioning of the organization as a whole.

References

Carpenter AJ. We Stand on the Shoulders of Giants: Let's Look Up. Ann Thorac Surg. 2019;108(3):657-61. doi: https://doi.org/10.1016/j.athoracsur.2019.03.097

Fingerhut A. Surgical ego, the good, the bad, and the ugly. Surg Innov. 2011;18(2):97-8. doi: https://doi.org/10.1177/1553350611411470

Bolsin SN. Professional misconduct: the Bristol case. Medical Journal of Australia. 1998;169(7):369-72. doi: https://doi.org/10.5694/j.1326-5377.1998.tb126806.x

Taylor-Robinson SD, De Sousa Lopes PA, Zdravkov J, Harrison R. A Personal Perspective: Is Bullying Still a Problem in Medicine? Advances in Medical Education and Practice. 2021;12:141-5. doi: https://doi.org/10.2147/AMEP.S297835

Seemann NM, Webster F, Holden HA, Moulton C-aE, Baxter N, Desjardins C, et al. Women in academic surgery: why is the playing field still not level? The American Journal of Surgery. 2016;211(2):343-9. doi: https://doi.org/10.1016/j.amjsurg.2015.08.036

Nakayama DK. Pioneering women in American pediatric surgery. J Pediatr Surg. 2018;53(11):2361-8. doi: https://doi.org/10.1016/j.jpedsurg.2018.08.038

Ceppa DP, Dolejs SC, Boden N, Phelan S, Yost KJ, et al. Sexual Harassment and Car¬diothoracic Surgery: UsToo? The Annals of Thoracic Surgery. 2020;109(4):1283-8. doi: https://doi.org/10.1016/j.athoracsur.2019.07.009

Freedman-Weiss MR, Chiu AS, Heller DR, Cut-ler AS, Longo WE, Ahuja N, et al. Understanding the Barriers to Reporting Sexual Harassment in Surgical Training. Annals of Surgery. 2020;271(4):608-13. doi: https://doi.org/10.1097/SLA.0000000000003295

Singh A, Alberti H. Why UK medical students change career preferences: an interview study. Perspect Med Educ. 2021;10(1):41-9. doi: https://doi.org/10.1007/S40037-020-00636-7

Shapiro J. Confronting unprofessional behaviour in medicine. BMJ. 2018;360:k1025. doi: https://doi.org/10.1136/bmj.k1025

Crebbin W, Campbell G, Hillis DA, Watters DA. Prevalence of bullying, discrimination and sexual harassment in surgery in Australasia. ANZ Journal of Surgery. 2015;85(12):905-9. doi: https://doi.org/10.1111/ans.13363

Halim UA, Riding DM. Systematic review of the prevalence, impact and mitigating strategies for bullying, undermining behaviour and harassment in the surgical workplace. British Journal of Surgery. 2018;105(11):1390-7. doi: https://doi.org/10.1002/bjs.10926

Einarsen SV, Hoel H, Zapf D, Cooper CL, eds. Bullying and Harassment in the Workplace: Theory, Research and Practice. 3rd ed. CRC Press; 2020. doi: https://doi.org/10.1201/9780429462528-2

Wood DE. How can men be good allies for women in surgery? #HeForShe. J Thorac Dis. 2021;13(1):492-501. doi: https://doi.org/10.21037/jtd-2020-wts-11

Ayyala MS, Chaudhry S, Windish D, Dupras D, Reddy ST, Wright SM. Awareness of Bullying in Resi-dency: Results of a National Survey of Internal Medicine Program Directors. Journal of Graduate Medical Education. 2018;10(2):209-13. doi: https://doi.org/10.4300/JGME-D-17-00386.1

Rimmer A. Trainees removed from cardiac surgery unit following concerns about “interpersonal behaviours”. BMJ. 2021;375:n2436. doi: https://doi.org/10.1136/bmj.n2436

Pei KY, Cochran A. Workplace Bullying Among Surgeons-the Perfect Crime. Annals of Surgery. 2019;269(1):43-4. doi: https://doi.org/10.1097/SLA.0000000000003018

Myers CG, Lu-Myers Y, Ghaferi AA. Excising the “surgeon ego” to accelerate progress in the culture of surgery. BMJ. 2018;363:k4537. doi: https://doi.org/10.1136/bmj.k4537

Lagoo J, Berry WR, Miller K, Neal BJ, Sato L, Lillemoe KD, et al. Multisource Evaluation of Surgeon Beha¬vior Is Associated With Malpractice Claims. Ann Surg. 2019;270(1):84-90. doi: https://doi.org/10.1097/SLA.0000000000002742

Heslin MJ, Singletary BA, Benos KC, Lee LR, Fry C, Lindeman B. Is Disruptive Behavior Inherent to the Surgeon or the Environment? Analysis of 314 Events at a Single Academic Medical Center. Annals of Surgery. 2019;270(3):463-72. doi: https://doi.org/10.1097/SLA.0000000000003469

Meloni M, Austin M. Implementation and outcomes of a zero tolerance of bullying and harassment program. Aust Health Rev. 2011;35(1):92-4. doi: https://doi.org/10.1071/AH10896

Methangkool E, Brodt J, Kolarczyk L, Ivascu NS, Hicks MH, Herrera E, et al. Perceptions of Gender Dispa-rities Among Women in Cardiothoracic Anesthesiology. Journal of Cardiothoracic and Vascular Anesthesia. 2022;36(7):1859-66. doi: https://doi.org/10.1053/j.jvca.2021.11.015

Mortensen M, Baarts CA. Killing ourselves with laughter … mapping the interplay of organizational teasing and workplace bullying in hospital work life. Qualitative Research in Organizations and Management: An International Journal. 2018;13(1):10-31. doi: https://doi.org/10.1108/QROM-10-2016-1429

Dupré KE, Barling J. Predicting and preventing supervisory workplace aggression. Journal of Occupational Health Psychology. 2006;11:13-26. doi: https://doi.org/10.1037/1076-8998.11.1.13

Matthiesen SB, Einarsen S. Bullying in the work-place: definition, prevalence, antecedents and conse-quences. International Journal of Organization Theory & Behavior. 2010;13(2):202-48. doi: https://doi.org/10.1108/IJOTB-13-02-2010-B004

Kawase K, Nomura K, Tominaga R, Iwase H, Ogawa T, Shibasaki I, et al. Analysis of gender-based differences among surgeons in Japan: results of a survey conducted by the Japan Surgical Society. Part. 2: personal life. Surgery Today. 2018;48(3):308-19. doi: https://doi.org/10.1007/s00595-017-1586-7

Kawase K, Nomura K, Nomura S, Akashi-Tanaka S, Ogawa T, Shibasaki I, et al. How pregnancy and childbirth affect the working conditions and careers of women surgeons in Japan: findings of a nationwide survey conducted by the Japan Surgical Society. Surgery Today. 2021;51(2):309-21. doi: https://doi.org/10.1007/s00595-020-02129-w

Lewis D. Perceptions of bullying in organisations. International Journal of Management and Decision Making. 2001;2(1):48-64. doi: https://doi.org/10.1504/IJMDM.2001.001221

Odell DD, Edwards M, Fuller S, Loor G, Antonoff MB. The Art and Science of Mentorship in Cardiotho¬racic Surgery: A Systematic Review of the Literature. The Annals of Thoracic Surgery. 2022;113(4):1093-100. doi: https://doi.org/10.1016/j.athoracsur.2020.06.051

Albuainain HM, Alqurashi MM, Alsadery HA, Al-ghamdi TA, Alghamdi AA, Alghamdi RA, et al. Work-place bullying in surgical environments in Saudi Arabia: A multiregional cross-sectional study. Journal of Family and Community Medicine. 2022;29(2):125-31. doi: https://doi.org/10.4103/jfcm.jfcm_392_21

Peltzer K, Nqeketo A, Petros G, Kanta X. Evaluation of a safer male circumcision training programme for traditional surgeons and nurses in the Eastern Cape, South Africa. Afr J Tradit Complement Alt M. 2008;5(4):346-54. doi: https://doi.org/10.4314/ajtcam.v5i4.31289

Rogers D, Lingard L, Boehler ML, Espin S, Klingensmith M, Mellinger JD, et al. Teaching operating room conflict management to surgeons: clarifying the optimal approach. Med Educ. 2011;45(9):939-45. doi: https://doi.org/10.1111/j.1365-2923.2011.04040.x

Johnson AH, Benham‐Hutchins M. The Influence of Bullying on Nursing Practice Errors: A Systematic Review. AORN Journal. 2020;111(2):199-210. doi: https://doi.org/10.1002/aorn.12923

Bruce AN, Battista A, Plankey MW, Johnson LB, Marshall MB. Perceptions of gender-based discrimination during surgical training and practice. Medical Education Online. 2015;20(1):25923. doi: https://doi.org/10.3402/meo.v20.25923

Colenbrander L, Causer L, Haire B. ‘If you can’t make it, you’re not tough enough to do medicine’: a qualitative study of Sydney-based medical students’ experiences of bullying and harassment in clinical settings. BMC Medical Education. 2020;20(1):86. doi: https://doi.org/10.1186/s12909-020-02001-y

Dulaney P, Zager LR. Lateral violence update: we are still listening & we thank you. South Carolina nurse. 2010;173:11.

Gianakos AL, Freischlag JA, Mercurio AM, Haring RS, Laporte DM, Mulcahey MK, et al. Bullying, Discrimination, Harassment, Sexual Harassment, and the Fear of Retaliation During Surgical Residency Training: A Systematic Review. World Journal of Surgery. 2022;46(7):1587-99. doi: https://doi.org/10.1007/s00268-021-06432-6

Moon MR. Equal means equal: Cardiothoracic surgery in its second century. Journal of Thoracic and Cardiovascular Surgery. 2021;161(4):1381-9. doi: https://doi.org/10.1016/j.jtcvs.2020.12.030

Zhu C, McCloskey D, Sandilos G, Zilberman B, Crudeli C, Hunter K, et al. The State of Racial and Gender Diversity in Cardiothoracic Surgery Training. The Annals of Thoracic Surgery. 2022;114(4):1492-9. doi: https://doi.org/10.1016/j.athoracsur.2022.02.083

Backhus LM, Fann BE, Hui DS, Cooke DT, Ber-field KS, Moffatt-Bruce SD. Culture of Safety and Gender Inclusion in Cardiothoracic Surgery. The Annals of Thoracic Surgery. 2018;106(4):951-8. doi: https://doi.org/10.1016/j.athoracsur.2018.07.011

Vosloo SM. Realities and challenges for female cardiothoracic surgeons: an African perspective. Journal of Thoracic Disease. 2021;13(1):448-55. doi: https://doi.org/10.21037/jtd-2020-wts-03

Clements JM, King M, Nicholas R, Burdall O, Elsey E, Bucknall V, et al. Bullying and undermining behaviours in surgery: A qualitative study of surgical trainee experiences in the United Kingdom (UK) & Re-public of Ireland (ROI). International Journal of Surgery. 2020;84:219-25. doi: https://doi.org/10.1016/j.ijsu.2020.07.031

Pompili C, Opitz I, Backhus L, Leschber G, Veronesi G, Lauk O, et al. The impact of gender bias in car-diothoracic surgery in Europe: a European Society of Thoracic Surgeons and European Association for Cardio-Thoracic Surgery survey. Eur J Cardio-Thorac Surg. 2022;61(6):1390-9. doi: https://doi.org/10.1093/ejcts/ezac034

Bleakley A, Marshall R, Levine D. He drove for-ward with a yell: anger in medicine and Homer. Medical Humanities. 2014;40(1):22-30. doi: https://doi.org/10.1136/medhum-2013-010432

Orlino JP, Sura TA, Kevin YP, Smeds MR. Bullying of vascular surgery trainees. Journal of Vascular Surgery. 2022;75(6):2065-71.e3. doi: https://doi.org/10.1016/j.jvs.2022.01.123

Morrison EW, Milliken FJ. Organizational silence: A barrier to change and development in a pluralistic world. The Academy of Management Review. 2000;25:706-25. doi: https://doi.org/10.2307/259200

Burris ER, Rockmann KW, Kimmons YS. The Value of Voice to Managers: Employee Identification and the Content of Voice. Academy of Management Journal. 2017;60(6):2099-125. doi: https://doi.org/10.5465/amj.2014.0320

Sexton JB. Error, stress, and teamwork in medicine and aviation: cross sectional surveys. BMJ. 2000;320(7237):745-9. doi: https://doi.org/10.1136/bmj.320.7237.745

Campos M, Lira MJ, Mery P, Calderón M, Sepúlveda M, Pimentel F, et al. Disruptive behavior in the operating room: Systemic over individual determinants. International Journal of Surgery Open. 2022;43:100492. doi: https://doi.org/10.1016/j.ijso.2022.100492

Hsiao CJ, Akhavan NN, Singh Ospina N, Yagnik KJ, Neilan P, Hahn P, et al. Sexual Harassment Experiences Across the Academic Medicine Hierarchy. Cureus. 2021;13(2):е13508. doi: https://doi.org/10.7759/cureus.13508

K MS, Hallberg LR. The origin of workplace bullying: experiences from the perspective of bully victims in the public service sector. J Nurs Manag. 2007;15(3):332-41. doi: https://doi.org/10.1111/j.1365-2834.2007.00662.x

Rosati CM, Koniaris LG, Molena D, Blitzer D, Su KW, Tahboub M, et al. Characteristics of cardiothoracic surgeons practicing at the top-ranked US institutions. Journal of Thoracic Disease. 2016;8(11):3232-44. doi: https://doi.org/10.21037/jtd.2016.11.72

Johan Hauge L, Skogstad A, Einarsen S. Relationships between stressful work environments and bullying: Results of a large representative study. Work & Stress. 2007;21(3):220-42. doi: https://doi.org/10.1080/02678370701705810

Spiliopoulos K, Gansera L, Weiland HC, Schuster T, Eichinger W, Gansera B. Chronic stress and coping among cardiac surgeons: a single center study. Rev Bras Cir Cardiovasc. 2014;29(3):308-15. doi: https://doi.org/10.5935/1678-9741.20140083

Benetis R, Sirvinskas E, Mikalauskas A, Marchertiene I, Macas A, Kinduris S, et al. Burnout Among Li-thuanian Cardiac Surgeons and Cardiac Anesthesiologists. Medicina-Lithuania. 2012;48(9):478-84. doi: https://doi.org/10.3390/medicina48090071

Amini K, Miyanaji H, Mohamadi MD. Bullying and burnout in critical care nurses: A cross-sectional descriptive study. Nurs Crit Care. 2023;28(2):202-10. doi: https://doi.org/10.1111/nicc.12744

Behaviors that undermine a culture of safety. Sentinel Event Alert. 2008;40:1-3.

Cooper WO, Spain DA, Guillamondegui O, Kelz RR, Domenico HJ, Hopkins J, et al. Association of Coworker Reports About Unprofessional Behavior by Surgeons With Surgical Complications in Their Patients. JAMA Surgery. 2019;154(9):828. doi: https://doi.org/10.1001/jamasurg.2019.1738

Pogue CA, Li P, Swiger P, Gillespie G, Ivankova N, Patrician PA. Associations among the nursing work environment, nurse‐reported workplace bullying, and patient outcomes. Nursing Forum. 2022;57(6):1059-68.. doi: https://doi.org/10.1111/nuf.12781

Cochran A, Elder WB. Effects of disruptive surgeon behavior in the operating room. American Journal of Surgery. 2015;209(1):65-70. doi: https://doi.org/10.1016/j.amjsurg.2014.09.017

Carter M, Thompson N, Crampton P, Morrow G, Burford B, Gray C, et al. Workplace bullying in the UK NHS: a questionnaire and interview study on prevalence, impact and barriers to reporting. BMJ open. 2013;3:6. doi: https://doi.org/10.1136/bmjopen-2013-002628

Shemanski KA, Ding L, Kim AW, Blackmon SH, Wightman SC, Atay SM, et al. Gender representation among leadership at national and regional cardiothoracic surgery organizational annual meetings. Journal of Thoracic and Cardiovascular Surgery. 2021;161(3):733-42. doi: https://doi.org/10.1016/j.jtcvs.2020.11.157

Hu Y-Y, Ellis RJ, Hewitt DB, Yang AD, Cheung EO, Moskowitz JT, et al. Discrimination, Abuse, Harassment, and Burnout in Surgical Residency Training. New England Journal of Medicine. 2019;381(18):1741-52. doi: https://doi.org/10.1056/NEJMsa1903759

Iyer MS, Way DP, MacDowell DJ, Overholser BM, Spector ND, Jagsi R. Bullying in Academic Medicine: Experiences of Women Physician Leaders. Academic Medicine. 2023;98(2):255-63. doi: https://doi.org/10.1097/ACM.0000000000005003

Ajoudani F, Baghaei R, Lotfi M. Moral distress and burnout in Iranian nurses: The mediating effect of workplace bullying. Nursing Ethics. 2019;26(6):1834-47. doi: https://doi.org/10.1177/0969733018779210

Lallukka T, Rahkonen O, Lahelma E. Workplace bullying and subsequent sleep problems the Helsinki Health Study. Scand J Work Environ Health. 2011;37(3):204-12. doi: https://doi.org/10.5271/sjweh.3137

Giorgi G, Mancuso S, Fiz Perez F, Castiello D'Antonio A, Mucci N, Cupelli V, et al. Bullying among nurses and its relationship with burnout and organizational climate. International Journal of Nursing Practice. 2016;22(2):160-8. doi: https://doi.org/10.1111/ijn.12376

Paice E, Smith D. Bullying of trainee doctors is a patient safety issue. The Clinical Teacher. 2009;6(1):13-7. doi: https://doi.org/10.1111/j.1743-498X.2008.00251.x

Aristidou L, Mpouzika M, Papathanassoglou EDE, Middleton N, Karanikola MNK. Association Between Workplace Bullying Occurrence and Trauma Symptoms Among Healthcare Professionals in Cyprus. Front Psychol. 2020;11:575623. doi: https://doi.org/10.3389/fpsyg.2020.575623

Chow OS, Sudarshan M, Maxfield MW, Seese LM, Watkins AA, Fleishman A, et al. National Sur¬vey of Burnout and Distress Among Cardiothoracic Surgery Trainees. The Annals of Thoracic Surgery. 2021;111(6):2066-71. doi: https://doi.org/10.1016/j.athoracsur.2020.06.062

Reason J. Safety paradoxes and safety culture. Injury Control and Safety Promotion. 2000;7(1):3-14. doi: https://doi.org/10.1076/1566-0974(200003)7:1;1-V;FT003

Edmondson AC. Speaking Up in the Operating Room: How Team Leaders Promote Learning in Interd-isciplinary Action Teams. Journal of Management Studies. 2003;40(6):1419-52. doi: https://doi.org/10.1111/1467-6486.00386

Nembhard IM, Edmondson AC. Making It Safe: The Effects of Leader Inclusiveness and Professional Status on Psychological Safety and Improvement Efforts in Health Care Teams. Springer Netherlands; 2009. p. 77-105. doi: https://doi.org/10.1007/978-90-481-2605-7_5

Illing J, Carter MM, Thompson N, Crampton PES, Morrow G, Howse JH, et al., editors. Evidence synthesis on the occurrence, causes, consequences, prevention and management of bullying and harassing behaviours to inform decision-making in the NHS2013 [Internet]. Durham Research Online (DRO). 2013 [cited 2024 Apr 21]. Availablefrom: http://www.nets.nihr.ac.uk/projects/hsdr/10101201

Preece R, Ben-David E, Rasul S, Yatham S. Are we losing future talent? A national survey of UK medical student interest and perceptions of cardiothoracic surgery. Interactive Cardiovascular and Thoracic Surgery. 2018;27(4):525-9. doi: https://doi.org/10.1093/icvts/ivy119

Lavelle-Jones M. Bullying and Undermining Campaign – Let’s Remove it The Royal College of Surgeons of Edinburgh [Internet]. 2017 [cited 2024 Apr 21]. Available from: https://www.rcsed.ac.uk/news-public-affairs/news/2017/june/bullying-and-undermining-campaign-let-s-remove-it

Time's UP [Internet]. No more sexual harassment and gender discrimination in health care; 2022 [cited 2024 Apr 21]. Available from: https://timesupnow.org/work/times-up-healthcare

Trudell AM, Frankel WC, Luc JGY, Black-mon SH, Kane L, Varghese TK, et al. Enhancing Support for Women in Cardiothoracic Surgery Through Allyship and Targeted Initiatives. Ann Thorac Surg. 2022;113(5):1676-83. doi: https://doi.org/10.1016/j.athoracsur.2021.06.064

Ortmeyer KA, Raman V, Tiko-Okoye CS, Espinosa JA, Cooke DT, Starnes SL, et al. Goals, organizational change, advocacy, diversity literacy, and sustainability: A checklist for diversity in cardiothoracic surgery training programs. The Journal of Thoracic and Cardiovascular Surgery. 2021;162(6):1782-7. doi: https://doi.org/10.1016/j.jtcvs.2020.11.112

Nina V, Mendes AG, Sevdalis N, Marath A, Mejia OV, Brandão CMA, et al. Applicability of the Dis-ruptions in Surgery Index in the Cardiovascular Manage-ment Scenarios — A Marker for Developing Functionally Efficient Teams. Brazilian Journal of Cardiovascular Surgery. 2021;36(4):445-52. doi: https://doi.org/10.21470/1678-9741-2020-0685

Ling M, Young CJ, Shepherd HL, Mak C, Saw RPM. Workplace Bullying in Surgery. World Journal of Surgery. 2016;40(11):2560-6. doi: https://doi.org/10.1007/s00268-016-3642-7

Gostlow H, Vega CV, Marlow N, Babidge W, Maddern G. Do Surgeons React?: A Retrospective Ana-lysis of Surgeons’ Response to Harassment of a Colleague During Simulated Operating Theatre Scenarios. Annals of Surgery. 2018;268(2):277-81. doi: https://doi.org/10.1097/SLA.0000000000002434

Abi-Jaoudé JG, Kennedy-Metz LR, Dias RD, Yule SJ, Zenati MA. Measuring and Improving Emotional Intelligence in Surgery: A Systematic Review. Ann Surg. 2022;275(2):e353-e60. doi: https://doi.org/10.1097/SLA.0000000000005022

Arora S, Aggarwal R, Moran A, Sirimanna P, et al. Mental practice: effective stress ma¬nagement training for novice surgeons. J Am Coll Surg. 2011;212(2):225-33. doi: https://doi.org/10.1016/j.jamcollsurg.2010.09.025

Sinskey JL, Chang JM, Shibata GS, Infosino AJ, Rouine-Rapp K. Applying Conflict Management Strate-gies to the Pediatric Operating Room. Anesth Analg. 2019;129(4):1109-17. doi: https://doi.org/10.1213/ANE.0000000000003991

Brinkert R. Conflict coaching training for nurse managers: a case study of a two-hospital health system. J Nurs Manag. 2011;19(1):80-91. doi: https://doi.org/10.1111/j.1365-2834.2010.01133.x

Kim JS, Hernandez RA, Smink DS, Yule S, Jackson NJ, Shemin RJ, et al. Nontechnical skills training in cardiothoracic surgery: A pilot study. Journal of Thoracic and Cardiovascular Surgery. 2022;163(6):2155. doi: https://doi.org/10.1016/j.jtcvs.2021.01.108

Stagg SJ, Sheridan D, Jones RA, Speroni KG. Eva-luation of a workplace bullying cognitive rehearsal program in a hospital setting. J Contin Educ Nurs. 2011;42(9):395-401. doi: https://doi.org/10.3928/00220124-20110823-22

Wilson JL, Whyte RI, Gangadharan SP, Kent MS. Teamwork and Communication Skills in Cardiothoracic Surgery. The Annals of Thoracic Surgery. 2017;103(4):1049-54. doi: https://doi.org/10.1136/bmjopen-2017-017389

Dahl AB, Ben Abdallah A, Maniar H, Avidan MS, Bollini ML, Patterson GA, et al. Building a collaborative culture in cardiothoracic operating rooms: pre and postintervention study protocol for evaluation of the implementation of teamSTEPPS training and the impact on perceived psychological safety. BMJ Open. 2017;7(9):e017389. doi: https://doi.org/10.1136/bmjopen-2017-017389

DiMeglio K, Padula C, Piatek C, Korber S, Barrett A, Ducharme M, et al. Group cohesion and nurse satisfaction: examination of a team-building approach. J Nurs Adm. 2005;35(3):110-20. doi: https://doi.org/10.1097/00005110-200503000-00003

Barrett A, Piatek C, Korber S, Padula C. Lessons learned from a lateral violence and team-building inter-vention. Nurs Adm Q. 2009;33(4):342-51. doi: https://doi.org/10.1097/NAQ.0b013e3181b9de0b

King HB, Battles J, Baker DP, Alonso A, Salas E, Webster J, et al. Advances in Patient Safety. Team-STEPPS(™): Team Strategies and Tools to Enhance Performance and Patient Safety. In: Henriksen K, Battles JB, Keyes MA, Grady ML, editors. Advances in Patient Safety: New Directions and Alternative Approaches. Vol. 3: Performance and Tools. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008.

Lim MC, Jeffree MS, Saupin SS, Giloi N, Lukman KA. Workplace violence in healthcare settings: The risk factors, implications and collaborative preventive measures. Annals of Medicine and Surgery. 2022;78:103727. doi: https://doi.org/10.1016/j.amsu.2022.103727

Bulutlar F, Öz EÜ. The Effects of Ethical Climates on Bullying Behaviour in the Workplace. Journal of Business Ethics. 2009;86(3):273-95. doi: https://doi.org/10.1007/s10551-008-9847-4

Dimarino TJ. Eliminating Lateral Violence in the Ambulatory Setting: One Center's Strategies. AORN Journal. 2011;93(5):583-8. doi: https://doi.org/10.1016/j.aorn.2010.10.019

Wild JR, Ferguson HJ, McDermott FD, Hornby ST, Gokani VJ. Undermining and bullying in surgical training: A review and recommendations by the Associa-tion of Surgeons in Training. Int J Surg. 2015;23(Suppl 1):S5-9. doi: https://doi.org/10.1016/j.ijsu.2015.09.017