Harassment, Incivility, Disrespect in the Workplace Contributes to Anesthesia Workforce Shortage, Compromises Patient Safety

CHICAGO — With the pervasiveness of harassment, incivility, and disrespect (HID) among health care professionals in the workplace impacting clinician well-being, patient health, and disproportionately affecting anesthesiology, the American Society of Anesthesiologists (ASA) is providing new recommendations to help eradicate these behaviors in the operating room and hospitals.

“There is no place for harassment, incivility or disrespect of any kind in the operating room,” said ASA President Donald E. Arnold, M.D., FACHE, FASA. “When these behaviors are demonstrated in the workplace, they negatively affect personal and team performance, adversely impacting patient safety, quality of care and outcomes. Furthermore, these behaviors strongly affect the growing imbalance in the supply of anesthesiologists and anesthesia care professionals that we are seeing. The work environment and culture of a health care facility has a direct correlation to its ability to recruit and retain staff.”

Data shows the rate of HID in anesthesiology is equal to, if not higher, than other specialties. Additionally, according to a report by the Association of American Medical Colleges, there is a persistent presence of gender harassment across all medical specialties in academic medicine, with approximately 1 in 3 of all female faculty and 1 in 10 of all male faculty having reported sexual harassment. Within anesthesiology specifically, 1 in 2 women and 1 in 4 men reported experiencing a form of sexual harassment in the past 12 months.

HID impacts both clinician and patient health. According to the new recommendations, the spectrum of these disruptive behaviors can negatively affect an anesthesiologist’s personal, as well as the anesthesia care team’s, performance through adverse safety consequences including poor information sharing, compromised decision-making, diagnostic error, and burnout.

The recommendations prioritize commitments and actions that should be made both organizationally and on an individual level for the benefit of patients, anesthesiologists, and all members of anesthesia and surgical care teams.   

Some of the organizational commitments and actions include:

• Create and employ a strategic plan to eliminate HID, which includes a statement of commitment, clear and consistent standards of behavior, and policies such as supporting those harmed and preventing weaponization and retaliation.
• Implement an expeditious and timely confidential reporting system.
  
  
  • The system should be transparent in aggregate reporting to the entire organization – with at least an annual review of metrics such as the number of reports, types of reports, and actions taken.
  • The organization should investigate the barriers to reporting and actively seek solutions.
• Ensure a group of individuals in the organization with relevant expertise manage the comprehensive strategic plan. These individuals should have adequate authority and resources to implement the plan, along with commensurate support for their time.
• Enforce leadership and organization accountability to address HID including, but not limited to, the process of investigation, due process, remediation, counseling, and escalation of consequences in proportion to context and patterns of behavior. 

Some of the individual commitments and actions include:

• Individuals should prioritize professionalism by practicing healthy workplace etiquette, which includes being respectful of those around them, self-aware of habits and biases, proactive in mitigating harmful biases, and attentive and responsive to organizational harassment policies. 
• Build cordial professional relationships with colleagues by finding common ground.
• Refuse to initiate, participate, or condone HID toward others.
• When witnessing HID, be an “upstander,” by providing support and protection as needed, and reporting to the appropriate party when safe to do so.

“In order to provide safe anesthesia care, it is imperative that every individual is treated with respect and dignity in our work environments,” said Della Lin, M.D., FASA, chair of ASA’s Ad Hoc Committee on Harassment, Incivility, and Disrespect. “Patient safety is compromised in health care when disrespectful behaviors hijack teamwork and performance resulting in clinicians being unable to function at their best in the perioperative setting. The work of our committee demonstrates how extensive and pervasive this problem is, no matter who you are in our specialty. Studies show that there is a ripple effect. If we want to perform at our clinical best, optimize the best of outcomes, including patient satisfaction, and recruit and retain a vibrant workforce, everyone needs to be part of the solution.”

THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS
Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 58,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during, and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/madeforthismoment. Like ASA on Facebook and follow ASALifeline on X.

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