OR is no place to get casual

Healthcare attorneys tell Healthcare Risk Management that they are privy to some things that might shock a risk manager, such as what really happens in the OR.

Surgical pranks and horseplay in surgery are surprisingly common, says Alex J. Keoskey, JD, a partner specializing in healthcare litigation with the law firm of DeCotiis, FitzPatrick & Cole, Teaneck, NJ. He bases that statement on what he has seen from lawsuits in which a too-casual OR atmosphere was revealed during the litigation of malpractice cases.

The pranks, or staff becoming too familiar with one another and acting unprofessionally, are a result of the same stress that can lead to outbursts and abuse by physicians, Keoskey says. "It's not uncommon, and I think most nurses who work in surgery will tell you this. You do see these practical jokes quite a bit," Keoskey says.

The risk manager and other hospital leaders often don't know about the problem because surgical teams will straighten up and act appropriately if supervisors are present, he says. Risk managers should instill a culture in which all staff member understand that, though camaraderie is encouraged, there must be a bright line beyond which all behavior is strictly professional.

"Lawyers joke with each other all the time, but we don't do it in the courtroom because we have great reverence for that particular place and we know that it demeans the entire profession when we joke around in an area that is at the core of what we do," Keoskey says. "The surgical suite should be the same way. Joke around in the locker room or the break room all you want, but that has to stop when you walk in the OR and you're responsible for a human being lying on the table."

Risk managers should establish a zero tolerance policy for practical jokes in the workplace, with a special emphasis on the OR and any other patient care, Keoskey says.

"Rules like that don't just need to be on paper, they need to be enforced," he says. "People need to sign off on them and agree that they will not only not engage in this type of behavior but will report others who do."