Presentation
Stayin' Alive: Hierarchy and Music Choice in the Operating Room
SessionPoster Session 1
DescriptionBackground
Psychological safety is a critical element of good teamwork in the Operating Room (OR). (1) The strict hierarchy in the OR threatens that psychological safety, as OR team members may feel hesitant to speak up when they see a potential threat to the patient. (2) The attending surgeon is at the top of that hierarchy, followed by the attending anesthesiologist, then by experienced (and thus older) nursing staff, and younger resident surgeons in training. Medical students are typically the youngest in the OR and are at the bottom of that hierarchy. As we have previously reported, students are the least likely to speak up for patient safety. (3)
Music is an understudied element of psychological safety in the OR. Music is commonly played during surgery, 90% of surgical cases in some hospitals. (4) Yet the selection of music is rarely distributed amongst the team. When an attending surgeon selects the music without input from the team, it can undermine team cohesion, diminish others’ confidence in challenging the surgeon, and reduce their willingness to speak up when patient safety is at risk. In this study we explored these team dynamics and music choice as it relates to the OR hierarchy.
Objective and Hypotheses
This study examined the relationship between music choice, role, and age. We hypothesized that attending surgeons and older team members are responsible for most music selection and that those who often choose the music rarely ask others for their music preferences.
Methods
We surveyed 138 surgeons, anesthetists, and nursing staff about music preferences and choice. The survey was developed by an interdisciplinary research team that included a medical student, a pelvic floor surgeon, research assistants, and Human Factors experts. It was constructed based on previous surveys (5) and additional questions from a Human Factors perspective, including hierarchy, authority, and team communication about music choice.
Surveys were administered using RedCap, in person at department and staff meetings. We also employed snowballing via email. Demographics, including age and role, were collected. Questions included who chooses the music, whether they prefer music, whether they mind when others choose for the room, and if they ask others their preferences. Outcomes were analyzed by age, years of experience, and role using Chi-square.
Results
Response rate was 63.6%, including 61 surgeons, 40 nursing staff, and 37 anesthesia providers. Surgical attendings and residents were widely distributed across surgical specialties. 47.4% of respondents were 35 or younger. 16.7% were 51 or older, including 33.3% of surgical attendings, 0.0% of surgical residents, 19.1% of anesthesia providers, and 33.3% of nursing staff. 14.6% of respondents had 20 or more years of OR experience.
89% of all respondents prefer music, yet musical preferences varied widely across role and age. In total, 91 respondents preferred 44 separate genres. Disfavored genres included rap and metal. As for the duration of music, 34.8% of respondents preferred music to be playing the entire time, including 33.3% of surgical attendings, 50.0% of surgical residents, 36.4% of surgical technicians, and 55.6% of anesthesia residents. 10.9% of respondents preferred no music to be played for the entire surgery, including 28.6% of surgical attendings, 18.2% of anesthesiology attendings, 15.4% of circulating nurses, and 27.3% of surgical technicians.
Only 9.4% said they get to choose. 58.3% who choose the music are over the age of 40, and 75% are attending surgeons, while no anesthesia providers or scrub techs choose. Among younger staff, 94.2% said others choose the music and 72.2% were ok with others choosing for them. Staff role was significantly associated with who chooses the music (χ² (8, n=127) =48.44, p<0.001, Cramér’s V=0.618). Surgical attendings identified circulating nurses often making the music selection, though only 9.5% circulating nurses reported choosing. 70% of attending surgeons did not ask other team members for their music preferences before making the music choice themselves.
Conclusions
Most OR team members prefer music, but music choice is highly varied and largely relegated to older staff, especially attending surgeons, who rarely ask team members about preferences. Bringing awareness and inclusivity to musical selection might improve teamwork and psychological safety.
Psychological safety is a critical element of good teamwork in the Operating Room (OR). (1) The strict hierarchy in the OR threatens that psychological safety, as OR team members may feel hesitant to speak up when they see a potential threat to the patient. (2) The attending surgeon is at the top of that hierarchy, followed by the attending anesthesiologist, then by experienced (and thus older) nursing staff, and younger resident surgeons in training. Medical students are typically the youngest in the OR and are at the bottom of that hierarchy. As we have previously reported, students are the least likely to speak up for patient safety. (3)
Music is an understudied element of psychological safety in the OR. Music is commonly played during surgery, 90% of surgical cases in some hospitals. (4) Yet the selection of music is rarely distributed amongst the team. When an attending surgeon selects the music without input from the team, it can undermine team cohesion, diminish others’ confidence in challenging the surgeon, and reduce their willingness to speak up when patient safety is at risk. In this study we explored these team dynamics and music choice as it relates to the OR hierarchy.
Objective and Hypotheses
This study examined the relationship between music choice, role, and age. We hypothesized that attending surgeons and older team members are responsible for most music selection and that those who often choose the music rarely ask others for their music preferences.
Methods
We surveyed 138 surgeons, anesthetists, and nursing staff about music preferences and choice. The survey was developed by an interdisciplinary research team that included a medical student, a pelvic floor surgeon, research assistants, and Human Factors experts. It was constructed based on previous surveys (5) and additional questions from a Human Factors perspective, including hierarchy, authority, and team communication about music choice.
Surveys were administered using RedCap, in person at department and staff meetings. We also employed snowballing via email. Demographics, including age and role, were collected. Questions included who chooses the music, whether they prefer music, whether they mind when others choose for the room, and if they ask others their preferences. Outcomes were analyzed by age, years of experience, and role using Chi-square.
Results
Response rate was 63.6%, including 61 surgeons, 40 nursing staff, and 37 anesthesia providers. Surgical attendings and residents were widely distributed across surgical specialties. 47.4% of respondents were 35 or younger. 16.7% were 51 or older, including 33.3% of surgical attendings, 0.0% of surgical residents, 19.1% of anesthesia providers, and 33.3% of nursing staff. 14.6% of respondents had 20 or more years of OR experience.
89% of all respondents prefer music, yet musical preferences varied widely across role and age. In total, 91 respondents preferred 44 separate genres. Disfavored genres included rap and metal. As for the duration of music, 34.8% of respondents preferred music to be playing the entire time, including 33.3% of surgical attendings, 50.0% of surgical residents, 36.4% of surgical technicians, and 55.6% of anesthesia residents. 10.9% of respondents preferred no music to be played for the entire surgery, including 28.6% of surgical attendings, 18.2% of anesthesiology attendings, 15.4% of circulating nurses, and 27.3% of surgical technicians.
Only 9.4% said they get to choose. 58.3% who choose the music are over the age of 40, and 75% are attending surgeons, while no anesthesia providers or scrub techs choose. Among younger staff, 94.2% said others choose the music and 72.2% were ok with others choosing for them. Staff role was significantly associated with who chooses the music (χ² (8, n=127) =48.44, p<0.001, Cramér’s V=0.618). Surgical attendings identified circulating nurses often making the music selection, though only 9.5% circulating nurses reported choosing. 70% of attending surgeons did not ask other team members for their music preferences before making the music choice themselves.
Conclusions
Most OR team members prefer music, but music choice is highly varied and largely relegated to older staff, especially attending surgeons, who rarely ask team members about preferences. Bringing awareness and inclusivity to musical selection might improve teamwork and psychological safety.
Event Type
Poster Presentation
TimeMonday, March 234:45pm - 6:15pm EDT
LocationRhinelander Gallery
Hospital Environments