Risky shortcuts taken during baby deliveries often not addressed

Newborn baby girl right after delivery, shallow focus

Most doctors, midwives and nurses who help deliver babies have observed their colleagues taking shortcuts or engaging in behavior that could compromise patient safety, but few speak up about the issue, a new study says.

Researchers surveyed more than 3,200 doctors, nurses and midwives on labor and delivery teams, and asked if they had observed a colleague taking a shortcut, such as not washing handsor failing to change gloves. The health care providers were also asked if they had ever witnessed a colleague having problems with his or her job performance, being disrespectful to a co-worker, or lacking the skills or knowledge needed to do his or her job.

More than 90 percent of doctors and midwives, and nearly 100 percent of nurses, said they had observed such problems within the last year.

About two-thirds of doctors, 60 percent of midwives and 77 percent of nurses said that what they saw undermined patient safety, harmed patients or led them to seriously consider leaving their job, the researchers said.

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But only 9 percent of doctors, 13 percent of midwives and 13 percent of nurses directly confronted the colleague about their concern.

Most said they did not directly speak to the colleague who caused the problem because they worried he or she would become harder to work with, or because they did not want to start a conflict in front of a patient.

Many participants said they did speak with someone, such as a manager, about the issue, but the manager did not always speak to the person responsible for the behavior.

Study researcher Audrey Lyndon, an associate professor at the University of California, San Francisco School of Nursing, said the findings were concerning. "We need to take these kinds of problems seriously, and put energy behind ensuring that we have a psychologically safe, healthy work environment," where people feel comfortable speaking up, Lyndon said.

Problems highlighted in the new study are not unique to health professionals who deliver babies — similar issues have been seen among health professionals who work in operating rooms and the intensive care unit, Lyndon said.

Disrespectful or disruptive behavior in health care settings may arise, in part, from a traditional hierarchy, in which doctors have a higher status than nurses and midwives, Lyndon said. Although such hierarchies today may be less pronounced than in the past, they may still be a problem. [See Midwives Make Home Births Safer for Babies].

One nurse-midwife interviewed for this article said she had indeed experienced these types of problems, including disrespect and hierarchy issues, during her more than 20 years of experience in the health field in three different states.

"Even if you speak up…oftentimes, it was just dismissed, or you were belittled, or you were made to feel wrong," said the nurse-midwife, who did not want to be identified, given the sensitive nature of the topic.

She recalled one instance in which she phoned a doctor at home to inform him of abnormal vital signs in a baby. The doctor told her she was wrong, even though he wasn't in the room to assess the issue. "He was just automatically right because he was the physician," she said.

There can be hurdles to resolving such problems. Health care workers are busy and may think they don't have time to address the issue, Lyndon said. Resolving conflicts in front of patients can also be difficult, she said.

But Lyndon said that, when health care workers see a colleague acting out of line, it's important to discuss the problem with that person directly. "You're giving that person a chance to respond," Lyndon said. "You have the potential, at least, to resolve it right then and there," which would be especially important if the issue involves patient care, she said.

The survey was emailed to members of certain professional organizations. It's possible that people were more likely to respond to the survey if they perceived problems with their colleagues — a factor that would have biased the results.

The study will be published in an upcoming issue of the American Journal of Obstetrics & Gynecology. One of the study authors is employed by VitalSmarts LC, a company that makes training materials aimed at improving corporate culture and interpersonal communication.

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