The impact of incivility in an obstetric emergency: an interventional crossover simulation study

Investigations into maternity failings in the UK have highlighted the problem of uncivil behaviour in obstetrics. Despite the importance of a civil environment being recognised, no research has been performed to demonstrate the effect of civility in the high-risk environment of obstetrics. This study aims to investigate the effect of an uncivil environment on the performance of an obstetric team with a focus on non-technical skills.

This study is an interventional, crossover simulation study. Ethical approval was received from the University of Southampton Research Ethics Committee (81008). The study was undertaken in the Wessex school of Obstetrics & Gynaecology (O&G) and participants were O&G trainees from training years one to seven. Following informed consent, 23 trainees observed two simulated scenarios of the management of a postpartum haemorrhage (PPH) and completed a Team Emergency Assessment Measure (TEAM) questionnaire which has four domains; leadership, teamwork, task management and a global rating of team performance. In the first scenario, the anaesthetist was civil and in the second, uncivil. ANOVA was used for statistical analysis, p values of < 0.05 were considered statistically significant. The study hypothesis was that there would be a decrease in sub-scores when utilising the TEAM questionnaire in an uncivil compared with civil simulated obstetric emergency.

There was a significant reduction in the overall team performance in an uncivil environment compared to a civil one (p = 0.006). The biggest differences in scores were observed in team morale (4.00/4.00 in the civil versus 2.22/4.00 in the uncivil simulation, p < 0.001) and effective communication (4.00/4.00 in the civil versus 2.22/4.00 in the uncivil simulation, p < 0.001).

Incivility impacts on the multi-disciplinary team's morale and communication when managing a simulated obstetric emergency.