S742 The Harmonious Touch: Exploring the Impact of Music on Team Dynamics in the Operating Room

Introduction: Music is often played during surgical procedures. Music in the non-medical workplace has been found to have many positive effects (facilitating learning, reducing stress, and mood regulation) as well as negative effects (distraction, increasing occurrence of errors and mistakes, increasing tension and psychological distress). The medical literature lacks an understanding of how music affects team processes and the interactions with others in an operating room (OR). The purpose of this study is to understand how music affects work relationships with coworkers and the consequences of those interactions for organizational medical processes in the OR and endoscopy. Methods: This was a prospective, single center, qualitative study of healthcare professionals. First-person interviews were conducted virtually on Zoom and recorded on Otter.ai. Participants were recruited at Ohio State University Wexner Medical Center through hospital employee messaging. Participants were required to be 18 years or older, english speaking, and work in an OR environment to be eligible. Interviews were analyzed using Dedoose to identify higher-order themes, based on common properties, as well as relationships between these themes. Results: Forty-four interviews were conducted from a variety of sources including surgeons, anesthesiologists, fellows, residents, surgical technicians, and nurses. Interviews resulted in 1620 coded excerpts. Informants reported that music attributes such as familiarity, upbeat/fast paced, and preferred volume were perceived as positively contributing to the OR experience. Informats reported that music enhanced collegiality, humanized coworkers by learning about their music preferences, and facilitated perceptions of belonging and psychological safety within the OR. Respondents noted this music enhanced their focus during procedures, enhanced team efficiency, and contributed to their wellbeing. In contrast, music that lacked these attributes was reported to have a negative impact on individual focus and wellbeing, as well as team efficiency, communication, and cohesion (Table 1). Conclusion: Results from our qualitative study suggest the type of music played in the OR affects critical individual and team outcomes. In general, informants reported that music that was familiar to everyone, upbeat, and played at an appropriate volume improved OR outcomes for both the individual and the team as a whole. This study serves as preliminary evidence of the consequences of music for medical personnel. Table 1. - Primary and Secondary Themes That Emerged From Qualitative Analysis of Interviews About Music and the Environment in the Endoscopy Rooms and Operating Rooms Secondary Themes Primary Themes Representative Supporting Quotes Informant Salient Music Features Presence/Absence Preference If I had to say yes or no, I'm gonna vote no. Okay. Most of the music that is played is either too loud. It's disturbing. It can be offensive. You know, a lot of the rap music they're playing the OR has a lot of very offensive wording in it. So overall, I am not a fan of music in the operating room at all. If it is classical music or nonverbal I'm okay with it. Anesthesiologist Literally one of the reasons I went into surgery because I could listen to music while I worked. Surgeon Familiarity From my perspective to music that more people are familiar with, I think that tends to be, perhaps, in my perspective, a little bit more allows for more cohesion. That's yeah, so I think, I don't know, I think, depending on your age, I think kind of sometimes classic music or 80s, or 90s, music can be that type can fulfill that. GI Fellow I have never heard of this before my life and it's just like, not catchy. And it's like, I'm like trying to decipher like what in the world is happening. Like, I don't know that I can give a specific genre related to it. But those kinds of things are a little bit more difficult, because it for the same kind of reason that I mentioned, just that, like, it just distracts you a little bit because you're trying to decipher it and try to understand it in some way. I know, it's probably different parts of your mind that you're utilizing to, like, decipher that vs, like, decipher vital signs, but at the same time, you're being pulled like two different directions. Resident Genre Preference So I'm very poppy. I love Justin Bieber- just saw him in concert on Monday. It was amazing. And I love dance music and remixes and stuff like that and then 90s. That definitely will put me in a great mood or any kind of music that makes me want to dance or something. And then because like I said when X puts on alternative I'm like this sucks. I'm like why are we listening to this, this doesn't make me want to dance or you know. So I think there's a huge difference and that's what's you know, hard sometimes because everyone likes different genres and different music will put you know different people into different moods. Nurse I will give one instance of like, one example, we occasionally will have surgeons from, like different parts of the hospital come over, you know, like, for collaborative procedure or something like that. And I know one time, we had a surgeon come over, and I cannot tell you what we were doing exactly, I can't remember. But he had like, not gonna lie like metal screamo music and I just remember it kind of, I feel like it was very distracting for some of the members, because they were just, you know, it was a very odd thing. It's not everybody who has that music choice. Nurse Volume So I think that's another thing that can go both ways. Because like I said, if it's too loud, it really hinders communication, because you can't hear and sometimes this will lead to someone saying loudly, like, “turn off the music or turn down the music.” If it's quiet, and it's like, at a less tense part in the surgery, like if nothing dangerous is going on. And there's no problem with the volume, then, you know, sometimes we can chat about the music like, “Oh, I like this song, or I went to a concert once I heard this song.” And so the times of the surgery when it's appropriate to chat, it can kind of be fun to do that. Resident On occasion, you know, we'll have it up too high. Like sometimes one song plays a little louder than the other. And we'll turn it down. I mean, the circulating nurse can turn it down. But yeah, we want to be able to converse with our patient and not overdo it with the with the loudness of music. Surgeon Tempo I think the tone, the tempo kind of… it's like an upbeat tempo, it kind of makes the room move more efficiently. It does seem to be you know, it's so funny that I think back I can remember times when this this slow, lazy music just like kind of makes you want to, but the tempo does kind of get especially when when during turnovers, okay, so turnovers. I'm not sure if you're familiar with those, it's somewhere in between, it's from the time the last patient leaves the room or not the last patient but the patient leaves the room until the time the next patient enters. It's called a turnover time and it's usually about 20 minutes, you want it to be about 20 minutes. So it's from that time that you gotta clean up. mop. anesthesia has to turn over there's so many things going on. It's a whirlwind and then you could be switching from an orthopedic case to, you know, a spine case or something, you know, totally different ends of the spectrum. And if you have some fast music in there, everybody's gonna move faster. It's so funny. And but if you have some slow music, everybody's gonna kind of go to the tempo of the music and so it kind of does make a difference. Nurse Well, I'll give you an example. If the doctors put on like, classical music, or like meditation music, I understand where they're going with that like to relax the patient and everything. But for the staff, we're sitting in a dark room, it's quiet, like, like, you know, there's not a lot happening, and there's classical music. And it's like, it kind of drags the day on and puts you in a downer mood, like you want to sleep or you know, I don't think it's great for like, productivity or like mood. I understand why the docs pick that stuff. Nurse Variety I have felt like annoyed in the past when it was consistently on hairband music for hours. And I'm sure I've asked them to change it at some point, if it goes into like, we're going into the third case of the day and we're still listening to hairband, I would probably be like, that's enough hairband Nurse anesthetecist Yeah, like, you know, there's another doctor that I work with who likes to listen to whatever I want to listen to. And he likes the variety that I play for him. And it makes our day go so smooth and so nice. And sometimes I even get tired of what I picked in that moment and I change it to something else. So but it makes our day kind of snap along. Nurse Positive Outcomes Room Atmosphere: collegiality, collective mood I think it's a positivity. Work is a fun place to be, you know, you've got coworkers who seem to enjoy to be there too, you know, you're still getting the job done. People are getting their procedures, but you know, you've got good co workers that you're having, you know, a good time with. And you know, doing your job. Nurse It almost, if you're picking it, or I think the music kind of sets the vibe in the room. So I think it just lets you know, Oh, maybe I can be a little bit more relaxed with this person, because this person likes this type of music. And we can bond over this. And now I feel more comfortable to maybe communicate differently with them instead of just so, business and professional. Nurse Humanizing one another through music Sometimes it's just funny. Some people some nurses are so reserved, and then you come in and they're playing like hip hop barbecue or that something that is super funny like, you listen to it. Just kind of cracks you up? And, you know, like, or do you remember a song from when you were younger and it's you know, kind of sparks a feeling. So music in the OR is definitely a bonus. I can tell you that and you know as long as it doesn't interfere with anybody's focus on the procedure in the OR then it's definitely a nice bonus. Nurse It just kind of brings us together especially in, for instance, like, we opened up a new Endoscopy Center in New Albany, and so it's like new staff, everyone's still getting to know each other See, at Main, one of the nurses in particular, I mean, I've, she's been there longer than I've been there. And I've known her my whole time, even as a med student, you know, it's like, alright, we already know each other, like, it's, but when, when you're meeting people for the first time, and especially in your like, and now you're working together, to take care of somebody for the first time, things like that can I think, break down barriers a little bit, and meaning, you know, just Oh, like, they're, we're all people we’re all you know, just, just humans just trying to do our job best and take care of this, this patient. So I think it brings us together more than if it's just kind of, you know, that sterile… which, it needs to be of course, that sterile, safe environment, but not sterile, impersonal environment, and music helps makes that, that bring that kind of collaboration, kind of positive energy to the still very safe environment. Fellow Belonging I think sometimes there's some camaraderie there when a song comes out and everybody starts kind of singing to it or humming to it then you can like have like a shared, you know, lived experience other than just being in the OR together. Surgeon Yeah, I think so. I think team wise, if there's no music on I just think it's very, okay let's focus about the procedure, talk about the procedure. Let's get down to business. And then when there is music on I feel like the team is more bonding and more relaxed and talking about the song, maybe singing the song. And then maybe someone's laughing about it or someone's like, Oh, I love this song. There's definitely a difference. And then you can tell when somebody doesn't like the music compared to when somebody is, people are bonding over the actual music and they love this song, or they saw this person in concert, or I think it just, it doesn't make people distracted. I think it relaxes the team and because you still stay professional, and you still get the procedure done. But I think it's just a little extra factor. And gets people a little bit more relaxed. Nurse Psychological safety I think when you know, it's really, really dead, quiet, nobody's really saying anything, you know, you have this kind of feeling that maybe, you know, people aren't, aren't going to be like too receptive to like speaking up, or things like that. Because, again, you don't want to be the person that disrupts that kind of sort of environment. And I feel like the surgeons that I have worked with, who don't want to listen to music, or you know, want to keep it silent, can tend to have that sort of personality, where they might lash out a little bit, or, you know, really, you know, frown upon someone interrupting them. Even if it's, you know, for a legitimate concern or something like that. So I feel like, at least personally, it's kind of a more of a negative connotation to have a completely silent operating room. And that's a little bit different from like, if you're going through, like a critical time period, you know, maybe the patients aren't doing well, and then you turn off the music, but that when that's a different situation, in my opinion, where everyone's already communicating, everyone's talking, you turn off the music for a different reason entirely. Anesthesiologist It just helps everyone feel comfortable. You absolutely don't know everyoneand something you can connect with kind of starts a conversation and you know, it makes it like okay, now I'm not afraid to ask this doctor something. Enhanced well-being and satisfaction So like, you know, as the day goes by, it's like things can get mundane or like, the more procedures that you do have the same procedure then like, you know, things can get quite mundane. Like, not only does it give like a little bit of light air to the in the room that's like off in high stress, I think it's just like, makes the job a little bit more fun. You know, like, you learn more about the person that you're working with based on the music they choose. And you're still doing your job, but like, you just are enjoying it a little bit more. Resident Yeah, I think so. I think for me, though, if I leave in a better mood, and with more energy then I'm going to have that when I next interact with the patient, or when I next help with a procedure. So I think it's helpful. Resident Enhanced focus I think when it's positive, it definitely helps with endurance and morale. Like it can really if it's, you know, upbeat music that makes you feel good emotions, then that can help you get through really long and difficult procedures because it kind of keeps you going. And it helps you not think about how tired you are. It can also just be kind of this nice background noise that somehow it can help with focus. I don't know why but like having that in the background can make it easier to focus on what you're doing. Resident In their head, they're sort of present in the room, they're awake, their mind isn't drifting, they're not daydreaming about something, they're sort of staring into the corner, as opposed to paying attention to what's happening on the scrub table or at the bedside. They're just intellectually activated by the music. And as a consequence, their focus is where it needs to be for them to do the job that they have to do as it relates to the surgery. Surgeon Task efficiencies (pace of procedures) I mean, I think that if, if everybody is like me, where when they are doing procedural things, and they get into like, the zone. If we're all in the zone, then we're, like, more streamlined and doing our thing. Surgeon Yes, it's critical. Yeah, we want our chart or the nurse that is circulating the room to be headed out to go see that next patient at 10 minutes. So everyone else that's assigned to that room is doing turnover after the nurse takes her stuff out. Cleaning up the instruments are getting the next, mopping the floor, and nothing can come in until that room is totally clean. So then 10 minutes later that next case card should be rolling in the room with all the new equipment and instruments. Everything should be clean and ready to go and we start opening up and making sure all the equipment is ready for the next next case. Okay, so yeah, if you're playing some more upbeat music that definitely helps to stay within that 20 minute window. Nurse Negative Outcomes Room atmosphere: impersonal, flat I think that when there is no music playing people just tend to I mean, everyone's just kind of quiet. So you're just kind of focused on your job, but I don't think that it like has a positive impact on anyone's mood when there's no music on. I mean, you're just kind of doing your job but it can feel very like tedious because you're just kind of performing these tasks and nobody's talking and kind of thing. Nurse I do. Yes. When when there, there is no music, it's like deafeningly absent, like you can notice when there's no music playing, and almost always we have some kind of music in the background. Nurse Limited/impaired communication Like I said, it's just kind of boring in the room when there isn't- it's just work. There wasn't a whole lot of talking. It was just a procedure and we're done. Just notice that there's a change in the mood. Nurse It can obscure hearing what's being said whether it's the nurses to the tech or whether it's the doctor to the nurse, some people are a lot softer spoken than others. So is sometimes it can be hard to hear. I know anesthesia has, you know their moments where they don't like music being played when they're putting a patient under and honestly I get it because actually, I think there's some kind of science behind that and then going to sleep I don't know. But yeah, they don't like the music and that's I understand that. I don't think they should have music during the timeout. We tried to turn the volume down way low. I think if you have to notice the doctors or someone is like talking louder than their normal tone then music's probably a little too loud. But yeah, I mean, that's just it makes it a little harder to hear because of all the background noise and stuff for like, especially for someone like me. I do I mean, I just have to stand on this other side to hear better. It's not something I'm fully I don't really remember that I have hearing loss until I'm like, a doctor has their back to me and they're asking for something and we got music on over here, we got anesthesia like the heart monitors, beeping and stuff and I've got my back to the table and their back is to me and they're asking for something and I’m like “what, what” and then they're like, “you're not hearing?” and I'm like, “no” like other than that I don't really like remember it's not something I'm gonna put on a big board, hearing loss. Surgical tech Perceived tensions I'm trying to remember what we've like, go back to something like more fun and light-hearted, like, you know, pop or something like, usually they want something weirdly specific, or I think I ha one surgeon that really liked, it wasn't heavy metal, but it was something kind of angry sounding like that. And it just made everybody feel tense. And then when they left we put on like more happy light-hearted, you know, like peppy music that, that feel so intense Resident Yeah, for sure. And I've had it happen to myself, where, you know, I put something on and literally, the moment I scrub in, someone changes it. Like, okay, you said you like this, but you obviously don't like it, like, don't let me know, like I noticed. Or, you know, someone who, you know, like, like the example I gave with the fellow who listened to rap music that the circulator didn't like, like, that was very obvious tension in the room and stopping the case. And if you stop the case, that person that's harming is the patient. And so he was really calling out like, this is what you're doing, like you are you are putting now, you know, as possible, what aggressive way you're extending his procedure. And this is gonna, you know, could harm the patient by having a long procedure. And so that I have seen that tension of sort of like, Hey, come on, like, rarely angry, but sometimes just sort of frustrated. Chief resident Reduced well-being and satisfaction Like, I feel like it can just make things feel too serious and intense when all you're hearing is like instruments clanging around and the surgeon asking for things. So at least to feel to fill the void when you're in between asking for things, you can hear just some music in the background, just to kind of bring you back out of like the intensity of the situation. Because I just think that can be really overwhelming for the staff, when they're were put into like, really intense cases, and then the mood of the room. Is that just that same intensity, and there's nothing to really like bring you back out of it. If that makes sense. Like I'm not saying people don't need an intensity when they're operating or that they don't need to be focused. But it's probably just not really good for your brain to be or for like endurance to get through an entire operation when you're just so intense the entire time. Nurse anestheticst It does. I mean, I think like the needle tips to the negative, if it's something that I don't, if it's something that I really dislike, there's two things. So the type of music and the volume and either one of those can tip the needle in the negative. Reduced focus Depends on the day, I would say, I wouldn't say for sure. If you've had a bad day they would add to the bad day maybe yes. But, you know, some like say, no country no rap. There's one doctor that likes this EDM, like your electric and I'm just like it. Were going to have a seizure I'm like, Please give me not this because it's not relaxing at all. It's not focusing at all to me, you know, so usually he'll make sure that I'll make sure I don't have to listen to that. So that's kind of appreciative. Nurse I think that it drives my anxiety up a little bit. Like it sort of makes me feel like I need to work faster at the case. And I just feel like if it's really a sound that I don't enjoy, it's just sort of like, like a nuisance to me and it like interferes with my concentration. Surgeon Task inefficiencies (error propensity) In the same way, it can be, it can be a distraction, or it can be hard to hear communication. And so I think that can decrease the communication or can decrease the coordination. And that is sort of the cycle of if the music isn't as loud, people are talking louder, to speak over the music, and they're not going to hear requests, when directed out them. And so that can get in the way of coordination. Chief Resident I think that's hard because in that situation, like, that's the music that worked for him and he's the one who's really like, doing like, the critical components there. But at the same time, if it is distracting other members of the team, you know, that could be a delay in getting an instrument, or if there's a bleeder, and they need an instrument to clamp the bleeder. And they don't hear it right away, or they're, you know, delayed because they were distracted, then that affects, ultimately, it can affect patient care. Nurse Representative quotes and the role of the person being interviewed are also presented.