The present study was conducted to investigate the relationship between professional values and professional communication as perceived by the operating room personnel and doctors at the public hospitals of Shiraz. 603 individuals participated in the study. The findings of the study showed that the operating room personnel and doctors perceived professional communication to be important, indicating that they considered professional communication to have a significant impact on the quality of care provided in the operating room. This attitude makes professionals feel obligated to have verbal and non-verbal communication with other professionals to minimize the rate of errors caused by inadequate communication. This finding is consistent with the results of the studies of Hailu and Norful (21, 22).
On the other hand, the participants’ responses showed that stress and heavy workload account for ineffective relationships in operating rooms, which is in keeping with the study of Halim(23). Other contributory factors are assignment of too many responsibilities to one individual, too much reliance on paperwork for communication, and too much attention to the main purpose of professional communications, i.e., caring for patients, at the cost of the other aspects of professional communications, including consulting others, transferring experiences, professional training, and teamwork. According to Bellandi (2018), doctors and nurses spend a large amount of their time filling out forms in hospitals(24).
One of the domains of the professional communication questionnaire is teamwork, which includes support, cooperation, honesty, and satisfaction. The results of the present study show that the operating room personnel attached more importance to the role of teamwork in professional communication than the doctors did, which is consistent with the study of Kwon (2020). Kwon reports that nurses have a higher opinion of teamwork than doctors do and have learned that teamwork helps reduce the frequency of medical errors, including burns, operating on the wrong site, retaining surgical items, and falls(25). On the contrary, the results of the study of Gabriele Prati (2014) show that doctors have a better understanding of the significance of teamwork and claim to be more involved in teamwork activities(26). It appears that the main reasons for the personnel’s greater emphasis on teamwork are differences between individuals’ professional perceptions and doctor-centeredness in Iran: form the doctors’ point of view, since operations are performed by surgeons, teamwork in the operating room means being aware of the surgeons’ needs and following the surgeons’ instructions, not consulting others or transferring experiences(1, 27). In addition, since the healthcare system in Iran belongs to the public sector and the hospitals in the present study were educational organizations, the surgeons in these hospitals are frequently replaced by other surgeons, while the personnel’s stay lasts for many years. Accordingly, the doctors are likely to disregard the significance of teamwork and the personnel’s knowledge, which leads to the personnel’s frustration, burnout, and failure to share their experiences. In effects, the experienced personnel’s inability to transfer their experiences to new doctors is the outcome of past failures in professional communications. János Kollár (2016) refers to ineffective professional communication as a contributory factor in medical personnel’s burnout(28). Thekla Holmes (2019) introduces good teamwork as a primary contributor to personnel’s work satisfaction (27).
Another significant domain of the professional communication questionnaire is communication conflicts in the workplace, i.e., superiority, unprofessional and offensive behaviors, verbal abuse, and interpersonal issues. The results of the present study show that the operating room personnel considered conflicts as disruptive to professional communication more than the doctors did. According to the study of Laschinger (2014), doctors’ mistreatment of nurses in the workplace adversely affects nurses’ performance and undermines the quality of care and patients’ trust in nurses (29). Based on the personnel’s responses to the items on the questionnaire (direct expression of requests, unprofessional communications, etc.), it appears that operating personnel believe that, in the operating room, doctors and nurses experience two different kinds of professional communications: explicit (what happens when they meet each other) and implicit (their real impression of their professional communications). Nurses are not inclined to express their requests and issue openly and talk about their conflicts only in their implicit relationships, which can be due to fear of losing their jobs, not receiving support from their direct managers, and deficiencies in inter-professional communications. According to Narelle Borrott (2017), because of their higher self-confidence and the nature of their profession, doctors find it easier to openly discuss their workplace requests and conflicts (30). Replacement of the course of social skills with a course on professional communication in the medical and bachelor’s degree curricula may help reduce the current issues (31).
Regarding ethical competence (religious differences, job status, cultural differences, leader-follower relationship, and pride), the results of the study show that the doctors perceived this dimension as more important than the personnel did. The traditional nature of medical education and the absence of any training in professional communication in the past have inclined doctors to view operating room personnel as subordinates who should merely obey them. They do not have a proper understanding of nurses’ status and consider the leader-follower relationship in their interactions with nurses to be acceptable. In other words, from the doctors’ point of view, operating room personnel should obey doctors without question, which is in compliance with mutual respect, a domain regarded highly by doctors(32). The respondents (doctors and personnel) in the present study stated that religious and cultural differences were accepted in the workplace and there were not any conflicts in that area. As religious beliefs play an essential part in caring for patients, communicating with them, and maintaining their psychological health, it appears that absence of conflicts between doctors and personnel in religious matters can improve their professional communication(33).
As for the dimension of respect and mutual trust (respect for others’ opinions, mutual trust, and courtesy), the results of the present study show that the doctors perceived this dimension to be more important than the personnel did, which finding is consistent with the study of Esmaeilpour-Bandboni (2017). This study, which investigates doctors’ perception of their professional communication with nurses in Iran, reports that, in clinical procedures, doctors often trust nurses’ reports and rely on their insight in diagnoses and treatments. Doctors consider specialized knowledge, professional skill, and the ability to manage critical conditions as facilitators in professional communication and prefer to work with informed nurses(34, 35) (36). It was also found that, regardless of their personality traits, doctors with higher education have a higher opinion of the value of professional communication and values, while, regardless of their personality traits, personnel with higher education are more likely to find themselves in conflicts.
In operating rooms, professional values are as important as professional communications. In the present study, the operating room personnel and doctors were found to perceive professional values to have an essential part in their professions, which findings is consistent with the studies of Poorchangizi (2019)(37), Torabizadeh et al. (38), and Domenico Montemurro (2013)(39). Professional values are accepted and established criteria in medical sciences and doctors and nurses hold approximately similar views on them. According to Torabizadeh (2018), professional values are perceived similarly across different disciplines. However, doctors attach more significance to the caring dimension of professional values than nurses do, which is owing to the nature of their field and their responsibility for operations (24). Also, compared to men, women perceived professional values to be more important, which is consistent with the study of Torabizadeh (38).
As core principles which determine the quality of care in operating rooms, professional values are closely related to professional communications: operating room personnel and doctors believe that better professional communication correlate with higher observance of professional values in operating rooms. Among the dimensions of professional values, caring for patients (reduction in errors and improvement in the quality of care), trust between the personnel and patients, and justice and professionalism (sharing professional experiences) improve when the status of professional communication is satisfactory. Moreover, proper professional communication in operating rooms can help the personnel improve their knowledge and skills and have a better understanding of professional values (40–42). However, barriers to professional communications, including hierarchies, paperwork, disregard for teamwork, lack of a valid framework for dealing with communication issues, inequalities in the pay system of Iran, the dominance of a leader-follower relationship, unprofessional behaviors, and lack of education in professional communication in clinical environments, are undermining the significance of professional values for practitioners(28, 43).
Professional values have a complex nature, especially in the domains of justice and caring, and changes in these areas expose patients to hazards in ways over which they have no control. Even if they do not harm patients initially, poor professional communication scan inclines the personnel to attach less significance to professional values and change their attitude from being committed to benefitting patients to not causing harm to patients. The results of the present study show that operating room personnel’s commitment to professional values has diminished over time. According to Eriksson (2020), operating room nurses do not receive the respect which they deserve, which is often due to such issues as gaps between opinions and practice, occupational burnout, and lack of support in the workplace(44).