Participant Information Sheet

Study title: Exposure and responses to disruptive behaviour in the operating room

Invitation to participate

You are invited to participate in a research study examining exposure and responses to disruptive behaviour in the operating room. We define disruptive intraoperative behaviours as behaviours that undermine a reasonable person's standard of respectful behaviour. These behaviours range from mild incivility to egregious abuse.

These behaviours are important to study because they can undermine clinician wellbeing, institutional functioning, teamwork, and patient safety. The way people respond to these behaviours is also important, since responses may reduce or worsen the negative effects of disruptive behaviour.

Before deciding whether to participate, please read this information carefully.

Who is conducting the study?

This survey is being conducted by the Intraoperative Behaviours Research Group, consisting of researchers from the University of the Fraser Valley, the University of Michigan, the Australian National University, and several health regions across North America.

This group previously conducted the largest survey study on this topic, involving approximately 7500 clinician responses across 7 countries. That work resulted in multiple peer-reviewed articles and invited reviews.

This study has been approved by the University of the Fraser Valley Research Ethics Board and is being submitted for review by the ACT Health Human Research Ethics Committee.

Why am I being invited?

You are being invited because you are a perioperative clinician or operative staff member whose work may involve the operating room environment. The study is interested in the experiences of people who work in intraoperative care.

What is the purpose of the study?

The purpose of this study is to examine how clinicians and operative staff are exposed to disruptive intraoperative behaviour and how they respond to it. The study also examines institutional factors that may affect whether responses are more constructive or more harmful.

The findings may help identify institutional conditions that support safer, more respectful, and more constructive responses to disruptive behaviour in the operating room.

What will I be asked to do?

You will be asked to complete an anonymous online questionnaire. The survey will take approximately 15 minutes to complete.

The survey will ask about:

• your professional role and workplace context;
• your exposure to disruptive behaviour in the operating room;
• how you respond to disruptive behaviour;
• your institutional culture and working conditions;
• basic sociodemographic information about you

Some questions may ask about sensitive workplace experiences, including conflict, intimidation, harassment, or other disruptive conduct.

Please complete the survey only once.

Do I have to participate?

No. Participation is completely voluntary.

You may skip any question that you do not wish to answer. You may also stop completing the survey at any time by closing your browser.

Your decision to participate or not participate will have no effect on your employment, professional standing, relationship with any professional association, or access to any services or supports.

Can I withdraw my data?

Because the survey is anonymous, the research team will not be able to identify which survey response belongs to you.

You may withdraw by stopping the survey before completion, but your answers up to that point may still be used in the analysis. Once you submit the survey, or once you stop completing it, removal or modification of your data will not be possible because your responses will not be linked to your identity.

Are there any benefits?

There may be no direct benefit to you from participating in this study.

However, the information you provide may help identify institutional factors that affect exposure and responses to disruptive intraoperative behaviour. This may help inform future efforts to improve workplace culture, teamwork, and safety in operating room environments.

Are there any risks?

Some questions may prompt you to recall uncomfortable or distressing experiences. This may include experiences related to workplace conflict, bullying, harassment, intimidation, or other disruptive behaviour.

You may skip any question that makes you uncomfortable. You may also stop the survey at any time.

If you are currently feeling very distressed, you may prefer to delay participation until you feel ready or choose not to participate.

What if participation raises workplace-related concerns?

Completing this survey is anonymous and does not create an official report of workplace misconduct, malpractice, criminal behaviour, professional misconduct, or any other workplace health and safety concern.

The survey is not designed to receive or investigate formal complaints. The research team will not ordinarily be able to identify specific individuals, institutions, or events from survey responses.

If participation raises workplace-related concerns for you, or if you wish to report a specific incident, please use the appropriate local pathway available to you. This may include contacting your supervisor, service director, unit manager, workplace health and safety representative, human resources department, professional regulator, union representative, employee assistance program, staff wellbeing service, professional association support service, or another formal reporting process within your organisation.

If you or someone else is in immediate danger, call 000.

Support services

If you are experiencing distress to the degree that you require mental health support, please contact one of the following services:

- Lifeline 131114, lifeline.org.au

- Beyond Blue 1300224636, beyondblue.org.au

- 13YARN 139276 (for Aboriginal and Torres Strait Islander People)

- SANE Australia 1800187263 (10 am-8 pm), sane.org

- Suicide Call Back Service 1300659467

- Medicare Mental Health 1800595212, medicarementalhealth.gov.au

Psychological support may also be available through your family doctor or, where available, your employee assistance program or professional society, such as RACS or ACORN.

If you are, or someone you know is, in immediate danger, call 000 or Lifeline at 13 11 14.

Will I receive payment or compensation?

No. Australian participants will not receive payment, compensation, or entry into a prize draw for participating in this study.

Will my responses be anonymous?

Yes. Your responses will be anonymous. The research team will not link your responses to directly identifying information such as your name, email address, or IP address.

To help protect your anonymity, please do not write your name or other identifying information anywhere in the survey or in any textboxes.

Because the survey is anonymous, the research team will not be able to identify your response after submission.

How will confidentiality be protected?

Efforts will be made to safeguard your confidentiality. Data will be stored in password-protected, access-restricted electronic formats. Access to the dataset will be limited to authorised members of the research team and relevant research ethics oversight bodies, where required.

Results will be reported only in aggregate form. Where subgroup numbers are small, categories may be combined or not reported separately to reduce the risk that individuals could be indirectly identified.

However, absolute confidentiality cannot be guaranteed. This is because the survey is hosted online, data are stored electronically, and very small subgroups can sometimes create a risk of indirect identification. The research team will reduce this risk by reporting results in aggregate form and avoiding unnecessary reporting of very small groups.

What platform is used to collect the survey data?

This survey is hosted using SurveyMonkey, a U.S. based web platform. Australian participants will complete the survey online through SurveyMonkey.

SurveyMonkey is used only as the survey-hosting service. The study data will remain under the custody and control of the Principal Investigator and the University of the Fraser Valley.

Where will the data be stored?

Survey responses will initially be stored on the SurveyMonkey platform in the United States. Because the data are stored in the United States, they may be subject to U.S. laws such as the Patriot Act, which may permit law enforcement to request access to such records.

The de-identified survey dataset will then be securely accessed and stored by the Canadian research team at the University of the Fraser Valley.

Australian survey data will not be stored by the research team in Australia. No onward transfer of Australian survey data to Australian sites is planned.

How will data be transferred between countries?

Data transfer between jurisdictions will occur only through secure electronic transmission associated with the SurveyMonkey platform and secure access by the Canadian research team.

Access to the dataset will be limited to authorised members of the research team and protected through password-protected, access-restricted storage.

How long will the data be kept?

Survey data will be deleted from the SurveyMonkey account within 1 year of study completion, which is expected to be approximately the summer of 2027.

The de-identified analytic dataset retained by the research team will be stored indefinitely for future comparative analyses.

Will the data be used in future research?

The de-identified analytic dataset may be used in future comparative analyses related to disruptive behaviour, institutional culture, clinician responses, teamwork, and workplace conditions in perioperative settings.

These future analyses will use de-identified data and will not involve attempts to identify individual participants.

How will data quality be checked?

Survey responses may be reviewed for data quality. Responses that show clear evidence of invalid or non-meaningful completion, such as failed attention checks, implausibly short completion times, or strongly patterned responding, may be excluded from analysis.

Who owns and controls the data?

The study data will remain under the custody and control of the Principal Investigator and the University of the Fraser Valley. SurveyMonkey is used only as the survey-hosting service.

Who can I contact for more information?

For questions about the study, please contact:

Principal Investigator:
Dr. Alexander Villafranca
University of the Fraser Valley
Email: alexander.villafranca@ufv.ca

Who can I contact if I have concerns about the conduct of the study?

If you have questions about the way the study is being conducted and do not feel comfortable contacting the research team, please contact:

ACT Health Human Research Ethics Committee
ACTH-HREC
Level 6, Building 10, Canberra Hospital
Telephone: (02) 5124 7968
Email: ethics@act.gov.au

Consent

By proceeding to the survey, you confirm that you have read and understood this Participant Information Sheet and the consent information. You understand that participation is voluntary, that you may skip questions or stop the survey at any time, that the survey is anonymous, that your data cannot be withdrawn after submission or discontinuation, and that completing the survey does not create an official report of workplace misconduct, malpractice, criminal behaviour, professional misconduct, or a workplace health and safety concern.

If you agree to participate, please select "I agree" on the survey entry page.