Saying "Please" And "Thank You" Doesn't Slow Down The Case. Weird, Right?

In healthcare, we often chase the big solutions, new technology, cutting-edge procedures and data-driven process improvement. But what if one of the simplest, most effective ways to improve patient outcomes, reduce burnout, and boost efficiency in the operating room is something much smaller?

Something as small as saying “please” and “thank you.”

It sounds trivial, even laughable. But consider this: in high-stakes surgical environments where stress is intense and timelines are tight, we’ve come to accept unprofessional behavior as a norm. Biting sarcasm, curt responses, passive-aggressive comments— these are too often dismissed as “part of the job.”

But incivility in the operating room is not harmless. It is not efficient. And it is absolutely not cost-free.

The operating room is a pressure cooker. Surgeons carry the weight of life-or-death decisions. Nurses manage workflows, sterile environments and documentation. Scrub personnel are responsible for anticipating needs and maintaining precision. When communication breaks down or becomes hostile, safety is compromised.

“In high-stakes surgical environments, incivility isn’t harmless—it fuels errors, delays and burnout. Embedding simple courtesies like ‘please’ and ‘thank you’ alongside emotional intelligence training dramatically transforms team trust, patient safety and daily operating room efficiency as a critical safety measure”

Research consistently shows that incivility in the OR contributes to increased medical errors, delayed decision-making and higher turnover rates among perioperative staff. A study published in The Joint Commission Journal on Quality and Patient Safety (2015) found that exposure to rudeness in surgical settings impaired medical team performance and diagnostic accuracy, directly impacting patient safety and care outcomes (Riskin et al., 2015). Burnout, absenteeism, and a revolving door of less experienced staff are the downstream effects. In other words, poor culture leads to poor outcomes, clinical and financial.

Incivility often stems from rigid hierarchies. Surgeons traditionally sit atop this structure, while nurses and scrub techs are expected to “stay in their lane.” When a tech hesitates, they might receive a sharp rebuke. When a nurse raises a concern, they may be dismissed. Over time, this dynamic leads to silence and silence in the OR can be fatal.

Add to this a lack of formal training in emotional intelligence and you have a perfect storm. Surgical training rightly emphasizes technical excellence but often neglects interpersonal communication, empathy and conflict resolution. Without these skills, stress manifests as blame, defensiveness, or disengagement.

Hospital leaders have both the responsibility and the power to reverse this trend. Building a culture of civility and psychological safety in the OR isn’t about making people “nicer”, it’s about making surgical teams stronger.

So how can we lead the change? Invest in emotional intelligence and communication training. Make soft skills part of your hardwired curriculum. Equip OR staff with tools for self-awareness, deescalation, and assertive (not aggressive) communication. These are not “extras”, they are safety measures. Normalize two-way feedback. Structured debriefs after surgeries, where all team members, regardless of title, are encouraged to share observations that foster accountability and trust. This will assist in creating an environment where staffs feel safe to speak up, ask question or report concerns without fear of retaliation. When people feel heard, they engage more fully and perform more effectively. When everyone’s voice matters, everyone’s performance improves. Leadership doesn’t stop at the boardroom. When surgeons, department heads and executives model respect, humility, and accountability, it sets the standard for the entire organization. Normalize equitable accountability. No one should be above a code of professional conduct. Address disrespect consistently, regardless of a staff member’s role or tenure. Civility is not optional, it’s foundational.

Let’s stop viewing civility as a “nice to have.” It’s a patient safety issue. It’s a retention issue. It’s a leadership issue. It’s a human issue.

The future of surgical care doesn’t just depend on sharper tools or faster procedures, it depends on healthier teams. It depends on environments where trust is stronger than ego and where “please” and “thank you” are spoken as often as “scalpel.”