Surgeons' leadership in the operating room: an observational study

doi:10.1016/j.amjsurg.2011.03.009

The American Journal of Surgery

Volume 204, Issue 3, September 2012, Pages 347-354

https://doi.org/10.1016/j.amjsurg.2011.03.009 Get rights and content

Abstract

Background

There is widespread recognition in high-risk organizations that leadership is essential for efficient and safe team performance. However, there is limited empiric evidence identifying specific leadership skills and associated behaviors enacted by surgeons during surgery.

Methods

Observational data on surgeons' intraoperative leadership behaviors were gathered during surgeries (n = 29) in 3 hospitals. Observations were coded using 7 leadership elements identified from the literature on surgeons' leadership. Surgeries were categorized by complexity using British United Provident Association ratings.

Results

A total of 258 leadership behaviors were observed during more than 63 hours of observation. Surgeons most frequently showed guiding and supporting (33%), communicating and coordinating (20%), and task management behaviors (15%). In many instances the surgeons' leadership was directed to the room rather than to a specific team member. Surgeons engaged in leadership behaviors significantly more frequently during cases of high complexity compared with cases of lower complexity.

Conclusions

This study is the first step in developing an empirically derived taxonomy to identify and classify surgeons' intraoperative leadership behaviors.

Section snippets

Materials and Methods

This study was approved by the North of Scotland Research Ethics Committee.

Results

The results of this study are presented in 2 sections. The first examines surgeons' leadership behaviors relating to complexity of the surgery and the second offers a description and analysis of surgeons' intraoperative leadership behaviors.

Comments

The goals of this study were to identify and categorize surgeons' leadership behaviors in the OR and compare leadership in higher- versus lower-complexity surgeries. We found the 7-element leadership taxonomy a reliable method of coding observed behaviors and there was a statistically significant increase in the number of leadership behaviors observed during more complex surgeries, in line with our hypothesis. This study did not attempt to link leadership directly to any patient outcomes or

Acknowledgment

This work was funded by the Scottish Funding Council Strategic Research Development Grant to the Scottish Patient Safety Research Network.

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Physician leadershipSurgeons' leadership in the operating room: an observational study

Abstract

Background

Methods

Results

Conclusions

Section snippets

Materials and Methods

Results

Comments

Acknowledgment

Leadership Quarterly

Surgery

Am J Surg

Saf Sci

Surgery

Surgeon

Leadership Quarterly

Saf Sci

Leadership Quarterly

Leadership Quarterly

The Leadership and Management of Surgical Teams

Good Medical Practice

Development of a rating system for surgeons' non-technical skills

Med Educ

Leadership in Organizations

Team Leadership and Development: Theory, Principles, and Guidelines for Training Leaders and Teams

On error management: lessons from aviation

BMJ

Surgeons' non-technical skills in the operating room: reliability testing of the NOTSS behavior rating system

World J Surg

The Oxford NOTECHS System: reliability and validity of a tool for measuring teamwork behaviour in the operating theatre

BMJ Qual Safe

Safer. Surgery: Analysing Behaviour in the Operating Theatre

Development and test of a model linking safety-specific transformational leadership and occupational safety

J Appl Psychol

Safety-related behavior as a social exchange: the role of perceived organizational support and leader-member exchange

J Appl Psychol

Physician leadership
Surgeons' leadership in the operating room: an observational study