A Strategic Core Role Perspective on Team Coordination: Benefits of Centralized Leadership for Managing Task Complexity in the Operating Room

Abstract

Objective We examine whether surgical teams can handle changes in task requirements better when their formal leader and strategic core role holder—that is, the main surgeon—is central to team coordination. Background Evidence regarding the benefits of shared leadership for managing complex tasks is divided. We tested whether a strategic core role holder’s centrality in team coordination helps teams to handle different types of task complexity. Method We observed coordination as specific leadership behavior in 30 surgical teams during real-life operations. To assess the strategic core role holder’s coordination centrality, we conducted social network analyses. Task complexity (i.e., surgical difficulty and unexpected events) and surgical goal attainment were rated in a questionnaire. Results In the critical operation phase, surgical difficulty impaired goal attainment when the strategic core role holder’s coordination centrality was low, while this effect was nonsignificant when his/her coordination centrality was high. Unexpected events had a negative effect on surgical goal attainment. However, coordination centrality of the strategic core role holder could not help manage unexpected events. Conclusion The results indicate that shared leadership is not beneficial when teams face surgical difficulty during the critical operation phase. In this situation, team coordination should rather be centralized around the strategic core role holder. Contrarily, when unexpected events occur, centralizing team coordination around a single leader does not seem to be beneficial for goal attainment. Application Leaders and team members should be aware of the importance of distributing leadership differently when it comes to managing different types of task complexity.

Interprofessional teamwork for managing medical deterioration in pregnancy: what contributes to good clinical performance in simulated practice?

“…The findings are supported by research in surgical teams, which found that shared leadership was effective during certain phases of surgery and not beneficial at other times. 22 In this study, the type of leadership behaviour in the opening minutes of the scenario was critical to the subsequent teamwork, and to the effective performance of that team. Although effect sizes were small to medium, they are in line with those expected in a study of this nature.…”

“…20 21 Observational analysis of leadership behaviours of surgical teams during actual operations revealed that, during more complex phases of an operation, having one central clear leader rather than shared leadership resulted in better attainment of team goals. 22 This study is to our knowledge the first to conduct a detailed analysis of teamwork behaviour over time, during simulated medical deterioration due to medical conditions in pregnant women. Simulated practice is a promising avenue for research, which has been under used to date.…”

The room where it happens: The impact of core and non-core roles on surgical team performance.

“…In agreement with prior conceptualizations, we operationalized the surgeon as the core and the other surgical roles (i.e., anesthesia provider, scrub technician, circulator nurse) as the non-core (cf. Bolinger et al, 2018; Humphrey & Aime, 2014; Mathieu et al, 2014; Pasarakonda et al, 2020). In our sample, the core was occupied by 72 different individuals and the non-core was occupied by 93 different individuals.…”

“One Size Does Not Fit All”: Revisiting Team Feedback Theories From a Cultural Dimensions Perspective

“…However, we expect the negative influence of dominant members to be attenuated under high time constraints (P14). Although stringent time constraints generally inhibit complex information processing in tasks demanding creative problem-solving and decision-making (Mohammed & Harrison, 2013), narrowing control over decision-making and coordination to a few team members may be an effective strategy (Pasarakonda et al, in press). For example, under more stringent time constraints (e.g., during emergencies), when quick decisive action is vital, teams (e.g., surgery teams) could benefit from quick decisive actions taken by only a few people without impairing decision-making quality, compared with conditions under low time constraints.…”