Surgeons’ Leadership Style and Team Behavior in the Hybrid Operating Room

Abstract

Objective: This study aimed to assess the relationship between surgeons’ leadership style and team behavior in the hybrid operating room through video coding. Secondly, possible fluctuations possible fluctuations in leadership styles and team behavior during operative phases were studied. Background: Leadership is recognized as a key component to successful team functioning in high-risk industries. The ‘full range of leadership’ theory is commonly used to evaluate leadership, marking transformational, transactional, and passive. Few studies have examined the effects of these leadership styles on team behavior in surgery and/or their fluctuations during surgery. Methods: A single-center study included patients planned for routine endovascular procedures. A medical data capture system was used to allow post hoc video coding through Behavior Anchored Rating Scales. Multilevel statistical analysis was performed to assess possible correlations between leadership style and 3 team behavior indicators (speaking up, knowledge sharing, and collaboration) on an operative phase level. Results: Twenty-two cases were analyzed (47 hours recording). Transformational leadership is positively related to the extent to which team members work together (γ=0.20, P<0.001), share knowledge (γ=0.45, P<0.001), and speak up (γ=0.64, P<0.001). Passive leadership is significantly positively correlated with speaking up (γ=0.29, P=0.004). Leadership style and team behavior clearly fluctuate during a procedure, with similar patterns across different types of endovascular procedures. Conclusions: Consistent with other professional fields, surgeons’ transformational leadership enhances team behavior, especially during the most complex operative phases. This suggests that encouraging surgeons to learn and actively implement a transformational leadership style is meaningful to enhance patient safety and team performance.

Using the Operating Room Black Box to Assess Surgical Team Member Adaptation Under Uncertainty

“…To compare how roles adapted during instances of uncertainty associated with and without IAEs, the frequency of skills expressed was calculated 18 ; teamwork skills associated with an IAE were normalized by the sum of IAE durations whereas skills with “no IAE” were normalized by the sum of no-IAE durations. The frequency of teamwork skills per hour was analyzed in a 6 level (teamwork skill: 1: backup behavior vs 2: coordination vs 3: psychological safety vs 4: situation assessment and shared mental models vs 5: team decision-making and planning vs 6: team leadership) × 4 (role: 1: nurses vs 2: anesthetists vs 3: surgeons vs 4: trainees) × 2 (associated with IAE: no vs yes) mixed factors analysis of variance with repeated measures on the first 2 factors.…”

“…This variation in leadership skill is consistent with recent research that a surgeon's overall leadership style (eg, transformative vs transactional vs passive) fluctuates within an operation in response to context (eg, surgical phase). 18 Although most successful leaders modify their style to meet circumstances, this adaptation may be less intuitive for some new surgeons who could benefit from explicit mentorship and formal training in adaptive leadership. 29…”

“…For example, a recent study used the OR Black Box (ORBB), a multisource data and audio/video-recording platform, to reveal how surgeons' leadership styles fluctuated by operative phase. 18 There have been calls to use innovative methods to better understand the complexity of adaptative surgical teamwork by identifying and analyzing patterns of behavior by team member role and context (eg, uncertainty) to enhance teamwork skills and training resources. 6,17 We sought to use the ORBB to identify the frequency and distribution of teamwork skills exhibited by surgical roles during instances of uncertainty.…”

“…While existing research has provided little insight into these critical temporal and contextual adaptations, there is emerging evidence that innovative methods can help fill this gap. For example, a recent study used the OR Black Box (ORBB), a multisource data and audio/video-recording platform, to reveal how surgeons’ leadership styles fluctuated by operative phase 18 . There have been calls to use innovative methods to better understand the complexity of adaptative surgical teamwork by identifying and analyzing patterns of behavior by team member role and context (eg, uncertainty) to enhance teamwork skills and training resources 6,17 .…”

Multicentric Study on the Relation between Perceived Department Radiation Shielding Policies and Staff Radiation Shielding Conscientiousness

“…In spite of growing literature on safety conscientiousness, there is still a void of empirical evidence of PPE conscientiousness and its potential relation with the perceived PPE program. Prior safety research in multiple technological environments has revealed a positive association between an increased perception of safety policy by the employees and their safety conscientiousness (De Boeck et al 2017; Doyen et al 2020a and b; Soenens et al 2023). Accordingly, in this study we investigate as a first hypothesis if a similar positive association holds in the area of radiation shielding.…”