Surgeons’ Leadership Styles and Team Behavior in the Operating Room

Abstract

Background The importance of leadership is recognized in surgery, but the specific impact of leadership style on team behavior is not well understood. In other industries, leadership is a well-characterized construct. One dominant theory proposes that transactional (task-focused) leaders achieve minimum standards, whereas transformational (team-oriented) leaders inspire performance beyond expectations. Study Design We video-recorded 5 surgeons performing complex operations. Each surgeon was scored on the Multifactor Leadership Questionnaire, a validated method for scoring transformational and transactional leadership style, by an organizational psychologist and a surgeon-researcher. Independent coders assessed surgeons' leadership behaviors according to the Surgical Leadership Inventory and team behaviors (information-sharing, cooperative, and voice behaviors). All coders were blinded. Leadership style (MLQ) was correlated with surgeon behavior (SLI) and team behavior using Poisson regression, controlling for time and the total number of behaviors, respectively. Results All surgeons scored similarly on transactional leadership (2.38-2.69), but varied more widely on transformational leadership (1.98-3.60). Each 1-point increase in transformational score corresponded to 3× more information-sharing behaviors (p<0.0001) and 5.4× more voice behaviors (p=0.0005) amongst the team. With each 1-point increase in transformational score, leaders displayed 10× more supportive behaviors (p<0.0001) and 12.5× less frequently displayed poor behaviors (p<0.0001). Excerpts of representative dialogue are included for illustration. Conclusions We provide a framework for evaluating surgeons' leadership and its impact on team performance in the OR. As in other fields, our data suggest that transformational leadership is associated with improved team behavior. Surgeon leadership development therefore has the potential to improve the efficiency and safety of operative care.

Use of standardized letters of recommendation for otolaryngology head and neck surgery residency and the impact of gender

“…It remains unclear why female applicants received higher rankings compared to their male counterparts. Although the virtues of a team‐oriented approach within the operating room have recently been elucidated, a more authoritative, individualized approach to leadership remains more frequently employed by surgeons . Thus, applicants labeled “team players” may not be valued as highly within otolaryngology as well as other surgical fields as individuals described as “leaders.”…”

Development and evaluation of a patient-centred measurement tool for surgeons' non-technical skills

“…These findings contribute to the growing evidence base emphasizing leadership as an important skill for practising surgeons. A recent investigation has found that surgeons desire leadership training and that their leadership can transform team performance. It is now clear that patients can detect surgeons' leadership behaviours and think they are important.…”

“…The results show that patients' evaluations of non‐technical skills add meaningfully to their overall evaluation of service quality and are independent of evaluations of surgeons' empathy, a concept that also has a positive impact on patient satisfaction ratings. These findings contribute to the growing evidence base emphasizing leadership as an important skill for practising surgeons. A recent investigation has found that surgeons desire leadership training and that their leadership can transform team performance.…”

Managerial Decision-making for Daily Case Allocation Scheduling and the Impact on Perioperative Quality Assurance

“…This includes the ability to set goals for and with staff under their domain and in other departments and the skills to work cooperatively and collaboratively with others. (35)(36)(37) Under the leadership of an experienced shift supervisor with skill in identifying and utilizing resources and allocating tasks to appropriate members of various departments, a hospital's senior management team can focus on the target task management and smooth operation of the ORs on an ongoing basis.…”