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Published in: World Journal of Surgery 1/2014

01-01-2014

Factors Influencing Surgeons’ Intraoperative Leadership: Video Analysis of Unanticipated Events in the Operating Room

Authors: Sarah Henrickson Parker, Rhona Flin, Aileen McKinley, Steven Yule

Published in: World Journal of Surgery | Issue 1/2014

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Abstract

Background

The achievement of surgical goals and the successful functioning of operating room (OR) teams are dependent on leadership. The attending surgeon is a team leader during an operation, with responsibility for task accomplishment by the clinical team. This study examined surgeons’ leadership behaviors during surgical procedures, with particular reference to the effect of intraoperative events on leadership.

Methods

Videos of operations (n = 29) recorded at three UK teaching hospitals were analyzed to identify and classify surgeons’ intraoperative leadership behaviors using the Surgeons’ Leadership Inventory. The frequency and type of leadership behaviors were compared before and after the point of no return (PONR) (n = 24), and during an unexpected intraoperative event (n = 5).

Results

Most of the surgeons’ leadership behaviors were directed toward the resident during an operation. No significant differences were found for the overall number or type of leadership behaviors pre- and post-PONR. The frequency of leadership behaviors classified as “Training” and “Supporting others” significantly decreased during an unanticipated intraoperative event.

Discussion

Overall, surgeons engaged in the same leadership behaviors throughout the course of an operation unless they were dealing with an unanticipated event. Surgeons appeared to adopt a “one size fits all” leadership style approach regardless of the team or situation. Additionally, surgeons seemed to limit their intraoperative leadership focus to other surgeons rather than to the wider OR team.
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Literature
1.
go back to reference Kozlowski SWJ, Gully SM, Salas E et al (1996) Team leadership and development: theory, principles, and guidelines for training leaders and teams. In: Beyerlein M (ed) Advances in interdisciplinary studies of work teams: team leadership, vol. 3. Elsevier, New York, pp 253–291 Kozlowski SWJ, Gully SM, Salas E et al (1996) Team leadership and development: theory, principles, and guidelines for training leaders and teams. In: Beyerlein M (ed) Advances in interdisciplinary studies of work teams: team leadership, vol. 3. Elsevier, New York, pp 253–291
2.
go back to reference Zaccaro SJ, Rittman AL, Marks MA (2001) Team leadership. Leadersh Q 12:451–483CrossRef Zaccaro SJ, Rittman AL, Marks MA (2001) Team leadership. Leadersh Q 12:451–483CrossRef
3.
go back to reference Lim B, Ployhart RE (2004) Transformational leadership: relations to the five-factor model and team performance in typical and maximum contexts. J Appl Psychol 89:610–621PubMedCrossRef Lim B, Ployhart RE (2004) Transformational leadership: relations to the five-factor model and team performance in typical and maximum contexts. J Appl Psychol 89:610–621PubMedCrossRef
4.
go back to reference Parker SH, Yule S, Flin R et al (2011) Towards a model of surgeons’ leadership in the operating room. BMJ Qual Saf 20:570–579CrossRef Parker SH, Yule S, Flin R et al (2011) Towards a model of surgeons’ leadership in the operating room. BMJ Qual Saf 20:570–579CrossRef
5.
go back to reference Parker SH, Yule S, Flin R et al (2012) Surgeons’ leadership in the operating room: an observational study. Am J Surg 204:347–354PubMedCrossRef Parker SH, Yule S, Flin R et al (2012) Surgeons’ leadership in the operating room: an observational study. Am J Surg 204:347–354PubMedCrossRef
6.
go back to reference Kunzle B, Kolbe M, Grote G (2010) Ensuring patient safety through effective leadership behaviour: a literature review. Saf Sci 48:1–17CrossRef Kunzle B, Kolbe M, Grote G (2010) Ensuring patient safety through effective leadership behaviour: a literature review. Saf Sci 48:1–17CrossRef
7.
go back to reference Mishra A, Catchpole K, Dale T et al (2008) The influence of non-technical performance on technical outcome in laparoscopic cholecystectomy. Surg Endosc 22:68–73PubMedCrossRef Mishra A, Catchpole K, Dale T et al (2008) The influence of non-technical performance on technical outcome in laparoscopic cholecystectomy. Surg Endosc 22:68–73PubMedCrossRef
8.
go back to reference Halverson AL, Walsh DS et al (2012) Leadership skills in the OR part 1: communication helps surgeons avoid pitfalls. Bull Am Coll Surg 97:8–13PubMed Halverson AL, Walsh DS et al (2012) Leadership skills in the OR part 1: communication helps surgeons avoid pitfalls. Bull Am Coll Surg 97:8–13PubMed
9.
go back to reference Tschan F, Semmer NK, Vaetterli M et al (2011) Developing observational categories from group process research based on task and coordination requirement analysis: examples from research on medical emergency-driven teams. In: Boos M, Kolbe M, Kappeler P, Ellwart T (eds) Coordination in human and primate groups. Springer, London, pp 93–115CrossRef Tschan F, Semmer NK, Vaetterli M et al (2011) Developing observational categories from group process research based on task and coordination requirement analysis: examples from research on medical emergency-driven teams. In: Boos M, Kolbe M, Kappeler P, Ellwart T (eds) Coordination in human and primate groups. Springer, London, pp 93–115CrossRef
10.
go back to reference Kunzle B, Zala-Mezo E, Wacker J et al (2010) Leadership in anaesthesia teams: the most effective leadership is shared. BMJ Qual Saf 19:1–6 Kunzle B, Zala-Mezo E, Wacker J et al (2010) Leadership in anaesthesia teams: the most effective leadership is shared. BMJ Qual Saf 19:1–6
11.
go back to reference Orasanu J (1993) Decision-making in the cockpit. In: Weiner E, Kanki B, Helmreich RL (eds) Cockpit resource management. Academic Press, London, pp 137–168 Orasanu J (1993) Decision-making in the cockpit. In: Weiner E, Kanki B, Helmreich RL (eds) Cockpit resource management. Academic Press, London, pp 137–168
12.
go back to reference Flin R (1996) Sitting in the hot seat: leadership for critical incidents. Wiley, London Flin R (1996) Sitting in the hot seat: leadership for critical incidents. Wiley, London
13.
go back to reference La Porte T, Consolini P (1998) Theoretical and operational challenges of “high reliability organizations”: air-traffic control and aircraft carriers. Int J Public Admin 21:847–852CrossRef La Porte T, Consolini P (1998) Theoretical and operational challenges of “high reliability organizations”: air-traffic control and aircraft carriers. Int J Public Admin 21:847–852CrossRef
14.
go back to reference Sjoberg M, Wallenius C, Larsson G (2006) Leadership in complex, stressful rescue operations: a qualitative study. Disaster Prev Manag 15:576–584CrossRef Sjoberg M, Wallenius C, Larsson G (2006) Leadership in complex, stressful rescue operations: a qualitative study. Disaster Prev Manag 15:576–584CrossRef
15.
go back to reference Yukl G, Van Fleet DD (1982) Cross-situational, multimethod research on military leader effectiveness. Organ Behav Hum Perform 30:87–108CrossRef Yukl G, Van Fleet DD (1982) Cross-situational, multimethod research on military leader effectiveness. Organ Behav Hum Perform 30:87–108CrossRef
16.
go back to reference Crossley J, Marriott J, Purdie H et al (2011) Prospective observational study to evaluate NOTSS (non-technical skills for surgeons) for assessing trainees’ non-technical performance in the operating theatre. Br J Surg 98:1010–1020PubMedCrossRef Crossley J, Marriott J, Purdie H et al (2011) Prospective observational study to evaluate NOTSS (non-technical skills for surgeons) for assessing trainees’ non-technical performance in the operating theatre. Br J Surg 98:1010–1020PubMedCrossRef
17.
go back to reference Weinger M, Slagel J (2002) Human factors research in anesthesia patient safety: techniques to elucidate factors affecting clinical task performance and decision making. J Am Med Informat Assoc 9(suppl):58–63CrossRef Weinger M, Slagel J (2002) Human factors research in anesthesia patient safety: techniques to elucidate factors affecting clinical task performance and decision making. J Am Med Informat Assoc 9(suppl):58–63CrossRef
18.
go back to reference Henrickson Parker SE, Flin R, McKinley AM et al (2012) The Surgeons’ Leadership Inventory (SLI): a taxonomy and rating system for surgeons’ intraoperative leadership skills. Am J Surg 205:745–751PubMedCrossRef Henrickson Parker SE, Flin R, McKinley AM et al (2012) The Surgeons’ Leadership Inventory (SLI): a taxonomy and rating system for surgeons’ intraoperative leadership skills. Am J Surg 205:745–751PubMedCrossRef
19.
go back to reference Yukl G (2002) Leadership in organizations, 5th edn. Prentice Hall, Upper Saddle River Yukl G (2002) Leadership in organizations, 5th edn. Prentice Hall, Upper Saddle River
20.
go back to reference Fletcher G, Flin R, McGeorge M et al (2003) Anaesthetists’ non-technical skills (ANTS): evaluation of a behavioural marker system. Br J Anaesth 90:580–588PubMedCrossRef Fletcher G, Flin R, McGeorge M et al (2003) Anaesthetists’ non-technical skills (ANTS): evaluation of a behavioural marker system. Br J Anaesth 90:580–588PubMedCrossRef
21.
go back to reference Yule S, Flin R, Paterson-Brown S et al (2006) Development of a rating system for surgeons’ non-technical skills. Med Educ 40:1098–1104PubMedCrossRef Yule S, Flin R, Paterson-Brown S et al (2006) Development of a rating system for surgeons’ non-technical skills. Med Educ 40:1098–1104PubMedCrossRef
22.
go back to reference Mitchell L (2008) The non-technical skills of theatre nurses. J Perioper Pract 18:378–379PubMed Mitchell L (2008) The non-technical skills of theatre nurses. J Perioper Pract 18:378–379PubMed
23.
go back to reference Bass BM, Avolio BJ, Jung DI et al (2003) Predicting unit performance by assessing transformational and transactional leadership. J Appl Psychol 88:207–218PubMedCrossRef Bass BM, Avolio BJ, Jung DI et al (2003) Predicting unit performance by assessing transformational and transactional leadership. J Appl Psychol 88:207–218PubMedCrossRef
24.
go back to reference Halverson SK, Murphy SE, Riggio RE (2004) Charismatic leadership in crisis situations: a laboratory investigation of stress and crisis. Small Group Res 35:495–514CrossRef Halverson SK, Murphy SE, Riggio RE (2004) Charismatic leadership in crisis situations: a laboratory investigation of stress and crisis. Small Group Res 35:495–514CrossRef
25.
go back to reference Edmonson A (2003) Speaking up in the operating room: how team leaders promote learning in interdisciplinary teams. J Manag Stud 40:1419–1452CrossRef Edmonson A (2003) Speaking up in the operating room: how team leaders promote learning in interdisciplinary teams. J Manag Stud 40:1419–1452CrossRef
26.
go back to reference Ginnett R (1993) Crews as groups: their formation and their leadership. In: Weiner E, Kanki B, Helmreich RL (eds) Cockpit resource management. Academic Press, London, pp 71–97 Ginnett R (1993) Crews as groups: their formation and their leadership. In: Weiner E, Kanki B, Helmreich RL (eds) Cockpit resource management. Academic Press, London, pp 71–97
27.
go back to reference Xiao Y, Mackenzie CF (2004) Introduction to the special issue on video-based research in high risk settings: methodology and experience. Cogn Tech Work 6:127–130 Xiao Y, Mackenzie CF (2004) Introduction to the special issue on video-based research in high risk settings: methodology and experience. Cogn Tech Work 6:127–130
28.
go back to reference Wadhera RK, Henrickson Parker SE, Burkhart H et al (2010) Is the “sterile cockpit” concept applicable to cardiovascular surgery: critical intervals or critical events? The impact of protocol-driven communication during cardiopulmonary bypass. J Thorac Cardiovasc Surg 139:312–319PubMedCrossRef Wadhera RK, Henrickson Parker SE, Burkhart H et al (2010) Is the “sterile cockpit” concept applicable to cardiovascular surgery: critical intervals or critical events? The impact of protocol-driven communication during cardiopulmonary bypass. J Thorac Cardiovasc Surg 139:312–319PubMedCrossRef
Metadata
Title
Factors Influencing Surgeons’ Intraoperative Leadership: Video Analysis of Unanticipated Events in the Operating Room
Authors
Sarah Henrickson Parker
Rhona Flin
Aileen McKinley
Steven Yule
Publication date
01-01-2014
Publisher
Springer US
Published in
World Journal of Surgery / Issue 1/2014
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-013-2241-0

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