Surgeons' leadership in the operating room

The operating room (OR) is an area of particularly high risk for patients, due to technical and non-technical issues. Research in other high-risk industries has shown that leadership can impact safety and performance of work teams. As the leader of the surgical team, surgeons must demonstrate leadership along with technical excellence, to optimize performance and maximize patient safety in the OR. This thesis investigated surgeons’ leadership in the intraoperative period. A review of the surgical literature revealed ten empirical articles examining surgeon leadership. Of these, two articles linked leadership was an outcome measure. A preliminary taxonomy that included seven elements of leadership was developed based on definitions of leadership from the literature. To further investigate intraoperative leadership, observations (n=29) were conducted in three hospitals in Scotland across different types of surgery. Leadership was described in detail according to the leadership elements. Surgeons engaged in significantly more leadership during more complex operations. Ten focus groups with different members of the OR team were conducted to finalize the taxonomy. The final taxonomy, the Surgeons’ Leadership Inventory (SLI), was revised to include eight elements: maintaining standards making decisions, managing resources, directing, training, communicating, supporting others, and coping with pressure. The SLI was used with adequate reliability to code videos (n=29) of live operations. Elements of surgeons’ leadership differed before and after the surgical point of no return. Analysis revealed differences in training and supporting others behaviours in cases with an unexpected event. The element coping with pressure was significantly related to intraoperative blood loss. Surgeons’ intraoperative leadership was found to be reactive, situation based, and often transactional in nature. This thesis provides a first step in identifying the important behaviours and a basis on which improving surgeons’ intraoperative leadership may be made.EThOS - Electronic Theses Online ServiceGBUnited Kingdo