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Surgeons' Leadership Styles and Team Behavior in the Operating Room.
J Am Coll Surg. 2016 Jan; 222(1):41-51.JA

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 and transformational (team-oriented) leaders inspire performance beyond expectations.

STUDY DESIGN

We videorecorded 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 (Multifactor Leadership Questionnaire) was correlated with surgeon behavior (Surgical Leadership Inventory) and team behavior using Poisson regression, controlling for time and the total number of behaviors, respectively.

RESULTS

All surgeons scored similarly on transactional leadership (range 2.38 to 2.69), but varied more widely on transformational leadership (range 1.98 to 3.60). Each 1-point increase in transformational score corresponded to 3 times more information-sharing behaviors (p < 0.0001) and 5.4 times more voice behaviors (p = 0.0005) among the team. With each 1-point increase in transformational score, leaders displayed 10 times more supportive behaviors (p < 0.0001) and displayed poor behaviors 12.5 times less frequently (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 operating room. 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.

Links

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Authors+Show Affiliations

Hu YY
Center for Surgery and Public Health, Brigham & Women's Hospital, Boston, MA; Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA. Electronic address: yhu@connecticutchildrens.org.
Parker SH
National Center for Human Factors Engineering in Healthcare, MedStar Institute for Innovation, MedStar Health, Washington, DC.
Lipsitz SR
Center for Surgery and Public Health, Brigham & Women's Hospital, Boston, MA.
Arriaga AF
Center for Surgery and Public Health, Brigham & Women's Hospital, Boston, MA; Department of Anesthesiology, Brigham & Women's Hospital, Boston, MA; Department of Anesthesiology and Critical Care, University of Pennsylvania Health System, Philadelphia, PA.
Peyre SE
Center for Surgery and Public Health, Brigham & Women's Hospital, Boston, MA; STRATUS Center for Medical Simulation, Department of Surgery, Brigham & Women's Hospital, Boston, MA; Department of Surgery, University of Rochester, Rochester, NY.
Corso KA
Center for Surgery and Public Health, Brigham & Women's Hospital, Boston, MA.
Roth EM
Roth Cognitive Engineering, Stanford, CA.
Yule SJ
Center for Surgery and Public Health, Brigham & Women's Hospital, Boston, MA; STRATUS Center for Medical Simulation, Department of Surgery, Brigham & Women's Hospital, Boston, MA.
Greenberg CC
Center for Surgery and Public Health, Brigham & Women's Hospital, Boston, MA; Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, WI.

MeSH

HumansLeadershipObserver VariationOperating RoomsPatient Care TeamPatient SafetyPoisson DistributionSurgeonsSurveys and QuestionnairesVideo Recording

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26481409

Citation

Hu, Yue-Yung, et al. "Surgeons' Leadership Styles and Team Behavior in the Operating Room." Journal of the American College of Surgeons, vol. 222, no. 1, 2016, pp. 41-51.
Hu YY, Parker SH, Lipsitz SR, et al. Surgeons' Leadership Styles and Team Behavior in the Operating Room. J Am Coll Surg. 2016;222(1):41-51.
Hu, Y. Y., Parker, S. H., Lipsitz, S. R., Arriaga, A. F., Peyre, S. E., Corso, K. A., Roth, E. M., Yule, S. J., & Greenberg, C. C. (2016). Surgeons' Leadership Styles and Team Behavior in the Operating Room. Journal of the American College of Surgeons, 222(1), 41-51. https://doi.org/10.1016/j.jamcollsurg.2015.09.013
Hu YY, et al. Surgeons' Leadership Styles and Team Behavior in the Operating Room. J Am Coll Surg. 2016;222(1):41-51. PubMed PMID: 26481409.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgeons' Leadership Styles and Team Behavior in the Operating Room. AU - Hu,Yue-Yung, AU - Parker,Sarah Henrickson, AU - Lipsitz,Stuart R, AU - Arriaga,Alexander F, AU - Peyre,Sarah E, AU - Corso,Katherine A, AU - Roth,Emilie M, AU - Yule,Steven J, AU - Greenberg,Caprice C, Y1 - 2015/10/17/ PY - 2015/07/17/received PY - 2015/09/16/revised PY - 2015/09/21/accepted PY - 2015/10/21/entrez PY - 2015/10/21/pubmed PY - 2016/5/3/medline SP - 41 EP - 51 JF - Journal of the American College of Surgeons JO - J Am Coll Surg VL - 222 IS - 1 N2 - 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 and transformational (team-oriented) leaders inspire performance beyond expectations. STUDY DESIGN: We videorecorded 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 (Multifactor Leadership Questionnaire) was correlated with surgeon behavior (Surgical Leadership Inventory) and team behavior using Poisson regression, controlling for time and the total number of behaviors, respectively. RESULTS: All surgeons scored similarly on transactional leadership (range 2.38 to 2.69), but varied more widely on transformational leadership (range 1.98 to 3.60). Each 1-point increase in transformational score corresponded to 3 times more information-sharing behaviors (p < 0.0001) and 5.4 times more voice behaviors (p = 0.0005) among the team. With each 1-point increase in transformational score, leaders displayed 10 times more supportive behaviors (p < 0.0001) and displayed poor behaviors 12.5 times less frequently (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 operating room. 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. SN - 1879-1190 UR - https://www.unboundmedicine.com/medline/citation/26481409/Surgeons'_Leadership_Styles_and_Team_Behavior_in_the_Operating_Room_ DB - PRIME DP - Unbound Medicine ER -