title: Surgeons' leadership in the operating room: an observational study.
abstract: BACKGROUND
  There is widespread recognition in high-risk organizations that leadership is essential for efficient and safe team performance. However, there is limited empiric evidence identifying specific leadership skills and associated behaviors enacted by surgeons during surgery.
  
  
  METHODS
  Observational data on surgeons' intraoperative leadership behaviors were gathered during surgeries (n = 29) in 3 hospitals. Observations were coded using 7 leadership elements identified from the literature on surgeons' leadership. Surgeries were categorized by complexity using British United Provident Association ratings.
  
  
  RESULTS
  A total of 258 leadership behaviors were observed during more than 63 hours of observation. Surgeons most frequently showed guiding and supporting (33%), communicating and coordinating (20%), and task management behaviors (15%). In many instances the surgeons' leadership was directed to the room rather than to a specific team member. Surgeons engaged in leadership behaviors significantly more frequently during cases of high complexity compared with cases of lower complexity.
  
  
  CONCLUSIONS
  This study is the first step in developing an empirically derived taxonomy to identify and classify surgeons' intraoperative leadership behaviors.
authors.affiliation: School of Psychology, University of Aberdeen, Kings College, College of Life Sciences & Medicine, William Guild Building, Aberdeen, Scotland AB24 3FX, UK. sarah.henrickson.parker@gmail.com
authors.forename: Sarah Henrickson
authors.initials: SH
authors.lastname: Parker
authors.forename: Steven
authors.initials: S
authors.lastname: Yule
authors.forename: Rhona
authors.initials: R
authors.lastname: Flin
authors.forename: Aileen
authors.initials: A
authors.lastname: McKinley
mesh_terms: D000328:Adult; D003142:Communication; D003657:Decision Making; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D007857:Leadership; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms; D010348:Patient Care Team / Q000458:organization & administration; D010820:Physicians; D012449:Safety; D012606:Scotland; D013514:Surgical Procedures, Operative; D013647:Task Performance and Analysis