title: Factors influencing surgeons' intraoperative leadership: video analysis of unanticipated events in the operating room.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: School of Psychology, University of Aberdeen, Aberdeen, UK, sarah.henrickson.parker@gmail.com.
authors.forename: Sarah Henrickson
authors.initials: SH
authors.lastname: Parker
authors.forename: Rhona
authors.initials: R
authors.lastname: Flin
authors.forename: Aileen
authors.initials: A
authors.lastname: McKinley
authors.forename: Steven
authors.initials: S
authors.lastname: Yule
mesh_terms: D013502:General Surgery / Q000592:standards*; D006801:Humans; D007432:Intraoperative Period; D007857:Leadership; D009873:Operating Rooms; D014741:Video Recording