Surgeons' Leadership Styles and Team Behavior in the Operating Room.
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.


METHODS
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.
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.
Yue-Yung
YY
Hu
National Center for Human Factors Engineering in Healthcare, MedStar Institute for Innovation, MedStar Health, Washington, DC.
Sarah Henrickson
SH
Parker
Center for Surgery and Public Health, Brigham & Women's Hospital, Boston, MA.
Stuart R
SR
Lipsitz
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.
Alexander F
AF
Arriaga
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.
Sarah E
SE
Peyre
Center for Surgery and Public Health, Brigham & Women's Hospital, Boston, MA.
Katherine A
KA
Corso
Roth Cognitive Engineering, Stanford, CA.
Emilie M
EM
Roth
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.
Steven J
SJ
Yule
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.
Caprice C
CC
Greenberg
D006801:Humans; D007857:Leadership; D015588:Observer Variation; D009873:Operating Rooms / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration*; D061214:Patient Safety; D016012:Poisson Distribution; D066231:Surgeons / Q000458:organization & administration / Q000523:psychology*; D011795:Surveys and Questionnaires; D014741:Video Recording