Effective Leadership of Surgical Teams: A Mixed Methods Study of Surgeon Behaviors and Functions
Authors
Stone, JL
Aveling, Emma-Louise
Frean, M
Shields, MC
Wright, C
Gino, F
Sundt, TM
Singer, SJ
Publication Date
2017-08-01Journal Title
Annals of Thoracic Surgery
ISSN
0003-4975
Publisher
Elsevier
Volume
104
Pages
530-537
Language
English
Type
Article
This Version
AM
Metadata
Show full item recordCitation
Stone, J., Aveling, E., Frean, M., Shields, M., Wright, C., Gino, F., Sundt, T., & et al. (2017). Effective Leadership of Surgical Teams: A Mixed Methods Study of Surgeon Behaviors and Functions. Annals of Thoracic Surgery, 104 530-537. https://doi.org/10.1016/j.athoracsur.2017.01.021
Abstract
$\textit{Background.}$ The importance of effective team leadership for achieving surgical excellence is widely accepted, but we understand less about the behaviors that achieve this goal. We studied cardiac surgical teams to identify leadership behaviors that best support surgical teamwork.
$\textit{Methods.}$ We observed, surveyed, and interviewed cardiac surgical teams, including 7 surgeons and 116 team members, from September 2013 to April 2015. We documented 1,926 surgeon/team member interactions during 22 cases, coded them by behavior type and valence (ie, positive/negative/neutral), and characterized them by leadership function (conductor, elucidator, delegator, engagement facilitator, tone setter, being human, and safe space maker) to create a novel framework of surgical leadership derived from direct observation. We surveyed nonsurgeon team members about their perceptions of individual surgeon’s leadership effectiveness on a 7-point Likert scale and correlated survey measures with individual surgeon profiles created by calculating percentage of behavior types, leader functions, and valence.
$\textit{Results.}$ Surgeon leadership was rated by nonsurgeons from 4.2 to 6.2 (mean, 5.4). Among the 33 types of behaviors observed, most interactions constituted elucidating (24%) and tone setting (20%). Overall, 66% of interactions (range, 43%–84%) were positive and 11% (range, 1%–45%) were negative. The percentage of positive and negative behaviors correlated strongly ($r$ = 0.85 for positive and $r$ = 0.75 for negative, $p$ < 0.05) with nonsurgeon evaluations of leadership. Facilitating engagement related most positively ($r$ = 0.80; $p$ = 0.03), and negative forms of elucidating, ie, criticism, related most negatively ($r$ = –0.81; $p$ = 0.03).
$\textit{Conclusions.}$ We identified 7 surgeon leadership functions and related behaviors that impact perceptions of leadership. These observations suggest actionable opportunities to improve team leadership behavior.
Sponsorship
Authors acknowledge funding from CRICO/Risk Management Foundation (#225243), MGH’s Division of Cardiac Surgery, and Wellcome Trust (WT097899M).
Embargo Lift Date
2100-01-01
Identifiers
External DOI: https://doi.org/10.1016/j.athoracsur.2017.01.021
This record's URL: https://www.repository.cam.ac.uk/handle/1810/263150
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