Using Videos to Determine the Effect of Stage of Operation and Intraoperative Events on Surgeons’ Intraoperative Leadership

Abstract

Background Leadership is a key component for the successful functioning of teams and the achievement of task goals. During the intraoperative phase of surgery, the attending surgeon can be likened to a team leader with responsibility for task accomplishment by a small team. This study identified and evaluated surgeons’ leadership behaviors during operations, with particular reference to any changes that occurred following two types of events. Method Videos of live operations (n=29) from the operating rooms of three teaching hospitals in the UK were analyzed to identify and code surgeons’ intraoperative leadership behaviors using the Surgeons’ Leadership Inventory (SLI). The frequency and quality of the leadership behaviors were compared before and after the point of no return (PONR) (n=24) and before and after an unexpected intraoperative event (n=5). Results Most leadership behaviors were directed toward the resident during an operation. No significant differences were found for the overall frequency or quality of leadership behaviors pre- and post-PONR. The frequency of leadership behaviors classified as ‘training’ and ‘Supporting others’ significantly decreased after an unanticipated intraoperative event. Discussion This study provides a detailed description of surgeons’ intraoperative leadership during different types of operative situations and stages. During the intraoperative period, the attending surgeon seemed to lead the surgical trainee almost exclusively, and not other members of the operative team. Leadership was highly focused on the surgical task.