Background: There is widespread recognition that non-technical skills, including leadership, are essential for an effective, efficient and safe team performance. However, the empirical literature on specific skills required for effective leadership within the intraoperative setting is limited and inconclusive. Method: Observations (n = 23 operations) were conducted in operating rooms (OR) from three teaching hospitals in Scotland to gather data on intraoperative leadership behaviours. This analysis focused on the role of the lead surgeon. These were coded according to a task- and team-oriented structure, using seven leadership constructs identified in the surgical literature. Results: Leadership behaviours were categorised with acceptable inter-rater reliability. The analysis showed that as intraoperative leaders, surgeons exhibited both task- and team-oriented behaviours. They most frequently engaged in team-oriented leadership behaviours, namely ‘guiding and supporting’ followed by ‘communication and coordination’ behaviours. Discussion: This study is the first step in developing an empirically derived scale to measure and evaluate surgeons' intraoperative leadership. Future studies will investigate the relationship between the leadership behaviours identified here, team performance, and patient safety outcomes. Better understanding of intraoperative leadership can lead to improved surgical team performance, which could impact patient safety in the operating room.
