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Leadership Lessons From KHSC’s Operating Rooms

Leadership Lessons From KHSC’s Operating Rooms

Guest blog by Dr. Darren Beiko, Associate Professor, Department of Urology, and Dr. Julian Barling, Borden Chair of Leadership, Smith School of Business

Leadership defined.

The late Warren Bennis, leadership guru and USC business school professor, once said “To an extent, leadership is like beauty; it’s hard to define but you know it when you see it.” And this applies equally to both positive and negative leadership behaviours. Many people struggle to craft a categorical and precise definition of leadership (ourselves included), yet those of us working in operating room (OR) environments have all been exposed to the very best, and sometime worst, of leadership. But have we truly considered the potential consequences of leadership in the OR?

Leadership affects team performance in the OR.

There is mounting evidence that leadership behaviours affect performance of the OR team. In our recent American Journal of Surgery article, we studied both positive (transformational) as well as three negative (over-controlling, laissez-faire and abusive supervision) forms of leadership. Our analyses showed that negative leadership behaviours tended to override the effects of positive leadership on the performance of the OR team, including psychological safety.

Leadership impacts patient outcomes.

Patient outcomes – really? Yes. Our most recent analyses suggest that surgeon involvement with surgical team members, together with surgeon elevation of team members, contributed to higher surgical team psychological safety, which in turn predicted better patient outcomes, particularly for complex operations. Perhaps even more importantly, a recent quantitative systematic review showed that leadership training positively impacts patient safety and patient outcomes in acute hospital settings. And we expect further evidence to emerge in the literature.

Shared leadership: it’s not just about the surgeon.

Although our initial publication in the American Journal of Surgery focused on the effect of leadership behaviours of surgeons on team performance, we also studied the same leadership behaviours enacted by nurses, anesthesiologists and surgeons in the OR. Anyone who works in the OR knows only too well that nurses, anesthesiologists and surgeons function as leaders in the OR, hence the need to study all these OR healthcare professionals in a shared (or distributed) model of leadership. However, our findings showed that surgeons enacted both positive and negative leadership behaviours more frequently than anesthesiologists and nurses. Thus, leadership is not yet equally shared in the OR, pointing to the importance of the cultural changes that will be necessary before a shared leadership model can become a reality.

“Leadership skills” vs. “scalpel skills”?

Taking everything into consideration in the OR, how important is leadership? Earlier this year, The Globe and Mail printed an article entitled “For surgeons, their leadership style can be as important as their scalpel skills”. Catchy title? Sure. True? Not so sure. The Globe’s story was based our American Journal of Surgery article which reported initial findings from our research in the ORs at Kingston General Hospital (KGH). Our research team studied the leadership interactions and communication among OR nurses, anesthesiologists and surgeons, including interpersonal and team behaviours, during 150 live operations. Despite The Globe’s eye-catching title, not for a moment are we suggesting that positive leadership could ever compensate for the technical scalpel skills necessary to safely and proficiently perform complex surgical operations. At the same time, high quality leadership during complex surgeries could enhance team performance and patient safety.

No evidence for a leadership “style”

A widespread belief is that leaders can be characterized by their “style” of leadership. Based on our study’s findings and our personal experiences, we find little support for this. Thus, classifying a surgeon as a good or bad leader is simplistic and often wrong, and strategies that follow from this myth, such as ensuring that we select leaders who manifest a specific style, are likely to lead nowhere. Instead, it would best to develop the leadership skills we need to enhance surgical team performance and patient outcomes.

Leadership can be taught!

Yes, it’s true. And as repeatedly shown in the leadership literature, great leadership is not just the result of winning the genetic sweepstakes! We can learn how to become better leaders, and organizations have a role to play here. Increasingly, research from the leadership and medical literatures demonstrate the impact of leadership and leadership training in the OR and other healthcare environments on patient outcomes. Because of this, we cannot no longer afford to ignore the importance of leadership training.

Leadership training: where do we stand?

All healthcare professionals will be thrust into formal and/or informal leadership roles during their career. And these are invariably significant leadership roles, with people’s well-being in the balance. Are we missing an opportunity for our future nurses, physicians and other healthcare professionals by not institutionalizing leadership training in their respective curricula? More importantly, are we failing our patients by not offering leadership training? Probably (and sadly), yes, because we know that leadership can be taught. In the words of Christina Lacerenza and colleagues who recently conducted a meta-analysis of 335 independent groups that received leadership training, “leadership training is substantially more effective than previously thought”. We are encouraged by our School of Medicine’s UGME leadership curriculum, and think it is now time for Canadian nursing schools, medical schools and/or residency programs to offer leadership training in their curricula if we are to graduate well-rounded professionals who are highly skilled at leadership, who can navigate complicated relationships with patients and succeed in challenging, dynamic and technologically evolving healthcare working environments. What do you think?

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