New Study Shows Abusive Behavior in Hospital Operating Rooms Undermines Surgical Team Performance

Newswise — Hospital operating rooms can be pressure-cooker environments, with tempers fraying and surgical team members finding themselves on the receiving end of belittling comments or snippy rebukes to follow orders.

While these testy exchanges can be rationalized as inconsequential, the negative behavior has a real impact on a surgical team’s ability to successfully overcome challenges, according to a study conducted by three Queen’s University researchers. Their study, to be published in the American Journal of Surgery, was the first to assess the simultaneous effects of surgeons' positive and negative leadership behaviors on team performance.

“If we know that leadership matters in the operating room, I don’t think we can simply leave it to chance,” says Julian Barling, the Borden Chair of Leadership at Smith School of Business and one of the study’s authors.

The impact of surgeons’ leadership on surgical team performance has not been well studied. To help fill this gap, Barling teamed up with Amy Akers, a former doctoral student at Smith School of Business, and Darren Beiko, a urology surgeon at Kingston General Hospital and an associate professor at Queen’s School of Medicine. They focused on “psychological safety” and team efficacy. Psychological safety reflects the belief among team members that it is safe to take risks, voice dissent, and make errors. As the researchers note, “one of the most consistent predictors of psychological safety is high-quality leadership.”

In their study, trained observers attended 150 randomly selected operations at a tertiary care hospital to track the leadership styles of surgeons. Surgical team members being observed also completed questionnaires that rated their team’s cohesion and ability to overcome challenges.

Barling expected surgical teams would fare best when surgeons exhibited what is known as transformational leadership. “Transformational leadership picks people up and makes them feel taller, makes them feel like they can do more,” says Barling. “It leaves people with the mindset, ‘If I try hard, there’s nothing I cannot do.’ Destructive leadership leaves you with the mindset of, ‘No matter how hard I try, I can never do anything.’”

Surprisingly, the study did not find transformational leadership yielded any measurable improvement in team performance. But abusive supervision — such as putting down someone in front of others — and highly controlling behavior did undermine team results.

Prior research has associated operating room leadership with less information sharing during surgery, and that in turn has been linked with a greater likelihood of post-surgery complications. Given this finding and the results of their study, the Queen’s researchers call for leadership training to receive “the same rigor typically given to clinical trials and clinical research in general.”

Skeptics may point out that medical school students and surgeons are busy enough without having to add leadership to their load, or that leadership is less a learned skill than an inherited trait.

But Barling maintains effective leadership training need not take a lot of time. And he notes that a recent review of 335 studies found that leadership skills can indeed be developed. “The conclusion from that review is that the effects are larger than what we thought they would be,” says Barling. “So we know we can teach leadership, and what it takes to teach leadership is not that time consuming.”

Others may argue that a more authoritarian form of leadership inside the operating room is necessary during critical times. Barling heard otherwise — from surgeons and leaders in other contexts too. “The new generation [of surgeons] will tell you that this is the time to be creative. The fact that there’s a crisis means that all the traditional things haven’t been working. Exerting greater control over a situation is the human thing to want to do but it’s not necessarily the most effective thing to do.”

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Julian Barling is available to speak about this research. He can be reached at [email protected] or (613) 533-2477