Distributed leadership in the operating room: a naturalistic observation study

Abstract

Previous research shows that distributed leadership can improve performance and safety. Studies of leadership in the operating room have not considered distributed leadership, and the focus has primarily been on the leadership of the surgeon. The aim of this study was to explore leadership behaviors in the operating room and to test an approach to study leadership in complex socio-technical healthcare systems based on a distributed process perspective on leadership. Using an explorative naturalistic approach, ten surgical procedures were video recorded and observed. Based on predefined criteria, 248 leadership behaviors were identified and described. For each behavior, the person who was considered to be the leader was assigned according to profession. An inductive iterative process was used to develop nine leadership behavior categories grounded in the data. Our results show that while the surgeons conducted the most leadership, nurse anesthetists and scrub nurses also conducted leadership. The distribution of leadership differed from previous studies of surgeons' leadership alone. Some behavior categories were more associated with specific professions, others more distributed over the whole team. Leadership behaviors associated with patient safety appeared to be more distributed. A distributed leadership perspective, as applied here, could give a more holistic view of work processes. To better use the potential of distributed leadership in relation to performance and safety, the distributed nature of leadership should be considered. With this in mind, it becomes obvious that a distributed leadership perspective can complement a traditional leader-centered perspective when studying complex socio-technical healthcare systems.