Stone Juliana L, Aveling Emma-Louise, Frean Molly, Shields Morgan C, Wright Cameron, Gino Francesca, Sundt Thoralf M, Singer Sara J
Department of Health Research and Policy, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
Department of Health Research and Policy, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, United Kingdom.
Ann Thorac Surg. 2017 Aug;104(2):530-537. doi: 10.1016/j.athoracsur.2017.01.021. Epub 2017 Apr 8.
The importance of effective team leadership for achieving surgical excellence is widely accepted, but we understand less about the behaviors that achieve this goal. We studied cardiac surgical teams to identify leadership behaviors that best support surgical teamwork.
We observed, surveyed, and interviewed cardiac surgical teams, including 7 surgeons and 116 team members, from September 2013 to April 2015. We documented 1,926 surgeon/team member interactions during 22 cases, coded them by behavior type and valence (ie, positive/negative/neutral), and characterized them by leadership function (conductor, elucidator, delegator, engagement facilitator, tone setter, being human, and safe space maker) to create a novel framework of surgical leadership derived from direct observation. We surveyed nonsurgeon team members about their perceptions of individual surgeon's leadership effectiveness on a 7-point Likert scale and correlated survey measures with individual surgeon profiles created by calculating percentage of behavior types, leader functions, and valence.
Surgeon leadership was rated by nonsurgeons from 4.2 to 6.2 (mean, 5.4). Among the 33 types of behaviors observed, most interactions constituted elucidating (24%) and tone setting (20%). Overall, 66% of interactions (range, 43%-84%) were positive and 11% (range, 1%-45%) were negative. The percentage of positive and negative behaviors correlated strongly (r = 0.85 for positive and r = 0.75 for negative, p < 0.05) with nonsurgeon evaluations of leadership. Facilitating engagement related most positively (r = 0.80; p = 0.03), and negative forms of elucidating, ie, criticism, related most negatively (r = -0.81; p = 0.03).
We identified 7 surgeon leadership functions and related behaviors that impact perceptions of leadership. These observations suggest actionable opportunities to improve team leadership behavior.
有效团队领导对于实现卓越手术效果的重要性已得到广泛认可，但我们对实现这一目标的行为了解较少。我们对心脏外科团队进行了研究，以确定最能支持手术团队合作的领导行为。
2013年9月至2015年4月，我们观察、调查并访谈了心脏外科团队，其中包括7名外科医生和116名团队成员。我们记录了22例手术过程中的1926次外科医生/团队成员互动，按行为类型和效价（即积极/消极/中性）进行编码，并根据领导职能（指挥者、阐释者、授权者、参与促进者、基调设定者、人性化和安全空间营造者）进行特征描述，从而创建了一个基于直接观察的新型手术领导框架。我们对非外科团队成员进行了调查，让他们用7分制李克特量表对每位外科医生的领导效能进行评价，并将调查结果与通过计算行为类型、领导职能和效价的百分比所创建的个体外科医生概况进行关联分析。
非外科医生对外科医生领导能力的评分在4.2至6.2之间（平均分为5.4）。在观察到的33种行为类型中，大多数互动行为属于阐释（24%）和基调设定（20%）。总体而言，66%的互动行为（范围为43%-84%）是积极的，11%（范围为1%-45%）是消极的。积极和消极行为的百分比与非外科医生对领导能力的评价密切相关（积极行为的r = 0.85，消极行为的r = 0.75，p < 0.05）。参与促进与领导能力评价的正相关性最强（r = 0.80；p = 0.03），而消极形式的阐释，即批评，与领导能力评价的负相关性最强（r = -0.81；p = 0.03）。
我们确定了7种外科医生领导职能及相关行为，这些行为会影响对领导能力的认知。这些观察结果为改善团队领导行为提供了可操作的机会。
