Leadership helps reduce stress in operating rooms

The success of an operation depends on more than expertise and technical skills. A study by Leiden researchers shows that surgeons’ leadership skills under pressure play a crucial role. “The ability to perform under pressure starts long before the operation does.”

As part of the study, researchers from different disciplines observed 100 hours of surgeries and interviewed 32 health care professionals. The results were published in Current Problems in Surgery.

“A good performance starts with preparation, becomes visible during the operation and only gains real value through reflection afterward,” says researcher and public administration expert Eduard Schmidt, who specializes in leadership in the social and health care sectors.

Sources of pressure

The researchers examined three main sources of pressure: complications during surgery, teamwork and organizational pressures such as planning and workload. Staff used a range of mental strategies to cope, including preparing in advance for different scenarios, focusing on what matters most in the moment and regulating their emotions. “We looked at these self-regulation strategies, mental and behavioral techniques that help people regulate their thoughts and actions.”

But these skills are effective only if the team leader creates the right environment.

“Small things can make a huge difference,” says Schmidt. “If a surgeon starts swearing or ranting during a difficult operation, it increases tension throughout the whole team. It can help simply to say, ‘I’m starting to get frustrated because things aren’t going according to plan.’ Then the team understands what’s going on and is better able to respond.”

According to Schmidt, many surgeons underestimate the impact of their behavior. “Surgeons sometimes think that if they’re stressed, others won’t notice. But our research shows that a surgeon’s stress is a key driver of stress throughout the team.”

Opportunities for better leadership before the operation

Schmidt believes there is room for better leadership before the operation even begins. The compulsory briefing usually focuses on practical matters, such as the patient, the procedure and any allergies. The researchers encourage surgeons to discuss which moments they expect to be particularly challenging during the operation.

“If you say beforehand: ‘I’m expecting this part to be quite intense, and that’s when I’ll need you all the most,’ you prepare the team mentally. You also encourage people to speak up if they notice something or are unsure about it. That increases psychological safety.”

Schmidt also believes there is much to be gained afterward. At present, there tends to be a debrief only when something has gone wrong. The researchers think every operation should include a brief reflection on what went well, what could be improved and how the team worked together.

“It doesn’t have to take long. It can already make a difference if the surgeon says, ‘That was a stressful moment. I may have been a bit too direct.’ Even just thanking everyone can help. These small interventions take very little time but can have a big impact on how people look back on an operation. Some surgeons already do this, but it’s not yet standard practice.”

Research has broad relevance

The researchers believe the insights could be applied beyond health care. They suggest the same principles may be relevant to the military, police, fire service, elite sports and other professions in which teams must perform under intense pressure. “I think this could also include Michelin-starred restaurants,” says Schmidt.

Within health care, they hope leadership will become more firmly embedded in the training of future surgeons. “A great deal of attention is, quite rightly, given to medical and technical skills,” says Schmidt. “But skills like communication, motivation and creating a safe team culture are equally important. If you’ve worked in the same way for 40 years, I can understand that changing your behavior is difficult. We are seeing that the younger generation of surgeons is much more aware of this.”

Who’s behind this story?

Lisa Lock

BA art history, MA material culture. Former museum editor, paramedic, and transplant coordinator. Editing for Science X since 2021.

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Andrew Zinin

Master’s in physics with research experience. Long-time science news enthusiast. Plays key role in Science X’s editorial success.

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