Leadership and strong teams are important in any organization, but especially in the high-stress, high-stakes setting of the operating room. This makes leadership development and team building critical to perioperative success.
“Building a strong perioperative team is essential and contributes to an environment that supports and maintains respect, trust and the dignity of all team members and patients,” says Association of periOperative Registered Nurses (AORN) CEO Linda Groah, MSN, RN, CNOR, NEA-BC, FAAN.
“A strong team cultivates a healthy work environment and a culture that encourages innovation in practice,” Groah adds. “It also contributes to team members’ personal and professional well-being and to them finding joy in their work.”
Different Leadership Styles
In a landmark study published in 2000, Daniel Goleman and his research team identified six distinct leadership styles exhibited by mid-level managers:
- Pacesetting leaders expect and model excellence and self-direction.
- Authoritative leaders mobilize the team toward a common vision and focus on end goals.
- Affiliative leaders work to create emotional bonds that bring a feeling of bonding and belonging.
- Coaching leaders develop people for the future.
- Coercive leaders demand immediate compliance.
- Democratic leaders build consensus through participation.
Lisa Bailey, BSN, BS, RN, CNOR, a member of the AORN Board of Directors, says she has seen some of these leadership styles exhibited in the perioperative setting. She believes the most important leadership characteristics are being honest and open, trustworthy and a good listener.
“Leaders also need to be consistent in their words and actions and role model what they expect from their team members,” she says.
“Each of these leadership styles has its time and place,” adds Jamie Ridout, RN, MSN, MBA, NEA-BC, CNOR, CASC, the administrator at the Capital City Surgery Center in Raleigh, North Carolina. “That said, leaders must know their audience and use the style that’s most effective and produces the best results. One leadership style won’t work for every situation and every staff member.”
Independent perioperative consultant Missi Merlino, MHA, RN-BC, CNOR, CSSM(E), believes that each leadership style can play a part in the OR unless it will harm a patient or violate policies and procedures.
“However, the authoritative style is the least effective,” she says. “Collaboration and coaching work best in my opinion. As you develop your team, coaching them through difficult conversations or interactions can have a very positive impact.”
Groah adds another leadership style to this list, one that she calls contingency leadership. “In the current age of technology and pivoting expectations of leaders, I believe this is the most effective leadership style,” she says. “This type of leader has command of all the styles of leadership and will use the one that meets the situation and will produce the desired outcome.”
Sharon A. McNamara, BSN, MS, RN, CNOR, says she has employed each of these leadership styles at some point during her career, depending on the specific circumstances.
“I call this situational leadership,” says McNamara. “These leadership styles are based on components of emotional intelligence, so it’s important to know how these different styles affect performance or results in each situation.”
McNamara says she has adopted what she calls the “servant leader paradigm” because she believes the role of a leader is to serve. “As leader I have always worked to develop healthy symbiotic relationships,” she says.
“My major focus has always been identifying and meeting the legitimate needs of my people and removing any barriers so we could get results and meet the goal of safe, quality patient care,” says McNamara.
Leadership and Team Building in Action
Todd Masten, the founder and COO of SurgeryDirect, has faced a number of leadership and team building challenges since the company was founded in 2015.
“As an ASC management company, we have seen it all, from massive staff turnover to failed leadership,” says Masten. “At times we are asked to come in and provide leadership to get the center back on course, so to speak.”
According to Masten, stepping into the multi-license leadership role has required a greater focus on emotional intelligence, or EQ, than on IQ.
“In fact, I would argue that in intimate health care settings, EQ is more important than IQ for leaders,” he says.
Masten stresses that perioperative leaders must strive to manage their own emotions in difficult situations in order to relieve, not increase, the stress. “How many times have we worked for a leader who acted as accelerant to the problem instead of a suppressant?” he says. “Staff members can only exist in this environment for so long before trust with leadership is broken.”
SurgeryDirect’s latest ASC turnaround occurred at a host-center ASC and its four multi-licenses. “It’s by no means easy to manage this complex model, but that makes it even more rewarding when you empower your staff to succeed,” says Masten.
They started out by asking open-ended questions focused more on the individual staff members than on the job roles. “We gave staff an opportunity to get to know us not as a center leader, but as a human,” says Masten
“But what they gave us was even more cherished,” he adds. “We learned about their wants and desires, about their families and loved ones, and about what they loved about their profession and why they chose it.”
Masten likes to refer to a leadership quote from President Theodore Roosevelt: “People don’t care how much you know until they know how much you care.”
“Once the staff knows you care, they will be ready and willing to follow your ideas,” he says. “Staff morale will improve, and turnover will drop drastically.”
Leadership and Team Building Tips
Groah offers a number of tips for perioperative leaders when it comes to improving their leadership and team building skills.
“Demonstrate empathy, be authentic, recognize positive performance and behavior, and keep your commitments,” she advises. “Also be willing to mentor your team and to apologize when appropriate. And do all this while continuously monitoring trends so you are not surprised.”
Merlino stresses the importance of acknowledging the contributions, experience and passion of each team member. “Even nurses new to the perioperative setting bring valuable life lessons we all can learn and draw from to improve patient care,” she says. “It’s so important not to stereotype someone without giving them a chance to learn and grow.”
Ridout believes that building a strong team begins with setting expectations and vision as a leader.
“All perioperative leaders, from the director of nursing to the charge nurse, must have some level of oversight that expectations are being met and staff are bought in to the direction of the organization,” she says.
Bailey lists consistency and clear communication as her top leadership and team building tips.
“Consistency gives team members a feeling of stability while communicating clear expectations lets them know what is and isn’t allowed and what level of performance is expected,” she says.
Having an open and honest rapport with the team is also critical, as is listening to what team members say. “This helps team members feel important and valued by leadership,” says Bailey.
For McNamara, ensuring proper work-life balance is a critical characteristic for perioperative team leaders. “The research is out there regarding how working over 10 hours a day or 40 hours a week increases patient risk and perioperative team member safety,” she says. “Leaders should take a deep breath and look for ways to inject joy, fun and break times into the workday.”
McNamara is also a big believer in teamwork initiatives like TeamSTEPPS and Crew Resource Management.
“Research demonstrates that health care organizations that implement these kinds of initiatives have seen a reduction in adverse patient outcomes and ICU stays and a decrease in post-operative sepsis rates,” she says.
“One thing I learned many years ago was that the leader must know when to lead and when to follow,” McNamara adds. “There are no effective leaders without effective followers – both are important to successful outcomes.”
For example, McNamara says that effective team leaders are comfortable taking a risk and following the unofficial leader. They allow followers to test their ideas and encourage them to challenge the status quo. And they’re stimulated by out-of-the-box discussions, leaving their preconceived solutions at the door and being open to the team’s solutions.
Leadership During a Crisis
Nothing tests perioperative leadership skills like a crisis. “The keys to leading in a crisis are remaining calm, using good judgement, trying to stay as informed as possible and making the best decisions you can based on the information you have at the moment,” says Ridout.
Merlino spent much of her perioperative career working on cardio-thoracic and vascular teams. “Things can change so quickly during these cases,” she says. “Leaders must stay focused and depend on the training of everyone in the room. And the emphasis must always be on the patient’s safety, not on anyone getting their feelings hurt.”
Groah recommends developing a crisis action plan right away by assessing the situation and identifying the short-term and intermediate needs. “Communicate the plan to all team members and give them the authority they need to do the assignment,” she says. “Then continuously monitor and evaluate the results.”
According to Bailey, perioperative team members will have questions and want clarity about what will be expected of them as their environment changes to facilitate the crisis at hand. A good example of this was when COVID-19 entered her facility.
“The patient load outnumbered the rest of the patient population requiring care so the number of surgeries being performed was reduced each day to allow space for COVID patients,” says Bailey. “Of course, the perioperative staff was concerned about what that meant for their jobs. Leadership came together to explain how they could help if deployed out to the floors and ICU units.”
Masten’s biggest leadership takeaway is simple: Be flexible. “You can’t follow just one leadership style all the time,” he says. “Good leaders get to know their staff members, understand the setting and choose the style that’s best for the situation.”
The worst leadership situations Masten has witnessed occured when a leader read an article or book on leadership and immediately tried to use all the different styles. “We’re all human and strive for perfection,” he says. “But being human means we’re all flawed.”
Masten concludes: “I believe that when we as leaders understand our flaws, see our blind spots and become more predictable – even boring in that predictability – this allows a team to forget about all the other stuff and just be amazing at completing their role.”