You may be thinking, “Don’t they know who’s leading surgical teams?” The straight answer is, “not really”. There is very little research about leadership in today’s surgical teams.

There have been a number of official inquiries into serious failings in hospitals though. You may remember items in the news about the Mid Staffordshire hospital Trust and the children’s heart surgery unit in Bristol, for example. The reports highlighted that hierarchical leadership was one of the problems resulting in patients being harmed, or even dying.

Traditionally surgical teams have used a hierarchical format, with a senior surgeon in charge. In other areas, such as in schools, this top-down arrangement used to be the norm too. However, in recent years a more collaborative form of leadership has been documented. Sometimes members of staff are seen to be leading, even if they are relatively junior.

Often this is because they have certain specialised knowledge, or experience. This surpasses the seniority of another member of staff, which they hold by reason of their role or job title. There have been many studies about how this non-hierarchical leadership works in education, the military and other types of teams.

Those studies help us to see that how leadership is used is dependent on the type of team. Is the team doing ‘normal’ work, or do they need to have intensive, specific knowledge to carry out their duties? Is it ‘extreme’ work, like the emergency services do, or as soldiers under enemy fire might experience?

This research, in other non-healthcare environments also demonstrates that we can’t assume we can apply what works in one team to another environment. Similarly, the little evidence that we do have in healthcare workplaces shows that leadership differs between specialisms. So you might expect to see different forms of leadership in general medicine, compared to in a surgical context.

There are conflicting reports of what is happening though. There are anecdotal comments, such as on Twitter, and in medical journals, about a flattening of hierarchy. In other articles, healthcare staff say that hierarchy is alive and well. In the face of these conflicting fragmented insights into the unique world of surgical teams, I’m aiming to explore what is happening in contemporary surgical teams. The evidence may shed light on whether leadership is still top-down, collaborative or maybe a mix of different forms of leadership.

So your next question might be, “Why is this important to know?” I’ll be talking about this in a later blog, but here’s just one piece of food for thought. It has been estimated that 45% of variation in organisational performance is associated with leadership^[1].

You can find me on Twitter @LeadingChamp too.

[1] Day DV, Lord RG. 1988. Executive Leadership and Organizational Performance: Suggestions for a New Theory and Methodology. Journal of Management 14(3), pp.453–64.