What’s this about?

“Unlike being a junior doctor, I won’t just drop you in the deep end and expect you to know exactly what you’re doing”

Adam Kay, This is Going to Hurt

In my previous job I used to support people in Employment Tribunals, seeking closure on what were usually very stressful situations. I enjoyed advocating for my clients, but I was intrigued to discover if there was a way we could prevent, rather than cure, things going badly wrong in the workplace,

This led me to studying psychology in the workplace, and for my MSc dissertation in the subject, I researched why highly motivated teams were not complying with mandatory processes which had been shown to improve safety. During this introduction into the day-to-day work of surgical teams, I was infected by the research bug. Now, here I am, coming towards the end of my first year of my PhD, expanding my exploration into their unique environment.  

I am gathering data about leadership in surgical teams, to understand whether the senior surgeon is still the heroic, hierarchical leader, or whether there has been a move to more collaborative, non-hierarchical leadership.

I’m excited to be using quite a new approach to finding out about this – ‘Leadership-As-Practice’. It holds promise for delivering a broad view of how surgical team-members produce leadership. What objects, tools and processes they use, and where the leadership is triggered? Will we find it happening only over the operating table, or is there something going on in the corridors between operating theatres and the canteen? Is a WhatsApp group the new space to go to for discussion and decisions, before incision?

I invite you to join me on my journey as I put these questions, and more, to members of our NHS teams, to discover what contemporary leadership looks like for them. I can’t promise the drama of Gray’s Anatomy, or the humour of Scrubs, but I do promise not use jargon, medical or academic, and not to “drop you in the deep end”, by expecting you to automatically know what I’m talking about!

This is the first post on my new blog. I’m just getting this new blog going, so stay tuned for more. Subscribe below to get notified when I post new updates.

Short on time? Why not get quick updates by following me on Twitter @LeadingChamp

Tracey’s research is funded by the Economic and Social Research Council (Wales Doctoral Programme).

Dark Moments to Silver Linings

Like it was for many researchers, the Covid-19 pandemic impacted my study. The effect was sudden and dramatic.

Within days of finally getting ethical clearance and permissions to enter hospitals, after months of NHS and University processes, and what felt like the completion of a mountain of forms, I received an email saying all research in the NHS, other than research into the virus, was suspended.

The darkest moment

In that darkest moment of my doctoral journey, I thought the suspension of my project might bring my hopes of completing a PhD to an end. It was too early then to appreciate the devastating result of the disease, which has since paled my disappointment into insignificance.

I have adapted though and, thanks to the prompt support from my supervision team and the Cardiff Business School Ethics Committee, I began interviewing people who had worked in or with surgical teams but were not currently working for the NHS. Zoom has become my essential tool, as face-to-face interviews were no longer possible.

The number of interviews has been substantially less so far than I had planned. Although NHS research has restarted, the other hospital was unable to even allow virtual interviews, due to the strain on staff because they are in an area with a high rate of Covid-19 cases.

Now I am trying to open up new possibilities, seeking permission to work with hospitals who are able to accommodate my study. Will I manage to catch up sufficiently to keep to something that resembles my original research Plan? Or will I need to change my course if I am to complete my PhD?

Silver linings

Whilst this ‘unknown’ is a source of concern, there is a silver lining to the Covid-19 cloud. Two in fact. Firstly, when I reached out to retired members of surgical teams, their accounts of experiences span the 1990s to very recent NHS work. This has given a depth and contrast to the accounts of how leadership has changed, yet stayed the same in many ways, over time.

Secondly, I am right at the heart of the professionals who tackle Covid-19 head on. I find myself, by chance, in the privileged position of understanding how this crisis has affected leadership in a healthcare environment.

There is not much we could be thankful for when the pandemic hit. I am thankful for this opportunity though.

Why do research about leadership in surgical teams?

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.