Leadership, Psychological Safety, Team Trust, and Performance: A Study of Surgical Teams

Within the growing literature on team leadership, there is a lack of understanding which leadership process may be most reflective of intratsk leadership. In study 1, I explored leadership behaviors throughout the operating team's OR tasks and if a shared leadership approach is related to psycho-social attitudes and performance of the team. I also investigate surgical teams' engagement in safety related behaviors and if these are related to the team's workflow disruptions. As an exemplar environment, I chose to observe these dynamics in the operating theater, which is a high-stakes environment that necessitates the team to use both technical and non-technical skills. In study 2, I investigate whether a brief targeted leadership coaching sessions with residents in a simulated environment results in different (increase or decrease) leadership behaviors at an interval of 6 months. Multiple hypothesized models were tested in Study 1. The results of model 1 show that psychological safety and team trust are significantly correlated to each other (r=.704, p= <.001). The results show that psychological safety (β= -.505 p=.049) is related to performance (time of patient on bypass), while team trust (β= .177 p=.303) does not predict performance. The results of model 2 show that more extensive shared leadership behaviors are not significantly correlated with psychological safety (r=.087 p=.250) and performance (r=-.085, p =.295); however, the results show that there is a significant correlation with shared leadership and team trust (r=.260 p =.023), indicating that a more extensive shared leadership approach is related to higher team trust in a surgical team. The results of model 3 show that the length of the time-out (a safety critical behavior) does not mediate the relationship between perceptions of the usefulness of the time-out and frequency with which the circulating nurse leaves the operating room (OR). However, there is a strong relationship between the perceptions of the time-out and the number of times the circulating nurse leaves the OR (β = -.425, p<.001), indicating that for every unit increase in the perceptions of the usefulness of the time-out, the nurse leaves the OR .45 fewer times. In study 2, a paired sample t-test was conducted to understand if leadership behaviors post-coaching session are more frequent than pre-coaching session. The results show that there is no significant difference in the frequency of leadership behaviors at time 1 (M =.113, SD=.040) and the leadership behaviors at time 2 (M= .127, SD= .041); t (6)= -1.216, p = .270.