The surgeon with the highest transformational score engaged each
surgical team member. For example, upon entering the OR, this sur-
geon immediately put a scrub tech student at ease with professional
banter. The surgeon then asked for different team members' feedback
about the best way to manage the patient and re-emphasized the
importance of the case to this patient's health. Throughout the sur-
gery, he enthusiastically described anatomical and pathologic details,
conveyed excitement about anticipating post-op improvements in the
patient's symptoms and constantly updated the team about the
progress of the case. In contrast, the surgeon with the lowest transfor-
mational score walked into the room and immediately confronted the
anesthesia provider about the amount of blood on hold for the case.
This surgeon didn't ask the name of the medical student in the room
until more than 5 hours into the procedure, barely acknowledged a
concern voiced by the anesthesia provider about the patient's physio-
logical state and refused to answer a nurse's question, stating only
that it had already been addressed.
Free to speak up
We observed that the surgical teams led by surgeons exhibiting transfor-
mational qualities were significantly more inclined to speak up and
share information — behaviors with the potential to greatly impact intra-
operative safety and efficiency.
Transactional leaders clearly communicate their expectations, and
the rewards and consequences of achieving or failing to meet goals.
The surgical team might successfully complete a case, but may not feel
personally invested in the outcome. Some transactional qualities are
found in all leaders — it's important to identify and delegate what
needs to get done. However, the focus of a purely transactional leader
on negative consequences may be counterproductive. Research in
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Staffing
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