Table 1

Leadership articles reviewed in the literature

AuthorSample (n, response rate where available)Method, data collection toolDefinition of leadershipAnalysis (A) and outcome measures (O)
1Yule et al (2008)39UK, n=44 consultant surgeonsObservation, NOTSSLeading the team and providing direction, demonstrating high standards of clinical practice and care, and being considerate about the needs of individual team members.
  • A: mean within-group agreement, interclass correlations, reliability of the revised NOTSS for inter-rater and interclass coefficients was satisfactory

  • O: None

2Sevdalis et al (2008)40UK, junior surgical teams, 20 half day sessions, 10 full day sessions. Exact n not statedObservation, Revised NOTECHSAdherence to best practice, time management, resource utilisation, giving feedback, authority and assertiveness
  • Analysis: Cronbach alpha, reliability of the revised NOTECHS for inter-rater and test-retest were satisfactory

  • O: None

3Undre et al (2007)41UK, 20 teams, n=80Observation, OTAS, ICATS-N, Revised NOTECHS, technical performance evaluation from technical trainersAdherence to best practice, time management, resource utilisation, giving feedback, authority and assertiveness
  • A: Mixed model ANOVA, independent and paired sample t-tests, Cronbach alpha, evaluation of technical and non technical skills during simulation, self assessment and trainer assessment

  • O: None

4Catchpole et al (2008)42UK, 26 laparoscopic cholsystectomies, 22 cartoid endartrectomies, 54 total team membersObservation, Oxford NOTECHSInvolves, reflects on suggestions, coaches, inspires, motivates, maintenance of standards, planning and workload management, authority and assertiveness
  • A: ANOVA and linear regression

  • O: Time in theatre, technical problems, procedural problems, Oxford NOTECHS performance

5Healey et al (2004)43UK, 50 cases, 2 independent observers, type of cases not statedObservation, OTASProvision of direction, assertiveness and support among team members
  • A: Behavioural ratings during specific stages of surgery to validate of OTAS behavioural scale

  • O: None

6Horwitz et al (2008)44USA, n=65 surgical residentsQuestionnaire, MLQProcess of influence that an individual asserts over others to attain specified goals
  • A: Chi-squared, principal component analysis, multivariate and hierarchical analysis to define resident self reported leadership qualities

  • O: None

7Flin et al (2006)45UK, 17 hospitals, n=352, response rate (48%), 138 consultant surgeons, 93 trainee surgeons, 121 theatre nursesQuestionnaire, ORMAQFour leadership decision making styles were examined: autocratic, consultation, joint, delegation
  • A: Mean scores for each of the three groups compared using ANOVA

  • O: None

8Makary et al (2006)46USA, 60 hospitals only operating room personnel, n=2135, response rate 77.1%Questionnaire, SAQOverall teamwork assessed, leadership is a subscale of the SAQ
  • A: ANOVA, per cent rating teamwork high or very high for each care giver type to determine safety attitude in OR

  • O: None

9Edmonson, (2003)47USA, 16 cardiac surgery teams, 165 interviews from 16 different hospitalsInterview, observationCoordinate action when members might not know what to do, seeing the whole picture and understanding how different sources of expertise fit together, create shared meaning about the situations they face, address barriers, coach, provide clarification and feedback, seek input, be accessible and receptive to ideas and questions
  • A: Coded interview data, within method triangulation, coded rating of interview data, spearman's rho

  • O: Success of implementation of new cardiac surgery technology in OR

10Yule et al (2006)48UK, n=27 consultant surgeons, 11 hospitalsInterview, critical incident techniqueLeading the team and providing direction, demonstrating high standards of clinical practice and care, and being considerate about the needs of individual team members.
  • A: Coded interviews to establish categories of non-technical skills

  • O: None