Performance under pressure: the role of self-regulation and leadership in dealing with pressures in the OR

Objective Combating workforce shortages requires staff retention by focusing on individual resilience. To understand what makes OR staff resilient, this study analyzes what self-regulation and leadership strategies surgical staff identify to perform under pressure. Background A novel and innovative perspective integrating self-regulation and leadership to examine coping with pressure by surgical staff is presented. It takes a novel cyclical approach, adopted from performance psychology, by focusing on what happens before, during, and after surgery. Methods This is a qualitative single-institution study situated in an academic hospital using 32 interviews, prepared by 100 hours of observation. Data were coded and analyzed through an abductive approach to reveal different types of pressures and what self-regulation and leadership strategies are important in what phase of surgery. Results Three types of pressures impact surgical staff: (1) surgery-related, (2) team-related, and (3) organization-related. Before surgery, staff use proactive coping strategies. Attentional focus strategies and emotion regulation are important during surgery. After surgery, reflection helps cope with experienced pressures and prepare for future surgeries. Surgical leadership is vital, preparing teams before surgery, remaining communicative and attentive to team needs during surgery, and stimulating reflection post-surgery. Conclusion Specific self-regulation strategies and surgical leadership help surgical staff to be resilient and perform under pressure. This can support job satisfaction and, therefore, retention of staff. There is particular room for improvement in the briefing and debriefing phases. This study is the first to explore self-regulation and leadership strategies in response to different pressures in various surgical phases.