Why The Best OR Leaders Learn To Shift Gears
The Bottom Line: True surgical leadership isn’t about being the loudest voice in the room. It’s about knowing when to command, when to collaborate, and when to get out of the way. Your ability to shift styles isn’t a soft skill—it’s the difference between a good case and a great team.
Any Given Day
You walk into the operating room, pull on your gloves, and tie your gown. Everything is familiar. The monitors beep, the lights are bright, and the team is in place. But what happens next—how you lead that team—will matter as much as your scalpel.
Leadership in the OR isn’t just about being the best technician in the room. It’s about knowing when to command, when to listen, when to teach, and when to get out of the way.
Yet most of us weren’t trained for this.
We were trained to cut.
There’s No “One Way” to Lead in the OR
In surgery, we love algorithms. Hemorrhage? Step one. Sepsis? Step two. But leadership? There’s no easy flowchart for that.
The literature is clear: there isn’t just one leadership style in the OR. There are many. Transformational, transactional, authoritative, explanatory, consultative, delegative, inclusive… even passive (though let’s not glorify that last one). [Hu et al., 2016; Soenens et al., 2023]
Each style brings its own strengths and limitations.
Transformational leadership—think inspiring, motivating, elevating your team—improves collaboration, psychological safety, and morale. It’s the style that gets people to want to follow you, not just because of your title, but because of your presence.
But then the aorta ruptures.
And suddenly, it’s not about inspiration. It’s about decisive action.
In that moment, you must shift. Transform into the authoritative leader—the one who gives clear, direct orders. The one who cuts through the chaos with clarity and speed. The one who holds the line.
This is not a failure of consistency. It’s the very definition of adaptive leadership. And in surgery, adaptation is survival.
Leadership Style is Contextual—But Most Surgeons Stick to One
Here’s the uncomfortable truth: most of us default to one leadership style.
Some are naturally commanding—great in a crisis, not so great when the intern hesitates with a knot. Others are inclusive and patient, building team trust in normal cases—but struggle when the room fills with adrenaline and seconds matter.
A simple way to begin understanding your leadership approach is to take this quick quiz we put together for surgical professionals (Bonus: By doing so, you’ll also get free access to our Daily Selection).
The most effective surgical leaders? They’re the ones who shift gears.
They know when to explain, when to consult, and when to direct. They’re not married to one leadership style. They’re fluent in several—and they know when to speak which language.
According to Parker et al., the ability to flex leadership style to fit the moment is what sets great surgical leaders apart. It’s what keeps patients safe, keeps teams engaged, and keeps outcomes optimal.
But how do we learn that?
Why Our Training Leaves a Leadership Gap
Let’s be honest: most of us were taught to lead by watching whoever happened to be in charge. Good or bad.
We copied what we saw. We got through residency. We made it.
But leadership isn’t osmosis. It’s a skill. And in the OR, it’s a technical skill just like suturing, stapling, and dissecting.
The problem is, leadership training in surgery is still patchy. It’s seen as a “soft skill,” an elective. Something you fit in around journal club or M&M. And even when programs do exist, they’re often one-size-fits-all workshops with PowerPoints and no scalpel in sight.
Surgeons are hands-on. We learn by doing. That’s why the most effective leadership development programs are built around team-based training, simulation, feedback from peers (yes, even juniors), and real surgical contexts.
It’s also why most leadership training fails.
The OR Is a Hierarchy. But It Shouldn’t Be a Dictatorship.
One of the most cited barriers to effective leadership in the OR is hierarchy. We pretend we’ve flattened it. But anyone who’s seen a med student go quiet when the attending raises an eyebrow knows: the old pyramid is alive and well.
Leadership—real leadership—means knowing when to flatten that pyramid and when to climb it fast.
Authoritative leadership works in emergencies. No question. The literature is crystal clear: during trauma resuscitation or intraoperative crises, the best thing you can do is take control.
But once the crisis ends? Staying in authoritative mode can crush psychological safety. It silences voices that need to be heard. It makes it harder for a nurse to say, “That clamp is slipping.” Harder for a resident to ask, “Should we go retrograde?”
Inclusive leadership, on the other hand, invites those voices in. And that can be lifesaving.
As Minehart et al. note, inclusive leaders challenge traditional gender and status roles in the OR—and teams under their leadership perform better.
It’s not about being nice. It’s about creating a room where everyone feels safe enough to speak up when it matters most.
What We Talk About When We Talk About “Team Performance”
Surgical teams aren’t just groups of people. They’re systems of behavior.
And leadership is the glue—or the grenade.
The wrong leadership style, applied at the wrong time, can lead to dropped instruments, missed steps, and even patient harm. But the right leadership style, even if it changes minute by minute, can turn a chaotic case into a cohesive one.
You know that moment when everything clicks? The room is humming. You’re in flow. That’s not just skill. That’s leadership.
But how do you make that reproducible?
Want to Be a Better Leader? Start With These 3 Questions
- How do you lead during routine cases vs. emergencies? If your answer is “the same way every time,” start asking why.
- Do people speak up around you—or stay silent? Your leadership style affects the culture. Silence in the OR is often fear in disguise.
- When was the last time you got feedback on your leadership? Not your surgical technique. Not your case numbers. Your leadership.
Most of us don’t get feedback unless we mess up.
But what if feedback wasn’t a punishment? What if it was your growth edge?
The best leadership programs incorporate anonymous, multi-source feedback, simulation, mentorship, and team-based scenarios. They are not about perfecting your TED Talk. They are about navigating the messiness of real life, in real time, with real people.
Leadership Is Not a Personality Trait. It’s a Muscle.
And like any muscle, it can be trained—or it can atrophy.
We’re at a turning point in surgical culture. The old models—where the loudest voice leads, where fear keeps the room in check, where leadership is confused with control—are dying.
In their place, we’re building something stronger.
It starts with recognizing that leadership in the OR is not about being the leader.
It’s about being the right kind of leader, at the right time, for the right reason.
Sometimes, that means commanding the room.
Other times, it means shutting up and listening.
Either way—it’s surgery. You’ve got to be precise.