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As for surgical tradition, hierarchical authority is ingrained
in, and valued by, every surgeon in the operating
room. And in terms of value, all members of the team are
committed to training junior personnel. "The traditional
mantra of surgical training is to 'see one, do one, teach one'—that is, see a procedure, do one (or more) and then teach
others to do the procedure."
This structure, the researchers say, leads to a "paradoxical
leadership system characterized both by rigid hierarchy and
dynamic fluidity." The hierarchy means that junior members
know whom to defer to in times of uncertainty or crisis;
when senior leaders delegate authority, junior leaders benefit
from the learning experience; and when called for, senior
leaders seamlessly reassert their authority to prevent errors in
patient care. "It is a dynamic, integrated system," the authors
write, whose very fluidity is one of the reasons for its success.
'Leadership Does Not
Occur in a Vacuum'
So what can the leadership system of a trauma unit teach
teams in non-emergency situations? The researchers suggest
that organizations where "immediate task performance is
critical, goals are clear, team members vary in their expertise,
experience, and need for training, and the composition of the
team changes frequently" may have something to learn.
On the other hand, the rigid hierarchy and dynamic
delegation of the trauma unit teams would, the researchers
suspect, "interfere with the performance of teams tasked with
the development of creative new products and processes."
Even the challenges that cardiac surgery teams face in implementing
a new surgical procedure are significantly different
from those faced by a trauma team; the cardiac group, for
example, benefits from continuity of team membership—clearly not an attribute of trauma units.
In general, however, Klein's findings bolster studies suggesting
that leadership can be shared among the members of
a unit or team, rather than residing in one person in charge
of leading his or her subordinates. Such sharing can, in turn,
help to develop the abilities of other team members, resulting
in more effective functioning of the team as a whole.
Also, while most dominant models of leadership "present
a largely static picture of leadership" in which the leader
is "assumed, implicitly, to display the same style over time,"
the researchers point out that leader identity and behavior
in today's world "evolve as a team matures and also vary as a
function of team task cycles."
And where existing models also indicate that leaders shape
their organizations' culture, staffing and norms, "our findings
suggest that these effects may well be reciprocal," the
researchers write. Just as leaders influence the development
of team members, so too do team members influence their
leaders. "In short, leadership does not occur in a vacuum."
Finally, dominant models of leadership see leadership "as
a behavioral style, an individual difference, characterizing an
individual leader's interactions with his or her subordinates...Leadership is thus inextricably linked to the person who
occupies the leadership role."
Yet Klein and her colleagues offer a very different conceptualization
of leadership. The trauma unit system suggests
"that leadership is a role—or, more specifically, a dynamic,
socially enabled and socially constrained set of functions
which may be filled by the numerous individuals who, over
time, occupy key positions of expert authority on the team.
Leadership ... is not the product of a leader's individual differences,
but of any organization or unit's norms, routines and
role definitions."
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