Background/Introduction
Surgery leadership and its effects are barely investigated in recent literature (Barling, Akers, Di Lena, & Beiko, 2017; D’Innocenzo, Mathieu, & Kukenberger, 2016). Also, the methods of the introduction of SL in healthcare settings are rarely studied (Brún, O’Donovan, & McAuliffe, 2019). However, the existing literature suggests that SL training can introduce and improve SL (Brún et al., 2019; Tafvelin, Hasson, Holmström, & Schwarz, 2018). Also, it is fairly well-established that SL is correlated with improved performance (D’Innocenzo et al., 2016; Fausing, Joensson, Lewandowski, & Bligh, 2015; Wu, Cormican, & Chen, 2018). Finally, it is well-known that leadership in surgical settings is critical (Brún et al., 2019; D’Innocenzo et al., 2016). As a result, it is proposed to consider the relationship between SL and team performance in surgery settings with attention paid to the improvements in SL associated with SL training. The proposed research involves an evidence-based intervention (SL and SL training), but it is also associated with a topic that is rarely researched (SL in surgical units). Thus, the project is significant due to its ability to cover research gaps in an area that can benefit from additional research (surgical leadership), but it is also feasible.
PICOT Search Format Questions
PICOT 1: in a surgical unit team (P), does an SL training (I) improve critical team performance (O) as compared to pre-training data (C) over four weeks before and after the training (T)?
PICOT 2: in a surgical unit team (P), does SL training (I) improve SL score (O) as compared to pre-training outcomes (C) four weeks after the training (T)?
Search Strategy/Results
Based on the presented PICOTs, the literature that covers SL effects (especially its relationship with performance) and SL training is to be reviewed. Table 1 summarizes the search with databases, keywords, and numbers of articles found and reviewed. The keywords included SL, training, surgery, surgical, effectiveness, and outcomes; they were refined as more literature was reviewed. They were used in most combinations to ensure the presence of literature on SL training, SL in surgical or surgery units, and SL effectiveness.
The databases included medical ones (PubMed and PMC), as well as Google Scholar, which was used as a search engine for non-medical literature. The latter category was included after searches 1-12 (see Table 1) failed to produce a sufficient amount of specifically medical literature on SL that could contribute important information. As a result, it was deemed acceptable to study the effects of SL outside of medical settings to expand SL understanding. The limitations and inclusion criteria ensured that the search only involved peer-reviewed articles that were recent (no older than 2014) and that contained either primary research, systematic reviews, or meta-analyses, which incorporated all the key elements of an article (especially a detailed methodology section). According to Garrard (2011) and Polit and Beck (2017), these requirements can improve the quality of the evidence.
The final number of reviewed studies amounted to 15 to fit the current task criteria; they included meta-analyses, systematic reviews, experiments, and many observational and correlational studies. Most of the articles were relevant to only one or two aspects of the chosen topic (SL training and SL effectiveness in surgical settings). As a result, it can be assumed that the recent literature that is directly relevant to the project’s topic has been reviewed and that it is very scarce.
Table 1: Search Strategy and Results
Evidence Quality
The quality of available evidence depends on the specific topic. The presented search only included recent peer-reviewed high-quality sources, and with such inclusion criteria, there is little information about SL training and SL in surgical settings. However, there is a high-quality meta-analysis of SL in terms of surgical settings, even though it is not limited to reviewing surgical teams (D’Innocenzo et al., 2016), and there is an observational study about surgical leadership that does not focus on SL (Barling et al., 2017). Also, there are studies that incorporate SL training and demonstrate its effectiveness (Brún et al., 2019; Tafvelin et al., 2018). As for SL and its effects or effectiveness, evidence of diverse quality is available for it, including meta-analyses and systematic reviews of non-experimental data (Aufegger et al., 2019; D’Innocenzo et al., 2016; Wang, Waldman, & Zhang, 2014; Wu et al., 2018), randomized controlled trials (Serban & Roberts, 2016; Xu, Chiu, & Treadway, 2019), and lower-level evidence. The majority of the presented studies (seven) are correlational or observational single studies (Barling et al., 2017; Choi, Kim, & Kang, 2017; Fausing et al., 2015; Forsyth & Mason, 2017; Guenter et al., 2017; Sousa & Dierendonck, 2016; Tafvelin et al., 2018), which makes them level-IV evidence according to Polit and Beck (2017). One study included both correlational and experimental evidence (Sun et al., 2016).
Not all of the reviewed articles covered SL in healthcare workers; only five studies did that (Aufegger et al., 2019; Barling et al., 2017; Brún et al., 2019; D’Innocenzo et al., 2016; Forsyth & Mason, 2017). It is noteworthy that the systematic reviews of SL effects suggest that more research is required, especially with larger samples and randomization (Aufegger et al., 2019). Thus, there is a shortage of recent, high-quality, and high-level evidence on the topics of surgery SL and SL training, and while SL effects are better-studied, further investigation in that direction is justified as well.
Evidence Matrix
Table 2 presents an evidence matrix developed in accordance with the recommendations of Garrard (2011) and created to incorporate systematic reviews, meta-analyses, and research articles with diverse designs. The matrix was modified to fit into the paper and respond to the key questions of the review, which is why it includes key information about the design, evidence levels, and contribution of the studies to the literature review.
Table 2: Evidence Matrix
References
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