Do you remember the movie "M*A*S*H," with its maverick surgeons cracking jokes during surgery, turning a tough situation into a manageable one? The surgeons of the 4077th MASH unit may have been fictional, but they got one thing right: Creating a positive climate in the operating room can put everyone at ease, allowing doctors and nurses to perform at their best.
And therein lies a dose of wisdom for those of us who practice medicine in the real world.
As an academic surgeon involved in physician education for nearly 40 years, I have spent many days teaching young doctors how to perform surgery. In my field, we make surgeons wait years before allowing them to do procedures on their own, slowly handing over responsibility as they mature. One of the most important lessons I've learned from this experience centers on the effect of the OR's "social environment" on the performance of nurses, doctors, and especially young residents who are still learning the ropes.
In the OR, the senior surgeon is the captain. I fill that role on many occasions. But if I start a procedure in a bad mood, or if I'm hypercritical of other surgeons' technical abilities, or if I snap at a team member, I can almost certainly predict that performance will plummet. Indeed, even the most confident young doctors will rarely reach their potential if they know they're being scrutinized by a colleague with a critical eye and a nasty tone. And this discomfort can spread quickly to others in the OR -- putting everyone on edge and shifting the focus away from critical tasks that must be accomplished to ensure the best care for patients.
In my role as Cedars-Sinai's surgeon-in-chief, and in the leadership consulting work I do for other health care providers, I am struck by the lack of attention paid to this simple observation. Too often, organizations tolerate managers who fail to focus on their single most important responsibility: maximizing the performance of those working for them. In the modern operating room, we achieve the best outcomes when we ensure that all professionals feel valued, regardless of their roles or levels of seniority.
To some in corporate boardrooms, these words might sound like blasphemy. After all, in theory managers manage and underlings obey. There is, of course, a time for leaders to exert their will and make tough decisions. But the real magic lies in the way leaders bring everyone along as decisions get made.
I'm not suggesting that CEOs and other leaders stop holding people accountable, but that they tap an unused tool in their management belts to elevate everyone's game -- and foster more professional and personal satisfaction in the process. Creating this kind of workplace climate requires an institutional commitment to collegiality. This can only be accomplished if those in charge model the right behavior and provide meaningful incentives for workers to embrace a cooperative mindset. Managers who don't get it need to be actively coached and mentored by those who do get it.
We know that when someone expects good things from us in our personal lives, we are more likely to meet the mark. Approaching work the same way can produce the right results, whether you're a surgeon, a lawyer, a teacher or an athlete. We can't all be all-stars, but certainly we all should have the opportunity to succeed in an environment that fosters the right vibes.
I wonder what Hawkeye Pierce and Trapper John McIntyre would have thought about this advice during a break from another marathon surgery shift in their MASH unit. I can venture a guess: They probably would have mixed a fresh batch of martinis in their tent and made a toast to their own great wisdom.
Bruce L. Gewertz, M.D., is surgeon-in-chief and chair of the Department of Surgery at Cedars-Sinai Medical Center in Los Angeles.