Leadership and care behind a surgical episode

The key figure in the surgical care experience is often one individual: the surgeon, since without a successful operation outcome, nothing else matters. However, the story often ends there, leaving other contributions significantly less visible and restricting the surgeon’s role to one defining act: the surgical nurse’s soft reassurance ahead of the operation; nurses checking in through the quiet hours, some visibly carrying their own burdens; administrative staff whose warmth exceeds the job requirements; and the surgeon’s careful, gentle removal of the tube and sutures. Capturing these less visible contributions requires looking beyond individual healthcare professionals to the broader episode of care in which their contributions unfold. Drawing on a single surgical episode, we propose a model comprising four care types—technical, relational, continuous, and enabling—that traces, over time, what constitutes more complete surgical care. The care types and roles of different personnel in this surgical experience cross-classify in both directions. For example, a nurse’s care is relational and continuous, just as a surgeon's is. The four types of care can be understood through leadership perspectives developed in research on healthcare action teams. Current research on healthcare action teams examines simultaneous and joint leadership functions (e.g., resource activation) among individuals during a high pressure episode. This perspective is particularly relevant to surgical care because a surgical episode involves multiple healthcare professionals whose leadership can emerge at different stages of the patients’ care. We apply the horizontal differentiation of leadership to a different temporal and relational context: care provided by team members (the surgeon, nurses, and admin team) who may rarely be together, but whose contributions span the entire surgical episode.  We also draw on the vertical differentiation of leadership perspective used in research on healthcare action teams to care across a surgical episode. In healthcare action teams, vertical differentiation involves shifts in authority across hierarchical roles. Across the surgical episode, however, the surgeon retains a central role, even as care responsibilities are distributed and overlap among healthcare professionals. This distribution of care responsibilities suggests that the interrelated contributions of multiple healthcare professionals across the surgical episode may shape patients’ experiences of a surgical episode. Our model integrates these responsibilities within a single surgical episode, providing a leadership lens for understanding how healthcare professionals collectively shape patient care and satisfaction.  
Keywords: Surgical Episode, Care, Vertical Differentiation, Horizontal Differentiation, Leadership, Temporal