Karen M. Sutton, MD, FAAOS, makes a point at the Annual Meeting Instructional Course Lecture on Leadership in Orthopaedics as panelists (from left) Mary K. Mulcahey, MD, FAAOS, Asheesh Bedi, MD, FAAOS, and Matthew T. Provencher, MD, MBA, FAAOS, look on.


Published 8/2/2022
Terry Stanton

Presentation Illustrates ‘How To Be Your Own COO’

Panelists offer tips for steering a team effectively whether in the OR or a committee meeting

At the AAOS 2022 Annual Meeting in Chicago, four experienced orthopaedic surgeons shared their perspectives on “Leadership in Orthopaedics: How to Be Your Own Chief Operations Officer” in an Instructional Course Lecture.

Asheesh Bedi, MD, FAAOS, spoke on the qualities and practices that make a surgeon an effective leader across the scope of practice, and Karen M. Sutton, MD, FAAOS, homed in on “pillars of leadership” in the OR, positive ways to engage and motivate the team, and how a surgeon at any career stage can adopt leadership traits. Course moderator Mary K. Mulcahey, MD, FAAOS, offered guidance for making committee meetings more effective, whether as a leader or committee member. Matthew T. Provencher, MD, MBA, FAAOS, offered knowledge and wisdom gained from his lengthy experience chairing courses and society and educational meetings, including serving as program chair for the AAOS Annual Meeting from 2022 through 2024.

Dr. Bedi noted that the COVID-19 era has presented new challenges to leaders. “These are challenging times, but maybe a little brighter than a year ago,” he said. He enumerated and commented on some core principles of motivation, as follows:

  • Avoid “vague.” “Be clear about the exact tasks and expectations with boundaries. We may be vague to avoid confrontation, but the lack of clarity can lessen your effectiveness as a leader. That can lead to loss of enthusiasm and team building, as opposed to saying something tangible. Instead of saying, ‘Work harder; do more,’ specify the goal as one more case each day.”
  • Share in the sacrifice, and lead by example. Due to the COVID-19 pandemic, “We had limitations of resources, so [it provided an opportunity to] extend and expand our resources. We came to the concept of Saturday operating time. This only works if you as the surgeon leader are part of it. We all have family time and commitments. When you see your surgeon leader participating, even if it’s less frequent, there is a huge value in leading by example.”
  • Empathy goes a long way, versus to fear. “We assume it’s perceived that we care, but we don’t communicate that well. Spending time in the clinic and OR to express that you know people are putting in extra time and effort goes a lot further than intimidation.”
  • Empower and challenge people to meet expectations. Foster “local leadership” with respect and autonomy.
  • Respect experience and domain-specific expertise.

Whether in the clinic or the OR, Dr. Bedi said, “Your most important trait as a leader is to think about every member of the team and their responsibilities beyond your own.”

Thus, Dr. Bedi emphasized the concept of selfless leadership. If one is seeking to improve clinic efficiency or to increase time available for surgery, “Think about the resources and needs beyond your own,” he said. “Whenever you are asking about an investment, think about the collective group.”

Dr. Bedi also advised: “Always lead by example, with steadfast calm and an unemotional demeanor that inspires others.” A good leader will encourage data-driven and evidence-based discussions. “Don’t be the loudest voice in the room. Don’t respond in an emotional time. You might be remembered despite the best of intentions.”

Noting the words of author Simon Sinek, “A boss has the title; a leader has the people,” Dr. Bedi said. “People will gravitate to those they trust the most. A selfless, inclusive approach will yield the greatest collective returns.”

Be transformational
Dr. Sutton focused her talk on leadership in the OR and on “becoming the captain of your ship” in leading the surgical team. She spoke of a culture of excellence that “starts from well-established leadership by the captain, or lead surgeon.” Achieving it begins with preparation. “Familiarize yourself with how you want your next case to be handled,” Dr. Sutton said.

Leadership is established through a balance of the transactional style—which is task-focused, may concentrate on mistakes, and assigns responsibility for performance targets—and transformational style—which emphasizes the collective mission, is optimistic, solicits other perspectives, and is considerate of people on the team.

As an example, Dr. Sutton said, “Sometimes I’ll have a challenging case and I might be a little nervous. Preparedness is key. When I walk into the OR, I start looking at the trays and equipment to know at least we are on the right page. I’ll look at the team and greet them and make sure they are ready. Then I try to set a positive approach by saying, ‘This is going to be a great day. This is going to be a great case.’”

Optimizing team performance is a key goal. “I’ll express my appreciation to my scrub tech for doing a great job and to the circulating nurses and others. Then when I have to start a case at 6:30 a.m., they may be first to volunteer.”

Emotional intelligence “segues into all these factors,” Dr. Sutton said. “You want to make sure you are catching up on the room and being aware that people have personal problems, maybe with childcare. Check in with them and be supportive. The time coming out of COVID is challenging for people’s lives.” Her style, she said, “starts with positivity; I want to be sure people are in the happy zone before I’m seeing people in office and surgery.” Her “second style,” she said, is feeding people. “If I know the day is going to go longer, I’ll order in lunch for everybody. It pays off in spades down the road.”

The transformational leadership style increases cooperative behavior and knowledge sharing, leading to greater efficiency in the OR, Dr. Sutton said. It establishes a “confident and safe area to allow free flow of communication” so that “basically, everybody is able to speak up. If they see something going awry in a case or a surgeon is rushing through a timeout, they can say, ‘Look, hang on, let’s take a pause, can we go back?’”

In summary, she said, “Transformational leadership occurs through cooperative performance and knowledge sharing. Poor leadership can give rise to a higher incidence of avoidable mistakes.”

Have a good meeting
In describing the elements that define an effective committee, Dr. Mulcahey said committees are “the most important workforces of an organization because a committee allows us to break down work into manageable chunks. What we want to avoid are committee meetings where your input is not valued, nothing is ever accomplished, and it’s a waste of your valuable time.”

She delineated 10 principles of effective committees and committee meetings:

  1. starting and ending on time
  2. well-defined agenda
  3. advanced communication of meeting dates
  4. documents distributed well in advance of meeting
  5. consent agenda for longer meetings
  6. introduction of new members
  7. enthusiastic committee chair
  8. focused discussion and decision-making
  9. opportunity for all members to participate
  10. leaving with a sense of accomplishment

The role of meeting chair, Dr. Mulcahey said, is to guide, mediate, and facilitate discussions. “A chair should not dominate the discussion and should include everyone and encourage everyone to participate. A chair understands the goals of the organization and the committee’s role in achieving those goals.”

Knowing how to involve members and motivate them is an important skill for committee chairs. Volunteers who feel their work is valued will be engaged and will seek to contribute.

“Work to your members’ strengths,” Dr. Mulcahey advised. “If you have them pursue things they are interested in, they are much more likely to follow through.” In the same vein with respect to chairs, she said, “Know your own strengths and seek to improve weaknesses.”

At the conclusion of a meeting, she advised, “Address the specific tasks that were accomplished so everyone says, ‘Wow, look at all the things we got done.’ Thank them for their time; we are all volunteers. An effective meeting is achieved when committee members and leaders come away with a sense of accomplishment.”

Terry Stanton is the senior medical writer for AAOS Now. He can be reached at tstanton@aaos.org.