Leadership in the Operating Room

I read this article recently in the Bulletin of the Annals on leadership in the operating room. As a cardiac surgeon who mainly performs complex long surgeries, I should know something about this subject at this stage in my career.

When this topic is discussed, the airline industry and the deleterious effect of the shape of the hierarchical structure on outcomes is always brought up. In the early days of passenger airlines, the captain on the plane was king, absolute leader, infallible. It must have been clear to many that this state of affairs contributed to accidents and accidents in aviation equals multiple deaths. So TEREMA or team resource management came along, the hierarchical structure became 'flatter' and everything changed.
People tire of the frequent referrals to the airline industry when it comes to healthcare safety. The operating room is however one area in healthcare that has really benefited from changes imported from the airline industry. There is now strong evidence of patient benefit with a flatter hierarchy and the use of checklists in the OR.  Despite the flatter hierarchy, good leadership is absolutely necessary in the operating room and that leadership should always be provided by the surgeon.