When a surgeon feels stressed, the whole operating room feels it too. That's the key finding from a new study by researchers at Leiden University in the Netherlands, who spent months watching surgeries unfold and talking to the people inside them. Their work shows that a surgeon's behavior under pressure doesn't just affect that surgeon — it ripples through the entire team and can make the difference between an operating room that runs smoothly and one that falls apart under pressure.
The researchers observed 100 hours of surgeries and interviewed 32 healthcare professionals, looking at what creates stress in the operating room and how people cope with it. They identified three main pressure points: complications that arise during surgery, the challenges of working as a team, and outside pressures like scheduling and workload. The study was published in the journal Current Problems in Surgery.
The researchers found that surgeons and their teams use mental strategies to handle stress — things like preparing for different scenarios ahead of time, staying focused on what matters most in the moment, and keeping their emotions in check. But these strategies only work well if the team leader creates the right environment.
"Small things can make a huge difference," said Eduard Schmidt, a researcher at Leiden who studies leadership in healthcare. He gave a striking example: if a surgeon starts swearing or ranting during a difficult operation, tension spikes throughout the room. But something as simple as speaking up about it can help. "It can help simply to say, 'I'm starting to get frustrated because things aren't going according to plan.' Then the team understands what's going on and is better able to respond."
Schmidt said many surgeons don't realize how visible their stress actually is. "Surgeons sometimes think that if they're stressed, others won't notice. But our research shows that a surgeon's stress is a key driver of stress throughout the team."
The study points to real opportunities for improvement both before and after surgery. Before an operation, the standard briefing usually covers practical matters — the patient, the procedure, allergies. But the researchers suggest surgeons could also share which moments they expect to be the most challenging. "If you say beforehand: 'I'm expecting this part to be quite intense, and that's when I'll need you all the most,' you prepare the team mentally," Schmidt explained. That kind of openness also makes people more comfortable speaking up if they notice something wrong or feel unsure.
After surgery, the researchers want to see reflection become standard practice. Currently, a debrief — a discussion about how things went — usually only happens when something went wrong. But Schmidt argues every operation should include a brief look at what went well, what could improve, and how the team worked together. "It doesn't have to take long," he said. "Even just thanking everyone can help."
The researchers believe these lessons could apply far beyond the operating room — to military teams, police, firefighters, and even elite sports or professional kitchens. Within healthcare, they hope leadership training will become a bigger part of how surgeons learn their craft. "A great deal of attention is, quite rightly, given to medical and technical skills," Schmidt said. "But skills like communication, motivation and creating a safe team culture are equally important." He noted that younger generations of surgeons already seem more aware of these dynamics — suggesting the operating rooms of the future might be calmer, more supportive places to work.