Leadership, surgeon well-being and non-technical competencies of pediatric cardiac surgery

Expectations of pediatric cardiac surgeons grow as the specialty evolves and yesterday's challenges become tomorrow's routine. The pioneering era of fast-paced major technical advances is behind us. Integration of surgery, cardiology and intensive care is now the basis of incremental improvements in perioperative and long term outcomes. Surgeons can be natural leaders of this process because their skills, roles and experience are crucial in the preoperative, intra-operative and postoperative care of the patient and their family. However, the personality traits that draw physicians to the specialty and contribute to the drive to become a successful technical surgeon may be at odds with the collaborative aspects of this microsystem, both inside and outside the operating room. The potential for disruptive behavior on the part of the surgeon to impede the functioning of a large multidisciplinary team providing care of the upmost complexity raises fundamental questions about how to design reliable pediatric cardiac surgery teams. A new dynamic is needed to support team members, including the surgeon, in times of extreme stress and to help them avoid destructive, maladaptive responses. Focusing these efforts around the clinical microsystem requires a detailed analysis of the team interactions, the underlying culture and support, and the clinical engagement of staff. Building and nurturing a resilient system in a highly specialized environment where burnout, bullying and loss of staff exist remains a constant challenge.