Performance Under Pressure: The Role of Self-Regulation and Leadership in Dealing With Pressures in the OR

This qualitative study explored how surgical staff (including thoracic surgery) manage operating room (OR) pressure through 32 semi-structured interviews with surgeons, trainees, OR assistants, anesthesiologists, and anesthesia nurses in a Dutch university medical center. Three pressure sources emerged: surgery-related, team-related, and organization-related. Staff used phase-specific self-regulation strategies: proactive coping before surgery, attentional focus and emotion regulation during surgery, and cognitive reappraisal after surgery. Leadership also varied by phase, with task-oriented leadership supporting planning and intraoperative clarity, and relations-oriented leadership supporting psychological safety, reflection, and learning. The authors conclude that briefing and debriefing are underused opportunities to strengthen resilience, and that surgeons’ leadership is central to team performance under pressure.