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Operating Room Politics
There was an anesthesiologist who came to me and said, “What happens in the operating room is like chimpanzee politics.” He had read my book, and he said there was a lot of power struggles going on, and he said, “You should measure behavior.” So we did research on humans using primate techniques, basically, writing down their behavior. And so we analyzed 200 procedures, 200 operation procedures.
We were mostly interested in how well they cooperate with each other and how well structured that is, but there’s an enormous amount of social life going on in the operating room. And what we found is that the organization is very hierarchical, and most of the conflicts occur when the surgeon, who is the alpha individual in the room, is of the same gender as the majority of other workers in the room. So if you have a male surgeon who works mostly with men in the room, there’s more conflict. If it’s a female surgeon who works mostly with women in the room, there’s more conflict. And there’s less conflict if the surgeon is of a different gender than the majority of people.
And this, I think, relates to primates in the sense that the alpha individual needs to assert him or herself most towards individuals of the same gender. So an alpha male needs to assert himself to other males, an alpha female needs to assert herself to other females. And so that’s the source of conflict that we noted.
There are tensions that go deeper than people think. They think they have just professional tensions about my opinion versus your opinion about what we should do in the operating room, but there’s also a lot of basic social tension that relates to us being social animals, some sort of basic social psychology that’s going on that is a primate psychology, actually. And I think people need to recognize these things rather than glossing them over.
And in terms of behavior, we could not detect any difference between the female and the male surgeons. They were equally assertive or decisive or hierarchical, or they were not friendly or unfriendlier. They did both a little bit of teaching, of course. That’s what surgeons often do in the operating room. They teach others how to behave and what to do under certain circumstances, which made me think afterward, maybe when we say that male leaders and female leaders are different and act differently, maybe that’s an exaggeration, that’s in our heads. We perceive things differently. But if you measure actual behavior, you don’t find it. And so maybe the differences are much smaller than we think.
Setting Behavioral Guardrails
I showed the data one time to an anthropologist who works with hunter-gatherers in New Guinea. She said, “The fact that these mixed teams are doing so well is only possible because we have a culture in the West that prevents sexual harassment, or is at least against sexual harassment. Because if you don’t have that, then the men are going to be obnoxious to the women, and they’re going to be harassing them, and then the whole team will fall apart.”
If that’s true, that means that the cultural context in which these mixed teams are formed is extremely important. It’s very well possible to have mixed teams, provided that you have strict rules about how men and women interact and what men can do or not do in an environment like that. And so we, in the West nowadays, we have a Me Too movement. We have these movements that say men need to calm down a little bit and they need to behave like gentlemen. And if you don’t have these social rules, then a mixed team is not going to work very well. But if you do have them, as we saw in our study in the operating room, mixed teams can actually do extremely well. People usually look at it as essential for women, as a protection for women against men, but it’s also essential for the cooperation level that you get in a society, probably. So it has many more applications than people think.
Building Relationships
Many of these people who come together in the operating room, they don’t know each other very well. And sometimes you have people who have to work together there for 10 hours and then go their separate ways, and they will not meet each other for another six months. And so I thought one way to reduce conflict in the operating rooms, which is a very important task for the hospitals, one way to do that is to create occasions where people can meet each other outside of that context. So I think that’s an important part of relationship building that needs to be done. It is important to have activities outside of your regular job, so to speak.