Beyond clinical skills: Unlocking the drivers of effective crisis management in operating rooms -a qualitative study

Abstract Introduction In-hospital crises, particularly in operating rooms, are critical events where human factors significantly influence the quality of crisis management. While clinical guidelines are standardized, the performance of operating room head nurses during crises varies considerably. Traditional quantitative studies often fail to capture the operational and emotional experiences that enhance crisis management. To address this gap, this qualitative study aimed to explore the factors that improve the performance of operating room head nurses in crisis situations. Methods A qualitative content analysis was conducted in western Iran from [April/2025] to [September/2025]. Participants included 17 head nurses from operating rooms of major hospitals in the western region of Iran, selected through purposive sampling with maximum variation. Data were collected through in-depth, semi-structured interviews. Graneheim and Lundman's systematic approach was employed to analyze the data and uncover latent and manifest content. Results The mean age of participants was 39.45 years (range 37–56 years), and most held a bachelor's degree in operating room technology (82.58%). The collected data were categorized into a theme titled "drivers of effective crisis management" and five main categories with 33 subcategories. These categories included professional leadership competencies, emotional leadership and team cohesion, strategic management of reactive capacities, proactive preparedness and crisis operations, and post-crisis support and rehabilitation. Conclusion Professional leadership competencies, emotional leadership, strategic management of reactive capacities, proactive preparedness, and post-crisis support were key drivers of effective crisis management in operating rooms. Empowering head nurses through leadership skills training, strengthening psychological support, ensuring adequate physical space and equipment, providing organizational incentives, and implementing operational training will be effective measures in this regard.