Date

10-14-2026

Department

School of Behavioral Sciences

Degree

Doctor of Philosophy in Psychology (PhD)

Chair

Joshua Hays

Keywords

Flow, flow state, surgeons, operating room, phenomenology, peak performance, team flow, patient outcomes, self-determination theory, flow antecedents, flow inhibitors, challenge-skill balance, surgeon well-being, optimal experience

Disciplines

Psychology

Abstract

Flow supports optimal performance and well-being, yet surgical research has treated it as a static, intrapersonal state, leaving its interpersonal and organizational conditions poorly understood. The purpose of this descriptive phenomenological study was to explore how surgeons experience flow in the operating room and to identify the conditions and strategies participants described as supporting flow access. Guided by Csikszentmihalyi’s (1990) flow theory, McQueen et al.’s (2025) multifaceted framework, and self-determination theory (Deci & Ryan, 1985), purposive and snowball sampling recruited 20 surgeons across nine specialties (12–49 years, M = 33.95) for semi-structured interviews. Analysis followed Englander and Morley’s (2023) five-step method in NVivo 15 with member checking, peer debriefing, and an audit trail. Participants described flow across seven dimensions, with the cognitive dimension most prominent. The state was marked by complete concentration, effortlessness, time distortion, enjoyable experience, efficiency, and physiological quieting, rarely solitary and sustained with a familiar team. Participants reached flow most readily in high-stakes cases where mastery kept demands within perceived control. Nine antecedent categories were led by dedicated teams, preparedness, competence and continuous growth, challenging cases, and demonstrating leadership. Twelve inhibitor categories largely mirrored the antecedents, led by environmental, workflow, and organizational barriers, emotional strain, and physical depletion and fatigue. Four consequence categories spanned surgeon wellbeing, led by professional satisfaction and described protection from burnout, operational excellence, team engagement and retention, and patient outcomes. From the surgeons’ accounts the researcher developed the OR Flow State Unlocked conceptual model, offered for empirical testing rather than as a finding.

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