The CNS sat down for an interview with Pulitzer Prize-winning Journalist and New York Times Bestselling Author of The Power of Habit, Charles Duhigg, to explore the intersection of his research on human behavior and organizational development with neurosurgery. Charles Duhigg will speak on Wednesday, November 4, during the General Scientific Session at the CNS Annual Meeting.
In The Power of Habit, you explore how habits shape performance. What are the most impactful habits neurosurgeons can build to improve consistency in high-stakes environments like the operating room?
One thing we know is that the most valuable habits are mental habits. Within psychology, these are known as cognitive routines, and most of them are designed to help us think more deeply, particularly when thinking deeply is hardest because we’re overworked, running out of time, or dealing with a critical matter that has to be handled immediately.
These cognitive routines can be as simple as a checklist before surgery or taking a few moments at the end of each day to describe your day in excruciating detail to your spouse, to help review what went well and what didn’t. It might manifest as taking a walk in the afternoon to think through a problem, or setting aside some time on Sunday to look at your calendar for the coming week.
But differently, the most important and valuable habits are often things that don’t look like they are increasing efficiency. They often times are about slowing down and spending a little bit more time thinking. But as everyone knows, it’s this deep thought, this attention to detail and to planning, that makes us most effective and makes us most productive.
Many surgeons rely on routines. How do you distinguish between productive habits and those that may limit growth or adaptability?
An interesting aspect of habits is that our brain doesn’t distinguish between good habits and bad habits. Rather, it merely wants to create as many habits as it can, because that lessens our cognitive load.
So, when we’re talking about the routines of surgeons or any other high-performing, high-stakes profession, one of the things that’s really important is to spend time thinking about which habits or routines we want to encourage and which we want to discourage. Our brain won’t distinguish for us between what’s good and bad, and so what’s important is making decisions, particularly when decisions are hard to make because we’re tired, overworked, or in a stressful environment.
One of the best ways to determine which habits empower us and which don’t is, after a routine, to ask yourself: "If I were to start doing this activity for the first time, would I do it this way? Is this merely a habit that is a remnant of my history, or is this aligning with the core belief of how I ought to do my job?" That often gives us the most insight into which of our behaviors have persisted simply because they are routinized, and which ones we’ve really deliberately thought about and chosen.
Psychological safety is increasingly discussed in healthcare. What practical steps can leaders take to build it within surgical teams?
Study after study has found that psychological safety is the single most important factor in helping a team become effective, productive, and feel like it’s working as a unit. Psychological safety emerges when we feel like we can speak up and that what we say won’t be held against us. Leaders play a big role in creating psychological safety. One set of experiments conducted by Google found that psychological safety emerges when a team leader does two things: first, when they draw everyone into the conversation. Equality and conversational turn-taking are hallmarks of psychological safety, which doesn’t mean everyone speaks the same number of words at each meeting, but it means that everyone has a voice and everyone speaks up at least once during a meeting.
The second thing that creates psychological safety is what’s known as "ostentatious listening." When our leader repeats back what she’s heard people say, references previous comments, or compliments someone on saying something really smart, what they’re doing is listening ostentatiously. They’re proving that they are paying attention, and we know that when a leader does this, the team starts to imitate them, creating psychological safety among everyone.
What’s a key takeaway you hope the neurosurgical community gains from your session at the CNS Annual Meeting?
The key takeaway I hope that the neurosurgical community takes away from our time together is that the most powerful habits are those that we use to help ourselves think more deeply, particularly those moments when thinking is hardest. Overwork, burnout, fears of something going wrong: these are natural emotions for anyone to have in a high-pressure, high-expertise profession like neurosurgery, but, as I’m guessing many of your members already know, the way that we can overcome these challenges is by building the right routines to help us feel in control, to connect with the people around us, and find those moments of mastery that allow us to work at the highest levels.
Any habit can be changed. Any new routine can be created. It is simply a matter of understanding how habits function within our heads and within our lives, and then having the courage and commitment to change for the better.
Want to hear more about habits, leadership, and neurosurgery? Join your peers at the 2026 CNS Annual Meeting in Washington, D.C., October 31-November 4, 2026. Register by September 30 to save on your registration and housing!