Effective followership: A standardized algorithm to resolve clinical conflicts and improve teamwork

Abstract

In healthcare, the sustained presence of hierarchy between team members has been cited as a common contributor to communication breakdowns. Hierarchy serves to accentuate either actual or perceived chains of command, which may result in team members failing to challenge decisions made by leaders, despite concerns about adverse patient outcomes. While other tools suggest improved communication, none focus specifically on communication skills for team followers, nor do they provide techniques to immediately challenge authority and escalate assertiveness at a given moment in real time. This article presents data that show one such strategy, called the Effective Followership Algorithm, offering statistically significant improvements in team communication across the professional continuum from students and residents to experienced clinicians.

The effects of crew resource management on teamwork and safety climate at Veterans Health Administration facilities

“…forms (eg, oral, written, and electronic) transmitted among staff, physicians, administrators, patient, and family . The Veterans Health Administration National Center for Patient Safety Root Cause Analysis (RCA) database suggests that communication failures were a contributing factor in nearly 77% of all RCAs between 2010 and 2013 . Thus, the challenges resulting from communication failures in health care need to be addressed in order to promote patient safety, avoid failures, prevent errors, and reduce patient harm.…”

Interventions to improve antimicrobial prescribing of doctors in training (IMPACT): a realist review

“…Although doctor leadership has been widely discussed in the context of NHS improvement, little attention has been paid to how 'leading from beneath' -building leadership capabilities in the context of a hierarchical setting -could contribute to more appropriate antimicrobial prescribing decisions. 12,90,176,177 It may also be relevant to consider antimicrobial prescribing competencies for consultants (or for more senior doctors still in their training years) that could include how seniors consciously and deliberately role model prescribing practices for more junior staff or, when this is not feasible, how they facilitate assistance DISCUSSION NIHR Journals Library www.journalslibrary.nihr.ac.uk from antimicrobial specialists. Role modelling could also work across specialties, for example a medical registrar taking a leadership role in prescribing in surgery, or across professions, with pharmacists assuming a similar responsibility for other clinicians.…”

Follow the leader: followership and its relevance for surgeons

“…The challenges for followers in healthcare involve engagement, working within hierarchies and the need to switch roles between leader and follower. Most people in surgery are well educated, highly trained and clever . A surgical leader needs to be aware that such clever people do not like to be led badly; they prefer to be consulted and work better if they are consulted.…”

“…It is important that such hierarchies do not endanger patients. Effective followership algorithms have been shown to improve communication at critical moments for residents and nursing staff . Respect for a leader or fear of a leader should not prevent followers from speaking up.…”