Flexible knowledge repertoires: communication by leaders in trauma teams

Abstract

BackgroundIn emergency situations, it is important for the trauma team to efficiently communicate their observations and assessments. One common communication strategy is “closed-loop communication”, which can be described as a transmission model in which feedback is of great importance. The role of the leader is to create a shared goal in order to achieve consensus in the work for the safety of the patient. The purpose of this study was to analyze how formal leaders communicate knowledge, create consensus, and position themselves in relation to others in the team.MethodsSixteen trauma teams were audio- and video-recorded during high fidelity training in an emergency department. Each team consisted of six members: one surgeon or emergency physician (the designated team leader), one anaesthesiologist, one nurse anaesthetist, one enrolled nurse from the theatre ward, one registered nurse and one enrolled nurse from the emergency department (ED). The communication was transcribed and analyzed, inspired by discourse psychology and Strauss’ concept of “negotiated order”. The data were organized and coded in NVivo 9.ResultsThe findings suggest that leaders use coercive, educational, discussing and negotiating strategies to work things through. The leaders in this study used different repertoires to convey their knowledge to the team, in order to create a common goal of the priorities of the work. Changes in repertoires were dependent on the urgency of the situation and the interaction between team members. When using these repertoires, the leaders positioned themselves in different ways, either on an authoritarian or a more egalitarian level.ConclusionThis study indicates that communication in trauma teams is complex and consists of more than just transferring messages quickly. It also concerns what the leaders express, and even more importantly, how they speak to and involve other team members.

Communication in interdisciplinary teams: exploring closed-loop communication during in situ trauma team training

“…The variable authoritarian leadership style is the sum of coercive (orders, commands) and educating (transferring knowledge) turn-constructional units. 20 Since the variable is the sum of turn-constructional units, it is a continuous variable and can vary between 0 and ∞. In this study, the variable authoritarian leadership style varied between 0 and 20.…”

“…The variable egalitarian leadership style is the sum of discussing (involved team members agree in the decision-making process) and negotiating (disagreements between team members in the decision-making process) turn-constructional units. 20 The variable is a continuous variable, the sum of turnconstructional units, and can vary between 0 and ∞. In this study, the variable egalitarian leadership style varied between 2 and 16.…”

“…[18][19][20] Closed-loop communication (CLC), including call-out (CO), is an important part of the concept based on the assumption that safe communication in an emergency situation is achieved by standardised terminology and procedures. 14 15 CO is the first verbalisation of an observation and it makes the team aware of important changes, particularly when something appears to be wrong.…”

“…In a previous study, we showed that trauma team leaders used a mix of authoritarian and egalitarian leadership styles in order to achieve common goals. 20 Leadership style determines the culture within the team and can in turn influence when and how often team members speak up when unexpected and urgent changes in a patient's condition occur. 11 In sum, in order to prevent errors in healthcare, CLC has been assumed to be a necessary component to ensure and facilitate safe team communication.…”

Conducting the emergency team: A novel way to train the team-leader for emergencies

“…However, leadership in emergencies is considered very important for patient safety [3, 4, 5, 6, 7, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20] and can affect mortality [4, 7, 9, 16]. …”