Followership: A review of the literature in healthcare and beyond

Leung, Caleb; Lucas, Amanda; Brindley, Peter G.; Anderson, Shellie; Park, Jason; Vergis, Ashley; Gillman, Lawrence M.

doi:10.1016/j.jcrc.2018.05.001

Cited by 30 publications

(26 citation statements)

References 7 publications

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“… 42–44 However, speaking up behaviours have been reported to be psychologically uncomfortable for healthcare workers. 10 13 Japanese interviewees considered this behaviour as an important quality for exemplary followers, similar to US interviewees; however, they specified that it was difficult to do so in real life because of the relatively high power distance in Japanese culture. Acknowledging the impact of the cultural background on followership behaviours may help educators in their approach when teaching communication strategies during resuscitation training.…”

Section: Discussionmentioning

confidence: 97%

“… 7–9 Followership in a clinical setting is hard to define. 10 The followership behaviour of team members is a complex element of teamwork that incorporates role, skills and social interactions that compliments, enhances and enables both team and leader functions. In a qualitative study interviewing medical trainees in the UK, positive followership attributes were shown to be achieving and embracing change, doing the job and working with others.…”

Section: Introductionmentioning

confidence: 99%

“… 11–13 In such hierarchal organisations, proactive followership plays an important role in better team performance, job satisfaction and patient safety. 10 …”

Section: Introductionmentioning

confidence: 99%

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Physicians’ perceptions of followership in resuscitation in Japan and the USA: a qualitative study

et al. 2021

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ObjectivesWhile leadership is accepted as a crucial aspect of a successful resuscitation team, the role of followership has not been sufficiently explored. This study aims to explore physicians’ perceptions of common favourable followership in resuscitation teams in two different countries.DesignA qualitative study with interviews and a reflexive thematic analysis.SettingThe authors individually interviewed critical care and emergency physicians whose clinical experience exceeded 6 years in Japan and the USA.ParticipantsA total of 18 physicians participated in a face-to-face, semistructured and in-depth interviews.ResultsFive themes and nine subthemes related to followership in resuscitation were identified. Under technical skills, two themes (being knowledgeable and skilled) and three subthemes (understanding guidelines/algorithms, clinical course and being competent with procedural skills), were generated. Under non-technical skills, three themes (assuming roles, team communication and flattening hierarchy) and six subthemes (taking roles spontaneously, calm tone of voice, sharing information, closed-loop communication, respectful attitude and speaking up), were generated. Each generated theme involved commonly perceived favourable attributes of followership in resuscitation teams by experienced critical care and emergency physicians in both countries.ConclusionsThis study clarified physicians’ perception of common favourable followership attributes in resuscitation teams, both in Japan and in the USA. The results of this study shed light on followership-focused resuscitation education, where followership skills are generally underestimated.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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Physicians’ perceptions of followership in resuscitation in Japan and the USA: a qualitative study

et al. 2021

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“…This investigation found six characteristics supporting successful MIHTs that can be organized into two themes: (1) own your purpose and responsibilities, and (2) get it done, safely. We acknowledge that research into civilian interprofessional healthcare teams have noted the existence of some of these characteristics (e.g., leadership with followership [19][20][21][22]). However, this investigation highlights how these six characteristics are uniquely combined and relied upon by MIHTs to provide high-quality patient care under the most challenging circumstances.…”

Section: Discussionmentioning

confidence: 99%

Delivering patient care during large-scale emergency situations: Lessons from military care providers

et al. 2021

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Background Today, physicians are at the front lines of a pandemic response. Military physicians are uniquely trained to excel in such large-scale emergency situations. Civilian physicians can harness military know-how, but it will require research into military healthcare responses—specifically, we need to learn lessons from military interprofessional healthcare teams (MIHTs). Methods This research answers two questions: What are the characteristics of successful MIHTs? Why are those characteristics important to MIHT success in large-scale emergency situations? Using a Grounded Theory approach, 30 interviews were conducted soliciting perspectives from the broadest range of healthcare professionals who had experiences working in and leading MIHTs. Purposive sampling was used to recruit participants broadly across: contexts where MIHTs work; military branches; ranks; genders; and healthcare professions. Data were iteratively collected and analyzed. Results 30 participants were interviewed (18 male (60%); 21 officers (70%); 9 enlisted (30%)) who held various healthcare occupations (medic/tech/corpsman (9); nurse (7); physician (7); dentist (2); occupational therapist (2); chaplain (1); physician’s assistant (1); and psychiatrist (1)). Six characteristics of successful MIHTs that are directly applicable to large-scale emergency situations were identified thatthat clustered into two themes: own your purposes and responsibilities (through mission focus and ethical bearing) and get it done, safely (via situational awareness, adaptability, and leadership with followership). Conclusions This study provides insights, informed by decades of military service and training, to help civilian physicians succeed in large-scale emergency situations. These experiences from the war front can support today’s pandemic responses on the home front.

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“…One of the central tenets of leadership theory is that leadership is not defined by position, but rather by commensal relationships with their followers, whereby they are expected to rise up to the expectations of followers and others within the enterprise [4]. This means that leaders are not as independent and omnipotent as they are perceived by others, or even by themselves [5].…”

Section: Main Textmentioning

confidence: 99%

The ecology of program director leadership: power relationships and characteristics of effective program directors

2019

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BackgroundProgram directors are often perceived as strong and independent leaders within the academic medical environment. However, they are not as omnipotent as they initially appear. Indeed, PDs are beholden to a variety of different agents, including trainees (current residents, residency applicants, residency alumni), internal influencers (departmental faculty, hospital administration, institutional graduate medical education), and external influencers (the Accreditation Council for Graduate Medical Education (ACGME), medical education community, and society-at-large). Altogether, these agents form a complex ecosystem whose dynamics and relationships shape the effectiveness of program directors.Main bodyThis perspective uses management theory to examine the characteristics of effective PD leadership. We underline the importance of authority, accessibility, adaptability, authenticity, accountability, and autonomy as core features of successful program directors. Additionally, we review how program directors can use the six power bases (legitimacy, referent, informational, expert, reward, and coercive) to achieve positive and constructive change within the complexity of the academic medical ecosystem. Lastly, we describe how local and national institutions can better structure power relationships within the ecosystem so that PD leadership can be most effective.ConclusionKeen leadership skills are required by program directors to face a variety of challenges within their educational environments. Understanding power structures and relationships may aid program directors to exercise leadership judiciously towards fulfilling the educational missions of their departments.

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Followership: A review of the literature in healthcare and beyond

Cited by 30 publications

References 7 publications

Physicians’ perceptions of followership in resuscitation in Japan and the USA: a qualitative study

Physicians’ perceptions of followership in resuscitation in Japan and the USA: a qualitative study

Delivering patient care during large-scale emergency situations: Lessons from military care providers

The ecology of program director leadership: power relationships and characteristics of effective program directors

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