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

Abstract

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.

Followership in health care clinicians: a scoping review

“…In this subcategory, researchers attempted to identify some of the core skills, characteristics, qualities, abilities, and attitudes that are thought to be required for effective followers. There were only 4 studies classified in this subcategory based on their main aims 50–53 ; however, we searched all included literature for KSAOs relevant to effective followership, as illustrated in Figure 3.…”

“…The 42 included studies were conducted between 1983 and 2021 25–66 . Twenty-nine studies were published as journal articles, and the remaining 13 were PhD theses.…”

“…Studies in this category (n = 12; 29%) focused on exploring health care clinicians’ perceptions about the concept or role of followership, the core skills and qualities required for effective followership, and the quality of interaction between followers and leaders (Table 5). 46–57 More detail is provided in the following subcategories.…”

“…Approximately 31% of the included papers were at this level of followership research utilizing qualitative and observational studies. Qualitative studies have been employed to understand health care clinicians’ experiences of followership, 43–45 their perceptions about the roles of followership and leadership, 46,49 and the important KSAOs for effective followers and quality of interaction between followers and leaders in clinical practice 50,52,53,56 . Understanding clinicians’ experiences and perceptions, and what meaning they associate with the roles of leadership and followership, is important because this could impact the ways in which followers and leaders work together in the collaborative delivery of health care 46,51 .…”

Followership in interprofessional healthcare teams: a state-of-the-art narrative review

“…21 29 71-73 The literature also highlights the importance of being self-aware and able to manage emotions effectively while also being aware of other's emotions and managing those emotions when working with others. 14-16 49 53 55 70 72 Current research into followership in IHTs also argues for the importance of creating a psychologically safe environment 13 15 21 42-44 51 53 55 61 [69][70][71][72] to empower followers. And yet, while many publications encourage followers to be courageous 14 16 30 43 45 49 53 55 70 in taking on this new active collaborator role, several manuscripts also highlight the need to be honest, 13 14 16 49 51 53 55 70 73 credible 14 49 70 and trustworthy.…”