Trauma Leadership: Does Perception Drive Reality?

Sakran, Joseph V.; Finneman, B.; Maxwell, Chris; Sonnad, Seema S.; Sarani, Babak; Pascual, José L.; Kim, Patrick; Schwab, C. William; Sims, Carrie A.

doi:10.1016/j.jsurg.2011.09.004

Cited by 38 publications

(18 citation statements)

References 11 publications

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“…residents, trauma fellows, and nurses) after a resuscitation. The evaluation tool is rated on a four-point Likert-type scale in nine leadership domains: vision, management, empowerment, diplomacy, feedback, innovative/creative, style, energy, and leadership 18. The LBDQ was the only scale used in more than one study 9, 13.…”

Section: Resultsmentioning

confidence: 99%

Leadership and Teamwork in Trauma and Resuscitation

Ford

Menchine

Burner

et al. 2016

WestJEM

118

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IntroductionLeadership skills are described by the American College of Surgeons’ Advanced Trauma Life Support (ATLS) course as necessary to provide care for patients during resuscitations. However, leadership is a complex concept, and the tools used to assess the quality of leadership are poorly described, inadequately validated, and infrequently used. Despite its importance, dedicated leadership education is rarely part of physician training programs. The goals of this investigation were the following: 1. Describe how leadership and leadership style affect patient care; 2. Describe how effective leadership is measured; and 3. Describe how to train future physician leaders.MethodsWe searched the PubMed database using the keywords “leadership” and then either “trauma” or “resuscitation” as title search terms, and an expert in emergency medicine and trauma then identified prospective observational and randomized controlled studies measuring leadership and teamwork quality. Study results were categorized as follows: 1) how leadership affects patient care; 2) which tools are available to measure leadership; and 3) methods to train physicians to become better leaders.ResultsWe included 16 relevant studies in this review. Overall, these studies showed that strong leadership improves processes of care in trauma resuscitation including speed and completion of the primary and secondary surveys. The optimal style and structure of leadership are influenced by patient characteristics and team composition. Directive leadership is most effective when Injury Severity Score (ISS) is high or teams are inexperienced, while empowering leadership is most effective when ISS is low or teams more experienced. Many scales were employed to measure leadership. The Leader Behavior Description Questionnaire (LBDQ) was the only scale used in more than one study. Seven studies described methods for training leaders. Leadership training programs included didactic teaching followed by simulations. Although programs differed in length, intensity, and training level of participants, all programs demonstrated improved team performance.ConclusionDespite the relative paucity of literature on leadership in resuscitations, this review found leadership improves processes of care in trauma and can be enhanced through dedicated training. Future research is needed to validate leadership assessment scales, develop optimal training mechanisms, and demonstrate leadership’s effect on patient-level outcome.

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Section: Resultsmentioning

confidence: 99%

Leadership and Teamwork in Trauma and Resuscitation

Ford

Menchine

Burner

et al. 2016

WestJEM

118

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“…The capability and experience of the team leader seemed to be more important than his/her seniority. Sakran et al surveyed the prospective teamwork assessment of trauma teams and showed that the experience of the attending surgeon affected the clinical efficiency compared to those teams directed by less experienced surgeons, who also took significantly longer time to complete the survey [ 27 ]. The same authors also speculated that more formal leadership training could potentially improve patient care and should be included in surgical education.…”

Section: Discussionmentioning

confidence: 99%

Effect of a simulation-based workshop on multidisplinary teamwork of newborn emergencies: an intervention study

Rovamo

Nurmi

Mattila³

et al. 2015

BMC Res Notes

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BackgroundVideo analyses of real-life newborn resuscitations have shown that Neonatal Resuscitation Program (NRP) guidelines are followed in fewer than 50 % of cases. Multidisciplinary simulation is used as a first-rate tool for the improvement of teamwork among health professionals. In the study we evaluated the impact of the crisis resource management (CRM) and anesthesia non-technical skills instruction on teamwork during simulated newborn emergencies.MethodsNinety-nine participants of two delivery units (17 pediatricians, 16 anesthesiologists, 14 obstetricians, 31 midwives, and 21 neonatal nurses) were divided to an intervention group (I-group, 9 teams) and a control group (C-group, 6 teams). The I-group attended a CRM and ANTS instruction before the first scenario. After each scenario the I-group performed either self- or peer-assessment depending on whether they had acted or observed in the scenario. All the teams participated in two and observed another two scenarios. All the scenarios were video-recorded and scored by three experts with Team Emergency Assessment Measure (TEAM). SPSS software and nlme package were used for the statistical analyses.ResultsThe total TEAM scores of the first scenario between the I- and C-group did not differ from each other. Neither there was an increase in the TEAM scoring between the first and second scenario between the groups. The CRM instruction did not improve the I-group’s teamwork performance. Unfortunately the teams were not comparable because the teams had been allowed to self-select their members in the study design. The total TEAM scores varied a lot between the teams. Mixed-model linear regression revealed that the background of the team leader had an impact on differences of the total teamwork scores (D = 6.50, p = 0.039). When an anesthesia consultant was the team leader the mean teamwork improved by 6.41 points in comparison to specialists of other disciplines (p = 0.043).ConclusionThe instruction of non-technical skills before simulation training did not enhance the acquisition of teamwork skills of the intervention groups over the corresponding set of skills of the control groups. The teams led by an anesthesiologist scored the best. Experience of team leaders improved teamwork over the CRM instruction.

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“…However, non-verbal communication must also be taken into consideration since it represents more than 65 % of the communication [ 5 ]. Leadership has been described as another key factor in the trauma team’s performance [ 6 – 8 ]. The designated team leader is responsible for effective communication in order to supervise and coordinate the team members’ activities [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Trauma team leaders’ non-verbal communication: video registration during trauma team training

Härgestam

Hultin

Brulin

et al. 2016

Scand J Trauma Resusc Emerg Med

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BackgroundThere is widespread consensus on the importance of safe and secure communication in healthcare, especially in trauma care where time is a limiting factor. Although non-verbal communication has an impact on communication between individuals, there is only limited knowledge of how trauma team leaders communicate. The purpose of this study was to investigate how trauma team members are positioned in the emergency room, and how leaders communicate in terms of gaze direction, vocal nuances, and gestures during trauma team training.MethodsEighteen trauma teams were audio and video recorded during trauma team training in the emergency department of a hospital in northern Sweden. Quantitative content analysis was used to categorize the team members’ positions and the leaders’ non-verbal communication: gaze direction, vocal nuances, and gestures. The quantitative data were interpreted in relation to the specific context. Time sequences of the leaders’ gaze direction, speech time, and gestures were identified separately and registered as time (seconds) and proportions (%) of the total training time.ResultsThe team leaders who gained control over the most important area in the emergency room, the “inner circle”, positioned themselves as heads over the team, using gaze direction, gestures, vocal nuances, and verbal commands that solidified their verbal message. Changes in position required both attention and collaboration. Leaders who spoke in a hesitant voice, or were silent, expressed ambiguity in their non-verbal communication: and other team members took over the leader’s tasks.DiscussionIn teams where the leader had control over the inner circle, the members seemed to have an awareness of each other’s roles and tasks, knowing when in time and where in space these tasks needed to be executed. Deviations in the leaders’ communication increased the ambiguity in the communication, which had consequences for the teamwork. Communication cannot be taken for granted; it needs to be practiced regularly just as technical skills need to be trained. Simulation training provides healthcare professionals the opportunity to put both verbal and non-verbal communication in focus, in order to improve patient safety.ConclusionsNon-verbal communication plays a decisive role in the interaction between the trauma team members, and so both verbal and non-verbal communication should be in focus in trauma team training. This is even more important for inexperienced leaders, since vague non-verbal communication reinforces ambiguity and can lead to errors.

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Trauma Leadership: Does Perception Drive Reality?

Cited by 38 publications

References 11 publications

Leadership and Teamwork in Trauma and Resuscitation

Leadership and Teamwork in Trauma and Resuscitation

Effect of a simulation-based workshop on multidisplinary teamwork of newborn emergencies: an intervention study

Trauma team leaders’ non-verbal communication: video registration during trauma team training

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