Original ReportsA Video Analysis of Intra- and Interprofessional Leadership Behaviors Within “The Burns Suite”: Identifying Key Leadership Models
Introduction
Key leadership attributes are well defined in the literature and in the context of surgery encompass multiple virtues, which include technical competence, professionalism, motivation, innovation, teamwork, effective communication, emotional competence, and teaching; they can be developed through observation, experience, and education.1 Leadership is particularly important in complex highly interprofessional health care contexts involving a number of staff, some from the same specialty (intraprofessional), and others from different specialties (interprofessional). Recently interprofessional teamwork has become an important aspect of work in health care.2 Maximizing patient safety and reducing medical errors depends not only on technical expertise but also on how decisions are made and how relevant information is communicated and tasks are coordinated.
It is well established that simulation can play a powerful role in clinical training.3 Educational theory highlights the importance of contextualized simulation for effective learning.4 An important aspect of surgical practice is the ability to function effectively in a setting where team members share responsibility of the patient during a procedure.3 Such elements are more complex and much harder to define than technical skills. Often they are invisible when working well, surfacing only when things go wrong. A more satisfactory conception of effective simulation may therefore highlight it as a spectrum of resources alongside clinical care to complement its richness. Within the appropriate context and design, simulation may therefore provide a unique opportunity to help trainees/residents develop adequate leadership skills, within the surgical environment. Simulation-based team training (SBTT) and debriefing is an evolving educational strategy that encourages work-based learning, collaboration, and teamwork.5 Current SBTT programs often include targets and feedback focused on the whole team or leader or both, ignoring the “follower” as a unique entity. Such programs do not fully appreciate and recreate the dynamic realities and complexities of team leadership, where the follower is as important or leadership is “shared.”6
Dedicated simulation facilities are scarce, expensive, and resource intensive. To maximize the value of immersive simulation, it should be available to all those who require it. A novel, low-cost, high-fidelity, portable, immersive simulation environment (referred to as distributed simulation or DS) has recently been developed.3 This concept has been shown to be effective for the delivery of burns education to both surgical experts and novices within an acute resuscitation scenario, denoted as “The Burns Suite” (TBS).7 TBS was also shown to be a novel simulation tool to deliver interprofessional training and SBTT in a burns resuscitation scenario comprising doctors and nurses.8
Over the last decade there has been an interest in exploring leadership behaviors of trauma resuscitation teams9, 10, 11, 12 and surgeons.13, 14, 15 Künzle et al.12 examined intraprofessional leadership behaviors of anesthetists within a simulated airway induction on a mannequin in the operating room. They reported the effectiveness of shared (or distributed) leadership in situations with high task complexity and indicated that a clear distribution of content-oriented and structuring leadership of team members is an effective strategy. Henrickson Parker et al.13 have recently published the Surgeon’s Leadership Inventory (SLI) to rate surgeon’s intraoperative leadership behaviors. This was proposed following an in-depth analysis of the surgical and leadership literature, combined with data from focus group interviews with expert surgeons. They reported 8 domains for the SLI: maintaining standards, making decisions, managing resources, directing, training, supporting others, communicating, and coping with pressure. Although the SLI domains primarily indicate behaviors observed in the operating room, potentially they may be explored for use in working environments such as the resuscitation room (where, although the procedure is not an actual technical operation, the behaviors required to achieve a successful resuscitation require a combination of technical and nontechnical skills).
The dynamics of a team within a resuscitation scenario can be complex. It is unknown which leadership behaviors are the most important and whether they can be modeled on to current leadership theory. Exploring this may inform the development of future leadership scenarios within TBS, specifically if the use of TBS were to further expand into the delivery of “nontechnical skills.” Given the fact that TBS is a novel realistic simulation modality comprising an immersive portable simulation environment and authentic clinical scenario, the purpose of this study was to perform a comprehensive video analysis of leadership behaviors within TBS, to explore whether SBTT within TBS can elaborate on key leadership theories, and which leadership models appeared predominant within TBS.
Section snippets
Materials and Methods
This study had approval from the Imperial College London ethics committee. Using a wide-angle Sony HD camcorder, 3 burns resuscitation simulations within TBS were recorded and were available for analysis. The inclusion criteria were (1) a complete (i.e., start to finish) scenario recording and (2) clear audio quality requisite to capturing all communication between the burns resuscitation team. All 3 videos met these criteria and were scrutinized.
A total of 12 participants (6 doctors and 6
Results
All 3 scenarios were successfully completed. A total of 68 minutes of video recordings was reviewed, with a mean scenario duration of 23 minutes. A total of 362 leadership behaviors of the 12 participants were identified in all 3 videos. Table 3 summarizes the frequency of the 8 identified leadership behaviors by each of the 4 team member categories (i.e., senior surgeon, trainee surgeon, senior nurse, and trainee nurse). Although it appeared that senior surgeons displayed the greatest number
Discussion
This study reports a detailed video analysis of leadership behaviors within 3 authentically replicated burns simulation resuscitation scenarios in TBS. The results suggest that although the senior surgeon followed by the senior nurse displayed the highest frequency of leadership behaviors, statistically there was no difference in frequency of leadership behaviors of participants, i.e., effectively they showed a similar number of behaviors. It must be noted that frequency of specific leadership
Conclusions
Effective leadership is essential for successful functioning of work teams and accomplishment of task goals.33, 34 As the resuscitation of a patient with major burns is a dynamic event, team leaders require flexibility in their leadership behaviors to effectively adapt to changing situations. Understanding leadership behaviors of different team members within an authentic simulation can identify important behaviors required to optimize nontechnical skills in a major resuscitation, and it can be
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Cited by (18)
Leadership characteristics for interprofessional collaboration in China
2020, Journal of Professional Nursing“SIMBurns”: A high-fidelity simulation program in emergency burn management developed through international collaboration
2019, BurnsCitation Excerpt :Simulation is not an entirely new concept and has been used by several specialties including anesthesia, emergency medicine, gynecology, otolaryngology, cardiology, and cardiac surgery in order to teach CRM principles and decision-making skills [10–13]. While HFS is an ideal model to prepare healthcare providers for urgent situations, it is unclear to what extent emergency care teams in the field of burn management are utilizing HFS due to lack of published literature on the topic [14–18]. It also may be that HFS, while being a tremendous resource for emergency burn management has not been adopted by many institutions, even though it is an effective resource when it comes to the rare nature of burn injuries.
Training residents to lead emergency teams: A qualitative review of barriers, challenges and learning goals
2018, HeliyonCitation Excerpt :Qualitative research helps describe and find the reasons for needs, behaviour, emotions and its social context and therefore the reason for the methodology used in this study. It should be noted that in this study, articles with a qualitative approach were identified: Sadideen et al. [36], Leenstra et al. [10], Kolehmainen et al. [20], Jacobsson et al. [18], Hjortdahl et al. [4], and Yule et al. [37]. This study has three questions for the literature.
A search for training of practising leadership in emergency medicine: A systematic review
2018, HeliyonCitation Excerpt :A total of 24 studies found it appropriate to use statistics to prove the measurability of the outcome [1, 2, 3, 4, 5, 7, 8, 9, 10, 11, 15, 16, 20, 23, 25, 32, 33, 34, 35, 36, 37, 38, 39, 40], 15 studies used comparative statistics [1, 2, 3, 5, 7, 10, 11, 15, 23, 32, 33, 34, 35, 37, 38], nine other used descriptive statistics [4, 8, 9, 16, 20, 25, 36, 39, 40]. Six different definitions of leadership were identified [1, 4, 33, 35, 36, 40], the definitions were centred mostly on achieving common aims through collaboration between leader and team. Leadership is implicitly also defined in the Leadership Behaviour Description Questionnaire (LBDQ) checklist [29, 33, 41] (adapted from military, created in 1945), as well as in the Non-Technical Skills checklist (NOTECHS) (adapted from aviation to healthcare for the first time in 2003, Anaesthetists' non-technical skills [42] (ANTS)).
Education in burns: Lessons from the past and objectives for the future
2017, BurnsCitation Excerpt :Furthermore, team members dress as they would at work and play their roles as they do in real life, adding to the intended realism of the scenario [10,31,32]. Proponents argue that current burns courses are valuable for acquiring basic burns management skills, but lack the realism that can be achieved within contextualised simulation [10,31,32]. On a different note, as acute burn care is team based, non-technical skill development is also important in the effective acute management of a burn patient.
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