Development and Empirical Testing of a Novel Team Leadership Assessment Measure: A Pilot Study Using Simulated and Live Patient Encounters

Validity evidence of a resuscitation team leadership assessment measure for use in actual trauma resuscitations

Background

Team leadership is a critical skill in trauma resuscitation teams, linked to better teamwork and improved patient care. There are numerous published team leadership assessments, though data regarding the performance of these measures in patient care settings (vs. simulation-based settings) remain limited. There remains a need for a valid, reliable, and efficient measure of resuscitation team leadership in the clinical setting to support medical education and research efforts.

Methods

We constructed a 12-item behaviorally anchored rating scale (BARS) to measure trauma team leadership. Multiple raters then used the BARS to measure team leadership in 360 recorded trauma resuscitations across 60 participants. In addition to examining inter-rater reliability, we examined the construct validity of the BARS assessment through both correlational and latent modeling techniques to compare the ratings collected with the BARS to those collected using a previously studied checklist-based assessment using a multitrait-multimethod (MTMM) approach. Lastly, we examined the criterion validity of the BARS measure by examining its relationship with previously obtained patient care scores.

Results

BARS items demonstrated high inter-rater reliability when scores were computed using observations averaged over multiple raters (mean item intraclass correlations ICC1k 0.90, item range 0.85-0.98). The correlation between the aggregate ratings from the team leadership BARS and checklist measure demonstrated a strong positive correlation (r = 0.75), and the MTMM analyses indicated consistent evidence for both convergent (mean monotrait-heteromethod r = 0.50) and discriminant (mean heterotrait-heteromethod r = 0.27) validity. Hierarchical Bayesian regression analyses revealed that aggregate BARS scores were predictive of patient care scores (β = 7.06, 95% HDI 3.76-10.43).

Conclusions

The team leadership BARS and a previously studied checklist-based team leadership measure produced convergent assessments of team leadership behavior in the present data. Furthermore, higher overall ratings on the BARS correlated with better patient care delivery at the team level.

Leadership factors for cardiopulmonary resuscitation for clinicians in-hospital; behaviours, skills and strategies: A systematic review and synthesis without meta-analysis

AIM

To identify leadership factors for clinicians during in-hospital cardiopulmonary resuscitation.

DESIGN

Systematic review with synthesis without meta-analysis.

METHODS

The review was guided by SWiM, assessed for quality using CASP and reported with PRISMA.

DATA SOURCES

Cochrane, EMBASE, PubMed, Medline, Scopus and CINAHL (years of 2013-2023) and a manual reference list search of all included studies.

RESULTS

A total of 60 papers were identified with three major themes of useful resuscitation leadership; 'social skills', 'cognitive skills and behaviour' and 'leadership development skills' were identified. Main factors included delegating effectively, while being situationally aware of team members' ability and progress during resuscitation, and being empathetic and supportive, yet 'controlling the room' using a hands-off style. Shared decision-making to reduce cognitive load for one leader was shown to improve effective teamwork. Findings were limited by heterogeneity of studies and inconsistently applied tools to measure leadership.

CONCLUSION

Traditional authoritarian leadership styles are not wanted by team members with preference for shared leadership and collaboration. Balancing this with the need for team members to see leaders in 'control of the room' brings new challenges for leaders and trainers of resuscitation.

IMPLICATIONS FOR NURSING PROFESSION

All clinicians need effective leadership skills for cardiopulmonary resuscitation in-hospital. Nurses provide first response and ongoing leadership for cardiopulmonary resuscitation. Nurses typically display suitable skills that align with useful resuscitation leader factors.

IMPACT

What were the main findings? Collaboration rather than an authoritarian approach to leadership is preferred by team members. Nurses are suitable to 'control the room'. Restricting resuscitation team size will manage disruptive behaviour of team members.

TRIAL REGISTRATION

PROSPERO Registration: CRD42022385630.

PATIENT OF PUBLIC CONTRIBUTION

No patient of public contribution.

Validity evidence for a team-leading assessment tool in pediatric emergency resuscitations using video review

Background

Effective leadership of health care action teams has demonstrated positive influence on team performance and patient care, but there is no consensus on how to assess these skills. We developed a novel team leadership assessment tool for leaders of interprofessional pediatric resuscitation teams and collected validity evidence for this tool using video review.

Methods

This was a prospective cohort study from November 2021 to October 2022. A novel team leadership assessment tool was developed using literature review and local expertise and then piloted and refined using medical simulation. Pediatric emergency medicine (PEM) fellows from a single tertiary care pediatric medical center were enrolled, and videos of one medical resuscitation and one trauma resuscitation were collected per fellow each month. Three reviewers underwent reviewer training and then scored the videos using the assessment tool. Raters provided feedback on feasibility and ease of use using a 5-point Likert scale. Inter-rater reliability for the assessment tool using Gwet's agreement coefficient and the association between performance and clinical level of training using generalized linear mixed model were calculated.

Results

Twelve PEM fellows enrolled and 146 videos were reviewed. The inter-rater reliability for each domain ranged from 0.45 (p < 0.0001) to 0.59 (p < 0.0001), with the inter-rater reliability of the total score being 0.49 (p < 0.0001). The reviewers' mean ratings of the elements of the tool were as follows: clarity of the domains (4.6/5), the independence of each domain from each other (3.9/5), the ease of use of the 5-point Likert scale (4.5/5), the usefulness of the provided examples for each domain (4.6/5), and the ability to assess each domain without having to rewatch (4.5/5). The tool differentiated between levels of clinical training for two of the six domains (p < 0.02).

Conclusions

We developed a novel team leadership assessment tool for pediatric resuscitation team leaders that demonstrated moderate inter-rater reliability. The tool was easy to use and feasible for educators to assess the performance of PEM trainees in complex high-stakes clinical situations.

Elements of Teamwork in Resuscitation: An Integrative Review

Objective

To identify the elements of teamwork in resuscitation, an integrative review and synthesize current primary studies conducted.

Methods

PubMed, Scopus, Web of Science, and Embase, as well as Google Scholar search engine were searched from November 2015 to March 2020 to review previously published peer-reviewed studies. Out of the 5495 articles, 16 were finally included in the study. Search strategy implemented with these keywords (in the title/abstract) were (team* AND CPR) or (team* AND resuscitation). Six descriptive criteria was performed by using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline to analyze the articles and a modified version of Cooper's five-stage method.

Results

Sixteen studies were included in this research. Twenty elements related to teamwork in resuscitation were identified by using data synthesis, then classified into four categories includes team interaction elements, leadership skills, individual elements and environmental elements. Communication, leadership, situation awareness and scene organization had the highest frequency of reviewed articles 10, 5, 4, 4, respectively.

Conclusion

The interactions between resuscitation team members and the skills of the leader and team members along with environmental elements had attracted the most attention of researchers by focusing on teamwork in resuscitation. Due to the limited number of articles related to this subject, more research is needed to reveal all the key elements of teamwork in resuscitation.

Review article: Systematic literature review of leadership in emergency departments

Emergency medicine (EM) is a discipline with complex leadership demands. However, studies of EM physician leadership and ED leadership are in their infancy. As such, there is a lack of clarity about the forms, antecedents, enablers, barriers and consequences of EM physician leadership. A systematic review of the scientific literature was conducted to reveal the different conceptualisations of EM physician leadership, the activities involved in the practice of leadership, and the knowledge and skills of effective ED leaders. Seven databases were systematically searched for peer-reviewed empirical studies on the topic of EM physicians carrying out a manager or leadership role in an ED setting. Finally, 26 articles were included, and their findings were synthesised and analysed narratively. Two conceptualisations of EM physician leadership were found, reflecting clinical leadership and medical leadership, respectively. Clinical leadership is performed by all EM physicians, often informally, within their daily clinical practice, whereas medical leadership is performed by EM physicians who work at the management level within a hospital, in addition to or instead of their clinical practice. The focus of EM physician leadership and ED leadership research is team leadership, with much less attention given to wider organisation leadership. Consistent with the focus on team leadership, clinical knowledge and skill in orchestrating teams, especially trauma and resuscitation teams, emerged as the most important factors underpinning leadership effectiveness. Future research and training should make better use of existing leadership theory and research designs to illuminate the forms, dynamics, antecedents, moderators and consequences of EM physician leadership.