Advertisement

Implizite Führungstheorien in Akutsituationen im Gesundheitswesen

„Kobra, übernehmen Sie!“
  • Julia SeelandtEmail author
  • Bastian Grande
  • Michaela Kolbe
Hauptbeiträge

Zusammenfassung

In diesem Beitrag der Zeitschrift „Gruppe. Organisation. Interaktion. (GIO)“ untersuchen wir die impliziten Theorien zur Führung von medizinischen ad-hoc Teams in Notfallsituationen und diskutieren diese im Hinblick auf aktuelle Forschungsergebnisse. Führung spielt in medizinischen ad-hoc Teams, insbesondere in Notfallsituationen, eine entscheidende Rolle. Die Entwicklung von Führungskompetenzen ist daher essentiell. Studien haben gezeigt, dass sich erfolgreiche Führungskräfte eher durch ihre innere Handlungslogik als durch ihren Führungsstil von weniger erfolgreichen Führungskräften abheben. Die Kenntnis dieser impliziten Theorien ist für die Entwicklung und Durchführung von medizinischen Führungstrainings von großer Bedeutung. In dieser Studie haben wir die impliziten Führungstheorien von 119 Anästhesisten/-innen und Pflegefachpersonen im Verlauf von Debriefings im Rahmen von Simulationstrainings erfasst und anhand eines Kodiersystems kodiert. Die anschliessende Analyse ergab 125 implizite Führungstheorien, die wir vier Themen zuordneten: Ambivalenzen in der Übernahme der Führungsrolle, Last der Führungsrolle, Führung durch Erfahrung sowie Erfolgsdruck beim Führen. Diese impliziten Theorien haben wir mit Blick auf die aktuellen Forschungsergebnisse zu Führung diskutiert und Empfehlungen für den klinischen Alltag sowie theoretische Implikationen abgeleitet.

Schlüsselwörter

Führung Medizinische ad-hoc Teams Implizite Theorien Notfallsituation Zusammenarbeit Human factors 

Implicit leadership theories of ad-hoc healthcare teams during non-routine situations

Please take over!

Abstract

In this article in the journal “Gruppe. Interaktion. Organisation. (GIO)”, we aimed at identifying implicit leadership theories of ad-hoc healthcare teams during non-routine situations and discussed these theories with regard to current research findings. Leadership during non-routine situations has been found to be essential for team functioning in ad-hoc teams and patient safety. The development of leadership competence is essential. Studies have shown that what discriminates effective leaders from less effective leaders is their action logic rather than their leadership style. The knowledge of these implicit theories is particular important for the design and conduct of leadership training in healthcare. We have analyzed the implicit leadership theories of 119 anesthesia care providers (physicians and nurses) during debriefings of simulation-based team training. Through qualitative data analysis we identified four main implicit leadership theories: ambivalence of the leader role, burden of leadership, obtaining leadership via experience, pressure to succeed. We discuss these implicit leadership theories with regard to current research findings of leadership and practical relevance for leadership training in healthcare.

Keywords

Leadership Ad-hoc teams Implicit theories Non-routine situations Teamwork Human factors 

Notes

Danksagung

Wir bedanken uns herzlich für die Unterstützung bei der Durchführung der Simulationstraining und Debriefings bei Niels Buse, Michael Hanusch, Hubert Heckel, Axel Knauth und Adrian Marty sowie bei Alfons Scherrer und Andrina Nef für die technische Unterstützung und Sarah Kriech, Lynn Häsler sowie Rebecca Hasler für die Unterstützung bei der Kodierung der Debriefing-Videos.

Funding

Der Beitrag wurde im Rahmen des interdisziplinären Projektes „Debriefings as Enabler for Learning in Ad-hoc Action Teams in Healthcare“ verfasst, welches durch den Schweizer Nationalfond finanziell unterstützt wird (Grant Nr. 100014_152822).

Literatur

  1. Abelson, R. P. (1976). Script processing in attitude formation and decision making. In J. S. Caroll & J. W. Payne (Hrsg.), Cognition and social behavior (S. 33–46). Hillsdale: Lawrence Erlbaum.Google Scholar
  2. Burns, J. M. (1978). Transforming leadership. London: Grove.Google Scholar
  3. Burtscher, M. J., & Manser, T. (2012). Team mental models and their potential to improve teamwork and safety: a review and implications for future research in healthcare. Safety Science, 50, 1344–1354. doi: 10.1016/j.ssci.2011.12.033.CrossRefGoogle Scholar
  4. Chiu, C., Dweck, C. S., Tong, J. Y., & Fu, J. H. (1997). Implicit theories and conceptions of morality. Journal of Personality and Social Psychology, 73, 923.CrossRefGoogle Scholar
  5. Christian, Gustafson, Roth, Sheridan, Gandhi, Dwyer, Zinner, & Dierks (2006). A prospective study of patient safety in the operating room. Surgery, 139, 159–173. doi: 10.1016/j.surg.2005.07.037.CrossRefPubMedGoogle Scholar
  6. Cook-Greuter (2004). Making the case for a developmental perspective. Industrial and Commercial Training, 36, 275–281. doi: 10.1108/00197850410563902.CrossRefGoogle Scholar
  7. Cooper, & Wakelam (1999). Leadership of resuscitation teams: “Lighthouse Leadership”. Resuscitation, 42(1), 27–45. doi: 10.1016/s0300-9572(99)00080-5.CrossRefPubMedGoogle Scholar
  8. Cooper, Singer, Hayes, Sales, Vogt, Raemer, & Meyer (2011). Design and evaluation of simulation scenarios for a program introducing patient safety, teamwork, safety leadership, and simulation to healthcare leaders and managers. Simulation in Healthcare, 6, 231–238. doi: 10.1097/sih.0b013e31821da9ec.CrossRefPubMedGoogle Scholar
  9. Dankoski, Bickel, & Gusic (2014). Discussing the undiscussable with the powerful: Why and how faculty must learn to counteract organizational silence. Academic Medicine, 89, 1610–1613. doi: 10.1097/acm.0000000000000428.CrossRefPubMedGoogle Scholar
  10. Detert, & Edmondson (2011). Implicit voice theories: taken-for-granted rules of self-censorship at work. Academy of Management Journal, 54, 461–488.CrossRefGoogle Scholar
  11. Edmondson (1999). Psychological safety and learning behavior in work teams. Administrative Science Quarterly, 44, 350–383.CrossRefGoogle Scholar
  12. Edmondson (2003). Speaking up in the operating room: How team leaders promote learning in interdidisciplinary action teams. Journal of Management Studies, 40, 1419–1452.CrossRefGoogle Scholar
  13. Edmondson (2012). Teaming: How organizations learn, innovate, and compete in the knowledge economy. San Francisco: Jossey-Bass.Google Scholar
  14. Edmondson, & Lei (2014). Psychological safety: the history, renaissance, and future of an interpersonal construct. Annual Review of Organizational Psychology and Organizational Behavior, 1(1), 23–43. doi: 10.1146/annurev-orgpsych-031413-091305.CrossRefGoogle Scholar
  15. Fernandez Castelao, Russo, Cremer, Strack, Kaminski, Eich, Timmermann, & Boos (2011). Positive impact of crisis resource management training on no-flow time and team member verbalisations during simulated cardiopulmonary resuscitation: A randomised controlled trial. Resuscitation, 82(11), 1338–1343. doi: 10.1016/j.resuscitation.2011.05.009.CrossRefPubMedGoogle Scholar
  16. Fernandez Castelao, Russo, Riethmüller, & Boos (2013). Effects of team coordination during cardiopulmonary resuscitation: a systematic review of the literature. Journal of Critical Care, 28, 504–521.CrossRefPubMedGoogle Scholar
  17. Flin, Yule, Paterson-Brown, Rowley, & Maran (2006). The non-technical skills for surgeons (NOTSS) system handbook v1. 2. Aberdeen: University of Aberdeen.Google Scholar
  18. Fortune, Davis, Hanson, & Phillips (2012). Human factors in the health care setting: a pocket guide for clinical instructors. Chichester: John Wiley & Sons.Google Scholar
  19. Grande, Weiss, Biro, Grote, Steiger, Spahn, & Kolbe (2015). Is talking important? Technical versus combined technical/non-technical airway training in anaesthesia and intensive care medicine. Anästhesiologie & Intensivmedizin, 56, 5–12.Google Scholar
  20. Hunziker, Buhlmann, Tschan, Balestra, Legeret, Schumacher, Semmer, & Marsch (2010). Brief leadership instructions improve cardiopulmonary resuscitation in a high-fidelity simulation: a randomized controlled trial. Critical Care Medicine, 38, 1086–1091. doi: 10.1097/CCM.0b013e3181cf7383.CrossRefPubMedGoogle Scholar
  21. Kahneman (2011). Thinking, fast and slow. New York: Farrar, Straus and Giroux.Google Scholar
  22. Khamis, Satava, Alnassar, & Kern (2016). A stepwise model for simulation-based curriculum development for clinical skills, a modification of the six-step approach. Surgical endoscopy, 30(1), 279–287.CrossRefPubMedGoogle Scholar
  23. Klein, Ziegert, Knight, & Xiao (2006). Dynamic delegation: shared, hierarchical, and deindividualized leadership in extreme action teams. Administrative Science Quarterly, 51, 590–621.CrossRefGoogle Scholar
  24. Klimoski, & Mohammed (1994). Team mental model – construct or metaphor. Journal of Management, 20, 403–437.CrossRefGoogle Scholar
  25. Kolbe, & Grande (2013). Team coordination during cardiopulmonary resuscitation. Journal of Critical Care, 28, 522–523. doi: 10.1016/j.jcrc.2013.03.009.CrossRefPubMedGoogle Scholar
  26. Kolbe, & Grande (2016). „Speaking Up“ statt tödlichem Schweigen im Krankenhaus. Gruppe. Interaktion. Organisation, 47, 299–311.CrossRefGoogle Scholar
  27. Kolbe, Weiss, Grote, Knauth, Dambach, Spahn, & Grande (2013). TeamGAINS: a tool for structured debriefings for simulation-based team trainings. BMJ Quality & Safety, 22, 541–553. doi: 10.1136/bmjqs-2012-000917.CrossRefGoogle Scholar
  28. Kolbe, Grande, & Spahn (2015). Briefing and debriefing during simulation-based training and beyond: content, structure, attitude, and setting. Best Practice & Research: Clinical Anaesthesiology, 29(1), 87–96. doi: 10.1016/j.bpa.2015.01.002.Google Scholar
  29. Künzle, Kolbe, & Grote (2010). Ensuring patient safety through effective leadership behaviour: a literature review. Safety Science, 48(1), 1–17. doi: 10.1016/j.ssci.2009.06.004.CrossRefGoogle Scholar
  30. Künzle, Zala-Mezö, Kolbe, Wacker, & Grote (2010b). Substitutes for leadership in anaesthesia teams and their impact on leadership effectiveness. European Journal of Work and Organizational Psychology, 19, 505–531. doi: 10.1080/13594320902986170.CrossRefGoogle Scholar
  31. Künzle, Zala-Mezö, Wacker, Kolbe, & Grote (2010c). Leadership in anaesthesia teams: the most effective leadership is shared. Quality and Safety in Health Care, 19, 1–6. doi: 10.1136/qshc.2008.030262.CrossRefGoogle Scholar
  32. Larson, Christensen, Franz, & Abbott (1998). Diagnosing groups: the pooling, management, and impact of shared and unshared case information in team-based medical decision making. Journal of Personality and Social Psychology, 75, 93–108. doi: 10.1037/0022-3514.75.1.93.CrossRefPubMedGoogle Scholar
  33. Leonard, Graham, & Bonacum (2004). The human factor: the critical importance of effective teamwork and communication in providing safe care. Quality & Safety in Health Care, 13, 85–90. doi: 10.1136/qshc.2004.010033.CrossRefGoogle Scholar
  34. Levy, Chiu, & Hong (2006). Lay theories and intergroup relations. Group Processes & Intergroup Relations, 9(1), 5–24.CrossRefGoogle Scholar
  35. Loukopoulos, Dismukes, & Barshi (2009). The multitasking myth. Handling complexity in real-world operations. Farnham: Ashgate.Google Scholar
  36. Mangold (2014). INTERACT Benutzerhandbuch. http://www.mangold-international.com. Zugegriffen: 26.08.2016Google Scholar
  37. Manser (2009). Teamwork and patient safety in dynamic domains of healthcare: a review of the literature. Acta Anaesthesiologica Scandinavica, 53(2), 143–151.CrossRefPubMedGoogle Scholar
  38. Mathieu, & Rapp (2009). Laying the foundation for successful team performance trajectories: the roles of team charters and performance strategies. Journal of Applied Psychology, 94(1), 90–103. doi: 10.1037/a0013257.CrossRefPubMedGoogle Scholar
  39. Mathieu, Heffner, Goodwin, Salas, & Cannon-Bowers (2000). The influence of shared mental models on team process and performance. Journal of Applied Psychology, 85, 273–283. doi: 10.1037/0021-9010.85.2.273.CrossRefPubMedGoogle Scholar
  40. Mayring (2002). Einführung in die qualitative Sozialforschung. Eine Anleitung zu qualitativem Denken (5. Aufl.). Weinheim: Beltz Studium.Google Scholar
  41. Miles, & Huberman (1994). Qualitative data analysis. Thousand Oaks: SAGE.Google Scholar
  42. Mohammed, Ferzandi, & Hamilton (2010). Metaphor no more: a 15-year review of the team mental model construct. Journal of Management, 36, 876–910.CrossRefGoogle Scholar
  43. Morgeson, DeRue, & Karam (2010). Leadership in teams: a functional approach to understanding leadership structures and processes. Journal of Management, 36(1), 5–39. doi: 10.1177/0149206309347376.CrossRefGoogle Scholar
  44. Morrison (2014). Employee voice and silence. Annual Review of Organizational Psychology and Organizational Behavior, 1(1), 173–197. doi: 10.1146/annurev-orgpsych-031413-091328.CrossRefGoogle Scholar
  45. Nembhard, & Edmondson (2006). Making it safe: the effects of leader inclusiveness and professional status on psychological safety and improvement efforts in health care teams. Journal of Organizational Behavior, 27(7), 941–966. doi: 10.1002/Job.413.CrossRefGoogle Scholar
  46. Nemeth (2008). Improving healthcare team communication: building on lessons from aviation and aerospace. Hampshire: Ashgate.Google Scholar
  47. Northouse (2012). Leadership: theory and practice. Thousand Oaks: SAGE.Google Scholar
  48. Pearce, Watts, Watkin, Walshe, & Boaden (2006). Team performance, communication and patient safety. In K. Walshe & R. Boaden (Hrsg.), Patient safety: research into practice (S. 208–216). Buckingham: Open University Press.Google Scholar
  49. Porath, Gerbasi, & Schorch (2015). The effects of civility on advice, leadership, and performance. Journal of Applied Psychology, 100, 1527–1541. doi: 10.1037/apl0000016.CrossRefPubMedGoogle Scholar
  50. Pronovost (2013). Teamwork matters. In E. Salas, S. I. Tannenbaum, D. Cohen & G. Latham (Hrsg.), Developing and enhancing teamwork in organizations: evidence-based best practices and guidelines (S. 11–12). San Francisco: Jossey-Bass.Google Scholar
  51. Pronovost, Berenholtz, Goeschel, Needhan, Sexton, Thompson, Hunt, et al. (2006). Creating high reliability in health care organizations. Health Services Research, 41(1), 1599–1677.CrossRefPubMedPubMedCentralGoogle Scholar
  52. Raemer, Kolbe, Minehart, Rudolph, & Pian-Smith (2016). Improving anesthesiologists’ ability to speak up in the operating room: a randomized controlled experiment of a simulation-based intervention and a qualitative analysis of hurdles and enablers. Academic Medicine, 91, 530–539. doi: 10.1097/acm.0000000000001033.CrossRefPubMedGoogle Scholar
  53. Rall, & Gaba (2005). Patient simulators. In R. D. Miller (Hrsg.), Anesthesia (Bd. 6, S. 3073–3103). Philadelphia: Elseviert Churchill Livingstone.Google Scholar
  54. Riethmüller, Fernandez Castelao, Eberhardt, Timmermann, & Boos (2011). Adaptive coordination development in student anaesthesia teams: a longitudinal study. Ergonomics, 55(1), 55–68. doi: 10.1080/00140139.2011.636455.CrossRefGoogle Scholar
  55. Rooke, & Tobert (2005). Seven transformations of leadership. Harvard Business Review, 83(4), 66–76.PubMedGoogle Scholar
  56. Ross (1989). Relation of implicit theories to the construction of personal histories. Psychological Review, 96, 341.CrossRefGoogle Scholar
  57. Rudolph, Simon, Rivard, Dufresne, & Raemer (2007). Debriefing with good judgement: combining rigorous feedback with genuine inquiry. Anesthesiology Clinics, 25, 361–376.CrossRefPubMedGoogle Scholar
  58. Salas, Sims, & Burke (2005). Is there a “Big Five” in teamwork? Small Group Research, 36(5), 555–599.CrossRefGoogle Scholar
  59. Salas, Paige, & Rosen (2013). Creating new realities in healthcare: the status of simulation-based training as a patient safety improvement strategy. BMJ Quality & Safety, 22, 449–452. doi: 10.1136/bmjqs-2013-002112.CrossRefGoogle Scholar
  60. Schmutz, & Manser (2013). Do team processes really have an affect on clinical performance? A systematic literature review. British Journal of Anaesthesia, 110, 529–544. doi: 10.1093/bja/aes513.CrossRefPubMedGoogle Scholar
  61. Seelandt, Grande, & Kolbe (2016). DE-CODE: A coding scheme for assessing debriefing interactions Google Scholar
  62. St. Pierre, Hofinger, Buerschaper, & Simon (2011). Crisis management in acute care settings. Berlin: Springer.CrossRefGoogle Scholar
  63. St. Pierre, Scholler, Strembski, & Breuer (2012). Äussern Assistenzärzte und Pflegekräfte sicherheitsrelevante Bedenken? Simulatorstudie zum Einfluss des „Autoritätsgradienten“/Do residents and nurses communicate safety relevant concerns? Simulation study on the influence of the authority gradient. Anaesthesist, 61, 857–866. doi: 10.1007/s00101-012-2086-1.CrossRefPubMedGoogle Scholar
  64. Staender, Wacker, & Kolbe (2015). Ausbildung im Thema Patientensicherheit – Fachkräfte früh für eine Sicherheitskultur sensibilisieren. In P. Gaussmann, M. Henninger & J. Koppenberg (Hrsg.), Patientensicherheitsmanagement. Berlin: De Gruyter.Google Scholar
  65. Di Stefano, Gino, Pisano, & Staats (2016). Making experience count: the role of reflection in individual learning. Harvard Business School Working Paper, 14–093.Google Scholar
  66. Sundar, Sundar, Pawlowski, Blum, Feinstein, & Pratt (2007). Crew resource management and team training. Anesthesiology Clinics, 25, 283–300. doi: 10.1016/j.anclin.2007.03.011.CrossRefPubMedGoogle Scholar
  67. Tschan, Semmer, Gautschi, Hunziker, Spychiger, & Marsch (2006). Leading to recovery: group performance and coordinative activities in medical emergency driven groups. Human Performance, 19, 277–304.CrossRefGoogle Scholar
  68. Tschan, Semmer, Hunziker, & Marsch (2011). Decisive action vs. joint deliberation: different medical tasks imply different coordination requirements. In V. G. Duffy (Hrsg.), Advances in human factors and ergonomics in healthcare (S. 191–200). Boca Raton: Taylor & Francis.Google Scholar
  69. Tschan, Semmer, Hunziker, Kolbe, Jenni, & Marsch (2014). Leadership in different resuscitation situations. Trends in Anaesthesia and Critical Care. doi: 10.1016/j.tacc.2013.12.001.Google Scholar
  70. Tschan, Seelandt, Keller, Semmer, Kurmann, Candinas, & Beldi (2015). Impact of case-relevant and case-irrelevant communication within the surgical team on surgical-site infection. British Journal of Surgery, 102, 1718–1725.CrossRefPubMedGoogle Scholar
  71. Tucker, & Edmondson (2003). Why hospitals don’t learn from failures. California Management Review, 45, 55–72.CrossRefGoogle Scholar
  72. Undre, Sevdalis, Healey, Darzi, & Vincent (2006). Teamwork in the operating theatre: cohesion or confusion? Journal of Evaluation in Clinical Practice, 12, 182–189. doi: 10.1111/j.1365-2753.2006.00614.x.CrossRefPubMedGoogle Scholar
  73. van Knippenberg, van Ginkel, & Homan (2013). Diversity mindsets and the performance of diverse teams. Organizational Behavior and Human Decision Processes, 121, 183–193.CrossRefGoogle Scholar
  74. Vincent (2011). Patient safety. Chichester: John Wiley & Sons.Google Scholar
  75. Weiss (2014). Speaking up for the patient. Individual and team-related antecedents of voice in healthcare teams. PhD-Thesis. Zürich: ETH Zürich.Google Scholar
  76. Yukl (2002). Leadership in organizations (5. Aufl.). Upper Saddle River: Pearson Prentice Hall.Google Scholar
  77. Zaccaro, Rittman, & Marks (2002). Team leadership. The Leadership Quarterly, 12, 451–483.CrossRefGoogle Scholar

Copyright information

© Springer Fachmedien Wiesbaden 2017

Authors and Affiliations

  • Julia Seelandt
    • 1
    Email author
  • Bastian Grande
    • 2
  • Michaela Kolbe
    • 3
  1. 1.Simulationszentrum, Qualitätsmanagement und PatientensicherheitUniversitätsspital ZürichZürichSchweiz
  2. 2.Simulationszentrum, Institut für AnästhesiologieUniversitätsspital ZürichZürichSchweiz
  3. 3.Simulationszentrum, ETH ZürichUniversitätsspital ZürichZürichSchweiz

Personalised recommendations