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Teamwork and Leadership in the Critical Care Unit

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The Organization of Critical Care

Part of the book series: Respiratory Medicine ((RM,volume 18))

Abstract

Effective multidisciplinary teamwork and team leadership have been shown as essential for the safe management of patients in intensive care medicine (ICM). Solutions to improve teamwork and leadership have been developed, but with mixed success. It is observed that to improve teamwork in ICM, interventions must reflect (1) the demands and constraints of ICM, and how they influence team behaviour and (2) the specific teamwork skills and behaviours that are associated with safe patient care. Research in ICM shows that effective team leadership is the key determinant of team functioning, and that interventions should focus on enhancing leadership. Yet, simply applying leadership solutions developed in other domains (e.g. aviation) is not appropriate. Specifically, the flow and nature of work, and the changeable and complex construction of teams, means that tools for improving and assessing leadership need to be designed to reflect the very specific constraints of ICM.

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References

  1. Salas E, Bowers C, Edens E. Improving teamwork in organizations: applications of resource management training. Mawah: LEA; 2001.

    Google Scholar 

  2. O’Connor P, Campbell J, Newon J, Melton J, Salas E, Wilson K. Crew resource management training effectiveness: a meta-analysis and some critical needs. Int J Aviat Psychol. 2008;18:353–68.

    Article  Google Scholar 

  3. Bell ST. Deep-level composition variables as predictors of team performance: a meta-analysis. J Appl Psychol. 2007;92:595–615.

    Article  PubMed  Google Scholar 

  4. Burke CS, Stagl K, Salas E, Pierce L, Kendall D. Understanding team adaptation: a conceptual analysis and model. J Appl Psychol. 2006;91:1189–207.

    Article  PubMed  Google Scholar 

  5. Paris C, Salas E, Cannon-Bowers J. Teamwork in multi-person systems: a review and analysis. Ergonomics. 2000;43:1052–75.

    Article  CAS  PubMed  Google Scholar 

  6. Vincent C. Patient safety. London: Elsevier; 2006.

    Google Scholar 

  7. Gawande AA, Studdert D, Zinner M, Brennan TA. Analysis of errors reported by surgeons at three teaching hospitals. Surgery. 2003;133:614–21.

    Article  PubMed  Google Scholar 

  8. Flin R, Maran N. Identifying and training non-technical skills for teams in acute medicine. Qual Saf Health Care. 2004;13(Suppl 1):80–4.

    Google Scholar 

  9. Reader T, Flin R, Lauche K, Cuthbertson B. Non-technical skills in the intensive care unit. Br J Anaesth. 2006;96:551–9.

    Article  CAS  PubMed  Google Scholar 

  10. Bion J, Heffner JE. Challenges in the care of the acutely ill. Lancet. 2004;363:970–7.

    Article  CAS  PubMed  Google Scholar 

  11. Reader T, Cuthbertson B, Decruyenaere J. Burnout in the ICU: potential consequences for staff and patient well-being. Intensive Care Med. 2008;34:4–6.

    Article  PubMed  Google Scholar 

  12. Donchin Y, Gopher D, Olin M, et al. A look into the nature and causes of human errors in the intensive care unit. Crit Care Med. 1995;23:294–300.

    Article  CAS  PubMed  Google Scholar 

  13. Walker S, Brett S. Oiling the wheels of intensive care to reduce “machine friction”: the best way to improve outcomes? Crit Care Med. 2010;38(10 Suppl):S642–8.

    Article  PubMed  Google Scholar 

  14. Valentin A, Bion J. How safe is my intensive care unit? An overview of error causation and prevention. Curr Opin Crit Care. 2007;13:697–702.

    Article  PubMed  Google Scholar 

  15. Pronovost PJ, Thompson D, Holzmueller C, et al. Toward learning from patient safety reporting systems. J Crit Care. 2006;21:305–15.

    Article  PubMed  Google Scholar 

  16. Baggs JG, Schmitt MH, Mushlin AI, Mitchell PH, Eldrege DH, Oakes D. Association between nurse-physician collaboration and patient outcomes in three intensive care units. Crit Care Med. 1999;27:1991–8.

    Article  CAS  PubMed  Google Scholar 

  17. Shortell SM, Zimmerman JE, Rousseau DM, et al. The performance of intensive care units: does good management make a difference? Med Care. 1994;32:508–25.

    Article  CAS  PubMed  Google Scholar 

  18. Pronovost PJ, Berenholtz SM, Ngo K, et al. Developing and pilot testing quality indicators in the intensive care unit. J Crit Care. 2003;18:145–55.

    Google Scholar 

  19. Huang D, Clermont G, Sexton J, et al. Perceptions of safety culture across the intensive care units of a single institution. Crit Care Med. 2007;35:165–76.

    Article  PubMed  Google Scholar 

  20. Salas E, Wilson-Donnelly K, Sims D, Burke CS, Priest H. Teamwork training for patient safety: best practices and guiding principles. In: Carayon P, editor. Handbook of human factors and ergonomics in health care and patient safety. Mahwah: LEA; 2007. p. 803–22.

    Google Scholar 

  21. Thomas EJ, Sexton J, Helmreich RL. Discrepant attitudes about teamwork among critical care nurses and physicians. Crit Care Med. 2003;31:956–9.

    Article  PubMed  Google Scholar 

  22. Morgeson F, DeRue D, Karam E. Leadership in teams: a functional approach to understanding leadership structures and processes. J Manag. 2010;36:5–39.

    Google Scholar 

  23. Bion J, Fox-Kirk W. Eighteenth century mindsets, twenty-first century challenges: the physician as team player. Crit Care Med. 2009;37:1288–9.

    Article  Google Scholar 

  24. Reader T, Flin R, Cuthbertson B. Factors affecting team communication in the intensive care unit. In: Nemeth C, editor. Improving healthcare team communication: building on lessons from aviation and aerospace. Aldershot: Ashgate; 2008. p. 117–34.

    Google Scholar 

  25. Malhotra S, Jordan D, Shortliffe EH, Patel V. Workflow modeling in critical care: piecing together your own puzzle. J Biomed Inform. 2007;40:81–92.

    Article  PubMed  Google Scholar 

  26. Manser T. Teamwork and patient safety in dynamic domains of healthcare: a review of the literature. Acta Anaesthesiol Scand. 2009;53:143–51.

    Article  CAS  PubMed  Google Scholar 

  27. Reader T, Flin R, Mearns K, Cuthbertson B. Developing a team performance framework for the intensive care unit. Crit Care Med. 2009;35:1787–93.

    Article  Google Scholar 

  28. Kim J, Neilipovitz D, Cardinal P, Chiu M, Clinch J. A pilot study using high-fidelity simulation to formally evaluate performance in the resuscitation of critically ill patients: The University of Ottawa Critical Care Medicine, High-Fidelity Simulation, and Crisis Resource Management I Study. Crit Care Med. 2006;34:2167–74.

    Article  PubMed  Google Scholar 

  29. Ottestad E, Boulet J, Lighthall G. Evaluating the management of septic shock using patient simulation. Crit Care Med. 2007;35:769–75.

    Article  PubMed  Google Scholar 

  30. Thomas EJ, Sexton J, Lasky R, Helmreich RL, Crandell D, Tyson J. Teamwork and quality during neonatal care in the delivery room. J Perinatol. 2006;26:163–9.

    Article  CAS  PubMed  Google Scholar 

  31. Stockwell D, Slonim A, Pollack M. Physician team management affects goal achievement in the intensive care unit. Pediatr Crit Care Med. 2007;8:840–5.

    Google Scholar 

  32. Nembhard I, Edmondson AC. Making it safe: the effects of leader inclusiveness and professional status on psychological safety and improvement efforts in health care teams. J Organ Behav. 2006;27:941–66.

    Article  Google Scholar 

  33. Flin R, O’Connor P, Crichton M. Safety at the sharp end. A guide to non-technical skills. Aldershot: Ashgate; 2008.

    Google Scholar 

  34. Reader T, Flin R, Cuthbertson B. Communication skills and error in the intensive care unit. Curr Opin Crit Care. 2007;13:732–6.

    Article  PubMed  Google Scholar 

  35. Reader T, Flin R, Mearns K, Cuthbertson B. Interdisciplinary communication in the intensive care unit. Br J Anaesth. 2007;98:347–52.

    Article  CAS  PubMed  Google Scholar 

  36. Reader T, Flin R, Mearns K, Cuthbertson B. Team situation awareness and the anticipation of patient progress during ICU rounds. BMJ Qual Saf. 2011;20:1035–42.

    Article  PubMed  Google Scholar 

  37. Endsley M. Towards a theory of situation awareness in dynamic systems. Hum Factors. 1995;37:32–64.

    Article  Google Scholar 

  38. Wright M, Endsley M. Building situation awareness in healthcare teams. In: Nemeth C, editor. Improving healthcare team communication. Aldershot: Ashgate; 2008. p. 97–114.

    Google Scholar 

  39. Patel V, Zhang J, Yoskowitz N, Green RA, Osman RS. Translational cognition for decision support in critical care environments: a review. J Biomed Inform. 2008;41:413–31.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Gurses A, Xiao Y. A systematic review of the literature on multidisciplinary rounds to design information technology. J Am Med Inform Assoc. 2006;13:267–76.

    Article  PubMed Central  PubMed  Google Scholar 

  41. Stanton N, Salmon P, Walker G, Baber C, Jenkins D. Human factors methods: a practical guide for engineering and design. Aldershot: Ashgate; 2005.

    Google Scholar 

  42. Reader T, Cuthbertson B. Teamwork and team training in the ICU: where do the similarities with aviation end? Crit Care. 2011;15:313–9.

    Article  PubMed Central  PubMed  Google Scholar 

  43. Fackler J, Watts C, McHugh A, Miller T, Crandall B, Pronovost P. Critical care physician cognitive task analysis: an exploratory study. Crit Care. 2009;13:R33.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Raduma-Tomàs M, Flin R, Yule S, Williams D. Doctor’s handovers in hospitals: a literature review. BMJ Qual Saf. 2011;20:128–33.

    Article  PubMed  Google Scholar 

  45. Reader T, Flin R, Cuthbertson B. Team leadership in the intensive care unit. The perspective of specialists. Crit Care Med. 2011;39:1683–91.

    Article  PubMed  Google Scholar 

  46. Sexton J, Thomas EJ, Helmreich RL. Error, stress and teamwork in medicine and aviation: cross sectional surveys. Br Med J. 2000;320:745–9.

    Article  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Social Psychology, London School of Economics, Houghton Street, London, WC2A 2AE, UK

    Tom W. Reader

  2. Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, Canada, M4N 3M5

    Brian H. Cuthbertson

Authors
  1. Tom W. Reader
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  2. Brian H. Cuthbertson
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Corresponding author

Correspondence to Tom W. Reader .

Editor information

Editors and Affiliations

  1. Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada

    Damon C. Scales

  2. Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada

    Gordon D. Rubenfeld

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Reader, T.W., Cuthbertson, B.H. (2014). Teamwork and Leadership in the Critical Care Unit. In: Scales, D., Rubenfeld, G. (eds) The Organization of Critical Care. Respiratory Medicine, vol 18. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4939-0811-0_9

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  • DOI: https://doi.org/10.1007/978-1-4939-0811-0_9

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  • Publisher Name: Humana Press, New York, NY

  • Print ISBN: 978-1-4939-0810-3

  • Online ISBN: 978-1-4939-0811-0

  • eBook Packages: MedicineMedicine (R0)

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