Leadership in Healthcare Emergency Teams

Leadership in emergency healthcare teams is pivotal to ensuring optimal team performance and deserves significant attention. In a recent review, Steinbach et al. (2024) highlight the critical importance of leadership within ad hoc critical care teams. However, their findings reveal that despite substantial efforts to improve teamwork in healthcare, poor leadership persists. This stagnation may stem from the siloed development of leadership models within specific disciplines or the failure to incorporate social science frameworks that offer standardised approaches to studying leadership. However, their research confirms the relevance of many established leadership behaviours to critical care contexts.

Steinbach et al. (2024) explored how team members perceive effective leadership, emphasising the unique dynamics of ad hoc teams formed during unfolding emergencies. They argue that traditional models from trauma, emergency, or surgical teams may not adequately address the challenges of ad hoc groups. These challenges include diverse clinical scenarios, limited algorithmic guidance, and the need to lead in unfamiliar environments. While their findings align with established research across healthcare disciplines, they also underscore the distinct demands of such teams. 

Leadership, recognised as vital to team function, has been widely studied across various team types. Initial research emphasised the attributes and styles of hierarchical leaders, often focusing on command-and-control methods, termed “Lighthouse Leadership.” This approach positioned leadership as a role exclusive to one individual, overlooking the contributions of other team members without formal authority. Over time, researchers adopted a functional perspective, shifting from “who” leads to “what” leadership entails. This shift facilitated the development of taxonomies and tools to identify actionable and trainable leadership behaviours, particularly in surgical, trauma, and emergency department teams.

In ad hoc teams, as Steinbach et al. (2024) note, a leader’s ability to assemble and direct the team during an emergency is critical. Established research has long demonstrated the connection between team performance and the leader’s capacity to create structure. Steinbach et al.’s (2024) theme of “control,” which encompasses asserting leadership roles and delegating responsibilities, highlights this task’s importance. However, rapid and effective implementation of these practices requires further exploration. Strategies like role tagging have been attempted but face logistical and adaptability challenges.

Goal setting is another crucial leadership task, especially in uncertain or non-algorithmic situations. Balancing the time needed for organisation and planning with the urgency of action is a critical yet underexplored aspect of ad hoc leadership. Similarly, fostering psychological safety—ensuring team members feel supported and empowered to speak up—is vital for high-performing teams. Steinbach et al.’s (2024) themes of “collaboration” and “maintaining composure” align with existing frameworks, emphasising the importance of respectful communication and managing team affect. Simulation training and stress management strategies, such as using inclusive language during team updates, can help leaders build psychological safety and promote shared understanding.

Another essential task is developing shared mental models through regular updates, recaps, and team reflexivity. Effective recaps during transitions in team membership, patient condition, or location are crucial for maintaining alignment. Structured tools, like those described by Weller et al. (2014), offer practical frameworks for such updates, which can be adapted to fit various contexts.

To achieve these key tasks—structuring the team, setting goals, fostering psychological safety, and building shared mental models—leaders can employ simple frameworks like “name, claim, aim” during team formation, followed by structured recaps. However, the broad scope of leadership responsibilities, including clinical decision-making, resource management, and communication, often necessitates delegation and shared leadership approaches. These models distribute leadership tasks among team members, reducing the burden on a single individual and enhancing overall effectiveness.

Steinbach et al. (2024) provide valuable insights into effective leadership within ad hoc teams, reinforcing established principles while addressing unique challenges. Their findings underscore the need for future research to adopt a functional perspective, exploring how leadership tasks might be shared to prevent overburdening a single leader. With continued research and the implementation of evidence-based training programmes, healthcare can make significant strides toward achieving optimal performance in emergency team settings.

Source: Chest
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