Team leadership is hard [duh]. Teaching it to our trainees is even tougher. When you work in a team of true experts with established implicit communication, things just flow–giving the the team leader the impression that they actually know what the hell they are doing. The mark of a good team leader is how they handle a less than ideal team. I found a true master to interview on the topic of team leadership–friend of the show, Cliff Reid.
- Authoritative vs. empowering
- Be Aware that many of us are helped or hurt by implicit biases
Gender bias paper
- Ju et al. Effect of Professional Background and Gender on Residents’ Perceptions of Leadership. Academic Medicine. 2019 Nov;94:S42–7.
Prep and Prebrief
Where to Stand
- Foot of the bed in the opinion of Cliff and me
Zero Point Survey (ZPS)
- Cliff's Video on ZPS
- Perform STEP at the beginning then UP for team recaps
Recap / SitRep / Updates-Priorities
- What am I missing here?
How to Lead from the Follower Slot
- Pacing and Leading
- Play to their ego
Drive by Voice / Fly by Voice
- Commentary Driving
Eyes On / Eyes Off
More from Cliff on EMCrit
- How to Be a Hero with Cliff Reid
- Making Things Happen with Cliff Reid
- Mind of the Resuscitationist with Cliff Reid
- Cliff Reid's Own the Resus Room
- Resus Communication
- Hicks Human Factors for Teams Summary from Simulcast
- Hicks Fog of War
- Another of those duh studies, but it had to be done — No difference between EM and surgery resident team leading for trauma
- ABCs of Team Leadership from Regions
- Brindley on followership
Post Publication Peer Review from Iain Beardsell
I really enjoyed the podcast, and having learnt first hand from Cliff I hope I practice (as in try to get better at) lots of what you discussed. A few additional thoughts if you don’t mind…
1, I think it is useful to have some version of a script for parts – I have one for introductions and zero point survey, one for when the EMS arrive (“My name is Iain, I’ll be the trauma team leader – is your patient stable for a hands off handover?”), and one prior to transfer (using a checklist – “this is a challenge/response checklist please say yes is you believe it has been completed”). I think this especially useful for the introverted amongst us. It takes away the “pressure” of meeting new team members and sets the tone. It also gives “tent poles” around which to work and keep moving forward.
2, Use first names – during the introductions we all write our first names on stickers that also have our role. It flattens the hierarchy and feels more like a team of equals.
3, Do a mission rehearsal with the team beforehand if time allows. “The patient will arrive, I’ll ask the team if they are stable for a hands-off handover, if they are we will all listen quietly, Ann (anaesthetist) – look at her directly – please can you check the airway and Benton – look at him directly – please can you do the B & C, when that is complete we will reassess what will happen next, but our aim will be to got to scan if there are no immediate life threats.”
4, At the end of my briefing I always say “please remember that a quiet trauma call is a good trauma call. Please don’t just shout random instructions across the bay. If you need anything, just ask me, my name is Iain, and I will make it happen. If you see anything that you feel we are missing please also just say”.
5, If the patient is not “stable” for a hands off handover I will ask the EMS team leader to continue the resuscitation and I will stand back, until such time as there is an appropriate time for them to handover to me. If there is suspicion of this from the prealert I will brief the team that this may happen.
6, I usually remind the team that the EMS have been in a really tricky situation out “in the field” and have done their best. We weren’t there – there is absolutely nothing to be gained from criticizing their management (“did you know the tube was down the right main bronchus?”.
7, Set time goals (I learned this from Cliff!) – “We’ve got this and this and this to do…. (Look at the clock) – I want us to leave here for scan in ten minutes – that’s by 7.45.
8, As a TTL you are somewhat “playing a part”. I compare this to being in a West End musical – even a show that has been playing 8 times a week, for each audience member it has to feel like the first time. Bring the same enthusiasm to the next trauma as you did to your first.
9, Remember that some people will be s*-t scared. It may the first trauma they have seen or been part of. Forgive them if this then translates into uncertainty (or false confidence). This stuff is tricky.
10, Watch each other – just like doing a presentation/talk there will be things you don’t realize you do. You need others to spot these – ask a colleague to come in specifically with the role of watching what you do, your tone of voice, how you communicate, etc. When you ask someone to watch you, ask them if they’d like you to reciprocate.
11, Occasionally (again learned from Cliff) an appropriate physical contact can help people focus. Just a hand on the shoulder whilst you ask them to do something.
12, Never, ever make jokes at other team members expense. Use humor carefully.
14, Be a good follower – if you are being a primary survey doctor while a trainee is leading, exhibit positive followership. Follow requests, don’t subvert what they are doing. Role model behavior.
Sorry – that’s a lot more than I meant to write. Forgive me.
Now on to the Podcast…
- EMCrit 281 – Why Can't Emergency Medicine and Trauma Surgery Just Get Along? - September 4, 2020
- EMCrit 280 – Who Should Get Angiotensin II with Rinaldo Bellomo - August 19, 2020
- EMCrit Wee – Is it Tamponade with Jacob Avila - August 17, 2020