Leadership and interprofessional team management — branching viva

Viva on leading and managing an interprofessional team in child health: leadership styles, building a high-performing team, shared mental models, closed-loop communication, psychological safety, crew resource management, TeamSTEPPS and SBAR, structured handover, conflict and the evidence for team training and interprofessional collaboration.

branching clinical structured oral4 min readVerification in progress

Prompt

Ward: a four-year-old arrests on the paediatric ward at three in the morning; the senior registrar arrives first to find two nurses, a resident and a pharmacist at the bed space, with the parents watching; the registrar has previously been told they 'lead well but need to develop management'; the examiner wants to know how you would actually run this team and build one that performs when you are not there.

Opening (candidate)

My first job is to take the role of team leader out loud, before anything else. I would declare "I am taking the role of team leader", stand back far enough to see the whole bed space, and allocate roles by name and task — airway, compressions, drugs, scribe. I would use closed-loop communication for every dose, build a shared mental model in a structured pause each minute, and flatten the authority gradient so the most junior voice can stop a preventable error. After the event I would debrief. Beyond this single arrest, my job as a consultant is to build a team that performs like this even when I am not standing in it — through role clarity, psychological safety, TeamSTEPPS tools, structured I-PASS handover, and simulation-based crew resource management training with reinforcement. [4] [11] [14]

Paediatrics Fellowship Pro

You have read the opening of this viva. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References8Show ledger

[2]Leonard M, Graham S, Bonacum D The human factor: the critical importance of effective teamwork and communication in providing safe care. Quality & safety in health care, 2004.PMID 15465961
[3]Salas E, DiazGranados D, Klein C, Burke CS Does team training improve team performance? A meta-analysis. Human factors, 2008.PMID 19292013
[4]Manser T Teamwork and patient safety in dynamic domains of healthcare: a review of the literature. Acta anaesthesiologica Scandinavica, 2009.PMID 19032571
[5]Zwarenstein M, Goldman J, Reeves S Interprofessional collaboration: effects of practice-based interventions on professional practice and healthcare outcomes. The Cochrane database of systematic reviews, 2009.PMID 19588316
[11]Cheng A, Donoghue A, Gilfoyle E, Eppich W Simulation-based crisis resource management training for pediatric critical care medicine: a review for instructors. Pediatric critical care medicine, 2012.PMID 21499181
[13]Starmer AJ, Spector ND, Srivastava R, West DC Changes in medical errors after implementation of a handoff program. The New England journal of medicine, 2014.PMID 25372088
[14]Al-Sawai A Leadership of healthcare professionals: where do we stand? Oman medical journal, 2013.PMID 23904925
[15]Berghout MA, Fabbricotti IN, Buljac-Samardžić M, et al. Medical leaders or masters? A systematic review of medical leadership in hospital settings. PloS one, 2017.PMID 28910335