[[Leading]] #note/idea # Articles ### Leadership in different resuscitation situations Trends in Anesthesia and Critical Care 2014 [[Leadership in different resuscitation situations.pdf]] - [x] Read A leader should be identified in every resuscitation situation In the first three to 5 min of a resuscitation, the main tasks are to recognize the cardiac arrest as such and take immediate action. Leadership is most crucial in this phase. Simulator studies found that more directive leadership in the first few minutes, but not later on, increased the overall resuscitation performance. the most important challenge for a leader is to recognize which leadership behaviour is optimally adapted in a specific moment[[Initiation Phase of Resuscitation#Leading to Recovery Group Performance and Coordinative Activities in Medical Emergency Driven Groups]]. ...resident physicians often feel unprepared and uncomfortable to take the lead in resuscitations. Even after training, their confidence levels with regard to leading a resuscitation team remain low. There is signficant inter-individual variation in the number of leadership utterances [[Initiation Phase of Resuscitation#Leadership in Medical Emergencies Depends on Gender and Personality]] Ad hoc teams perform significantly worse than established teams in the first 3 minutes of CPR due to process losses from to having to integrate new team members & the need to integrate new team members hindered the emergence of a leadership structure in ad-hoc teams [[Hands on time during cardiopulmonary resuscitation is affected by the process of teambuilding Hunziker.pdf]] It is recommended to explicitly lead every resuscitation team. However, it is important that directive leadership is not enacted in an overly authoritarian or even demeaning way, because this may hinder team members to share their observations and to speak up. ### Leading to Recovery: Group Performance and Coordinative Activities in Medical Emergency Driven Groups Human **Performance**. 2006, Vol. 19 Issue 3, p277-304. 28p. ### Leadership in Medical Emergencies Depends on Gender and Personality Sim Healthcare 6:78–83, 2011 [[Leadership in Medical Emergencies Depends on Gender and Personality Streiff.pdf]] - [x] Read During the initial phase of a medical emergency, there is a substantial interindividual variation in the amount of leadership. The authors found correlation with the number of leadership statements with gender and personality, but not with clinical knowledge or experience. 4th year medical students in groups of 3 with one nurse. Not fully applicable but elements are likely helpful to keep in mind. To me, this correlation is less important than the fact that there is signficant interindividual variation. ### Speaking Up Is Related to Better Team Performance in Simulated Anesthesia Inductions : An Observational Study Kolbe, M. , Burtscher, M. J. , Wacker, J. , Grande, B. , Nohynkova, R. , Manser, T. , Spahn, D. R. & Grote, G. (2012). Speaking Up Is Related to Better Team Performance in Simulated Anesthesia Inductions. Anesthesia & Analgesia, 115(5), 1099–1108. doi: 10.1213/ANE.0b013e318269cd32. [[Speaking Up Is Related to Better Team Performance in Simulated Anesthesia Inductions An Observational Study.pdf]] - [x] Read ### Decisive action vs. joint deliberation: Different medical tasks imply different coordination requirements Tschan, F., Semmer, N. K., Hunziker, S., & Marsch, S. C. U. (2011). Decisive action vs. joint deliberation: Different medical tasks imply different coordination requirements. _Advances in human factors and ergonomics in healthcare_, 191-200. Chicago [[tschan decisive action vs joint deliberation.pdf]] ### Leadership of resuscitation teams: ‘Lighthouse Leadership’ - [x] Read This was a study of video taped resuscitations (only 20 total) that were cardiac arrests lasting 3-19 minutes at a large hospital. The leader becomes less likely to implement a structure within the team when they are performing hands on tasks, making the team less effective. There was no relationship between experience and leadership rating There was no relationship between ACLS training and leadership rating Direction and command are essential components of leadership but the leader must also engender trust and respect, accept assistance and guidance.