Taxonomy of Trauma Leadership Skills: A Framework for Leadership Training and Assessment

Purpose Good leadership is essential for optimal trauma team performance, and targeted training of leadership skills is necessary to achieve such leadership proficiency. To address the need for a taxonomy of leadership skills that specifies the skill components to be learned and the behaviors by which they can be assessed across the five phases of trauma care, the authors developed the Taxonomy of Trauma Leadership Skills (TTLS). Method Critical incident interviews were conducted with trauma team leaders and members from different specialties—emergency physicians, trauma surgeons, anesthesiologists, and emergency ward nurses—at three teaching hospitals in the Netherlands during January–June 2013. Data were iteratively analyzed for examples of excellent leadership skills at each phase of trauma care. Using the grounded theory approach, elements of excellent leadership skills were identified and classified. Elements and behavioral markers were sorted and categorized using multiple raters. In a two-round verification process in late 2013, the taxonomy was reviewed and rated by trauma team leaders and members from the multiple specialties for its coverage of essential items. Results Data were gathered from 28 interviews and 14 raters. The TTLS details 5 skill categories (information coordination, decision making, action coordination, communication management, and coaching and team development) and 37 skill elements. The skill elements are captured by 67 behavioral markers. The three-level taxonomy is presented according to five phases of trauma care. Conclusions The TTLS provides a framework for teaching, learning, and assessing team leadership skills in trauma care and other complex, acute care situations.

[1]  W. McGaghie,et al.  A critical review of simulation‐based medical education research: 2003–2009 , 2010, Medical education.

[2]  A multicentre observational study to evaluate a new tool to assess emergency physicians' non-technical skills , 2012, Emergency Medicine Journal.

[3]  L. Lingard,et al.  Grounded theory in medical education research: AMEE Guide No. 70 , 2012, Medical teacher.

[4]  H. Champion,et al.  The Injury Severity Score revisited. , 1988, The Journal of trauma.

[5]  Michaela Kolbe,et al.  Co-ACT—a framework for observing coordination behaviour in acute care teams , 2013, BMJ quality & safety.

[6]  Maritha Jacobsson,et al.  Flexible knowledge repertoires: communication by leaders in trauma teams , 2012, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.

[7]  M. Makary,et al.  Operating room teamwork among physicians and nurses: teamwork in the eye of the beholder. , 2006, Journal of the American College of Surgeons.

[8]  E. Cole,et al.  Can residents be effective trauma team leaders in a major trauma centre? , 2013, Injury.

[9]  T. Manser,et al.  Human factors in clinical handover: development and testing of a 'handover performance tool' for doctors' shift handovers. , 2013, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[10]  A. Edmondson Speaking Up in the Operating Room: How Team Leaders Promote Learning in Interdisciplinary Action Teams , 2003 .

[11]  Gudela Grote,et al.  Ensuring patient safety through effective leadership behaviour: A literature review , 2010 .

[12]  Ken R Catchpole,et al.  A Multicenter Trial of Aviation-Style Training for Surgical Teams , 2010, Journal of patient safety.

[13]  Colin F. Mackenzie,et al.  Adaptive leadership in trauma resuscitation teams: a grounded theory approach to video analysis , 2004, Cognition, Technology & Work.

[14]  Elaine Cole,et al.  The culture of a trauma team in relation to human factors. , 2006, Journal of clinical nursing.

[15]  Lawrence W. Way,et al.  The Efficacy of Medical Team Training: Improved Team Performance and Decreased Operating Room Delays: A Detailed Analysis of 4863 Cases , 2010, Annals of surgery.

[16]  J. Mckee,et al.  Compliance to advanced trauma life support protocols in adult trauma patients in the acute setting , 2013, World Journal of Emergency Surgery.

[17]  Anselm L. Strauss,et al.  Basics of qualitative research : techniques and procedures for developing grounded theory , 1998 .

[18]  D. Waisel Developing Social Capital in the Operating Room: The Use of Population-based Techniques , 2005, Anesthesiology.

[19]  Magnus Hultin,et al.  Communication in interdisciplinary teams: exploring closed-loop communication during in situ trauma team training , 2013, BMJ Open.

[20]  David J Lockey,et al.  The performance and assessment of hospital trauma teams , 2010, Scandinavian journal of trauma, resuscitation and emergency medicine.

[21]  Sallie J. Weaver,et al.  Does team training work? Principles for health care. , 2008, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[22]  Ruth Brown,et al.  Development and validation of a tool to assess emergency physicians' nontechnical skills. , 2012, Annals of emergency medicine.

[23]  S. Hunziker,et al.  Teamwork and leadership in cardiopulmonary resuscitation. , 2011, Journal of the American College of Cardiology.

[24]  Yan Xiao,et al.  Dynamic Delegation: Shared, Hierarchical, and Deindividualized Leadership in Extreme Action Teams , 2006 .

[25]  R Flin,et al.  Development of a rating system for surgeons' non‐technical skills , 2006, Medical education.

[26]  Rhona Flin,et al.  The Surgeons' Leadership Inventory (SLI): a taxonomy and rating system for surgeons' intraoperative leadership skills. , 2013, American journal of surgery.

[27]  Rhona Flin,et al.  Rating non-technical skills: developing a behavioural marker system for use in anaesthesia , 2004, Cognition, Technology & Work.

[28]  H. P. Sims,et al.  Contingent leadership and effectiveness of trauma resuscitation teams. , 2005, The Journal of applied psychology.

[29]  Brian Hilligoss,et al.  A handoff is not a telegram: an understanding of the patient is co-constructed , 2012, Critical Care.

[30]  Nick Sevdalis,et al.  An observational study of teamwork skills in shift handover. , 2012, International journal of surgery.

[31]  Rhona Flin,et al.  Towards a model of surgeons' leadership in the operating room , 2011, Quality and Safety in Health Care.

[32]  Sonya L Ranson,et al.  Teamwork training improves the clinical care of trauma patients. , 2010, Journal of surgical education.

[33]  J. Tallon,et al.  Trauma management outcomes associated with nonsurgeon versus surgeon trauma team leaders. , 2007, Annals of emergency medicine.

[34]  S. Cooper,et al.  Developing leaders for advanced life support: evaluation of a training programme. , 2001, Resuscitation.

[35]  Benjamin Berg,et al.  Assessing teamwork in the trauma bay: introduction of a modified "NOTECHS" scale for trauma. , 2012, American journal of surgery.

[36]  V. LeBlanc,et al.  Interprofessional intensive care unit team interactions and medical crises: A qualitative study , 2009, Journal of interprofessional care.

[37]  Rhona Flin,et al.  Team leadership in the intensive care unit: The perspective of specialists* , 2011, Critical care medicine.

[38]  J. Paige,et al.  Improved Operating Room Teamwork via SAFETY Prep: A Rural Community Hospital’s Experience , 2009, World Journal of Surgery.

[39]  Franziska Tschan,et al.  Brief leadership instructions improve cardiopulmonary resuscitation in a high-fidelity simulation: A randomized controlled trial* , 2010, Critical care medicine.

[40]  E. Salas,et al.  Toward a definition of teamwork in emergency medicine. , 2008, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[41]  S. Sonnad,et al.  Trauma leadership: does perception drive reality? , 2011, Journal of surgical education.

[42]  Rhona Flin,et al.  Non-technical skills for anaesthetists: developing and applying ANTS. , 2011, Best practice & research. Clinical anaesthesiology.

[43]  Eduardo Salas,et al.  A Measurement Tool for Simulation-Based Training in Emergency Medicine: The Simulation Module for Assessment of Resident Targeted Event Responses (SMARTER) Approach , 2008, Simulation in healthcare : journal of the Society for Simulation in Healthcare.

[44]  E. Salas,et al.  How to turn a team of experts into an expert medical team: guidance from the aviation and military communities , 2004, Quality and Safety in Health Care.