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Team leadership in the intensive care unit: The perspective of specialists*

Reader, Tom W. PhD; Flin, Rhona PhD; Cuthbertson, Brian H. MD, FRCA

doi: 10.1097/CCM.0b013e318218a4c7
Clinical Investigations

Objectives: To identify the behaviors senior physicians (e.g., specialists, staff attendings) report using to lead multidisciplinary teams in the intensive care unit.

Design: Semistructured interviews focusing on team leadership, crisis management, and development of an environment that enable effective team performance in the intensive care unit.

Setting: Seven general intensive care units based in National Health Service hospitals in the United Kingdom.

Participants: Twenty-five senior intensive care medicine physicians.

Measurements and Main Results: Responses to a semistructured interview were transcribed and subjected to “content” analysis. The interview analysis focused on references to the “functional” behaviors used by leaders to manage team performance and the “team development behaviors” used to build the conditions that enable effective team performance. Seven of the interviews were coded by a second psychologist to measure inter-rater reliability. Inter-rater reliability (Cohen's κ) was acceptable for both scales (κ = 0.72 and κ = 0.75). In total, 702 functional leadership behaviors (behaviors for information gathering, planning and decision-making, managing team members) were coded as being used to manage the intensive care unit, along with 216 team development behaviors (for providing team direction and establishing team norms). These behaviors were grouped together in a theoretically driven framework of intensive care unit team leadership.

Conclusions: Intensive care unit senior physicians report using a variety of leadership behaviors to ensure high levels of team performance. The data described in this study provide insight into the team leadership behaviors used by intensive care unit team leaders and have implications for the development of team leadership training and assessment tools.

From the Institute of Social Psychology (TWR), London School of Economics, London, UK; School of Psychology (RF), University of Aberdeen, Kings College, Aberdeen, Scotland, UK; Department of Critical Care Medicine (BHC), Sunnybrook Health Sciences Centre, Toronto, Canada.

Supported by the Leverhulme Trust and the Scottish Funding Council.

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: t.w.reader@lse.ac.uk

© 2011 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins