A Video Analysis of Intra- and Inter-professional Leadership Behaviours Within “The Burns Suite”: Identifying Key Leadership Models

Objective Leadership is particularly important in complex highly interprofessional health care contexts involving a number of staff, some from the same specialty (intraprofessional), and others from different specialties (interprofessional). The authors recently published the concept of “The Burns Suite” (TBS) as a novel simulation tool to deliver interprofessional and teamwork training. It is unclear which leadership behaviors are the most important in an interprofessional burns resuscitation scenario, and whether they can be modeled on to current leadership theory. The purpose of this study was to perform a comprehensive video analysis of leadership behaviors within TBS. Methods A total of 3 burns resuscitation simulations within TBS were recorded. The video analysis was grounded-theory inspired. Using predefined criteria, actions/interactions deemed as leadership behaviors were identified. Using an inductive iterative process, 8 main leadership behaviors were identified. Cohen’s κ coefficient was used to measure inter-rater agreement and calculated as κ = 0.7 (substantial agreement). Each video was watched 4 times, focusing on 1 of the 4 team members per viewing (senior surgeon, senior nurse, trainee surgeon, and trainee nurse). The frequency and types of leadership behavior of each of the 4 team members were recorded. Statistical significance to assess any differences was assessed using analysis of variance, whereby a p < 0.05 was taken to be significant. Leadership behaviors were triangulated with verbal cues and actions from the videos. Results All 3 scenarios were successfully completed. The mean scenario length was 22 minutes. A total of 362 leadership behaviors were recorded from the 12 participants. The most evident leadership behaviors of all team members were adhering to guidelines (which effectively equates to following Advanced Trauma and Life Support/Emergency Management of Severe Burns resuscitation guidelines and hence “maintaining standards”), followed by making decisions. Although in terms of total frequency the senior surgeon engaged in more leadership behaviors compared with the entire team, statistically there was no significant difference between all 4 members within the 8 leadership categories. This analysis highlights that “distributed leadership” was predominant, whereby leadership was “distributed” or “shared” among team members. The leadership behaviors within TBS also seemed to fall in line with the “direction, alignment, and commitment” ontology. Conclusions Effective leadership is essential for successful functioning of work teams and accomplishment of task goals. As the resuscitation of a patient with major burns is a dynamic event, team leaders require flexibility in their leadership behaviors to effectively adapt to changing situations. Understanding leadership behaviors of different team members within an authentic simulation can identify important behaviors required to optimize nontechnical skills in a major resuscitation. Furthermore, attempting to map these behaviors on to leadership models can help further our understanding of leadership theory. Collectively this can aid the development of refined simulation scenarios for team members, and can be extrapolated into other areas of simulation-based team training and interprofessional education.

Developing and Using Consultancy Skills

In Chapter 4, ‘Developing and using consultancy skills’, Ruth Sacks and I discuss what it means to be a consultant and what is it that consultants do. This is presented in the order of stages in a project; starting, ‘doing’ and ending, with specific sections dedicated to examining each stage. Adopting a consulting approach helps L&D professionals to ‘demonstrate’ the value they bring, and may be undertaken through projects that have been articulated and justified through a business case.

Developing Professional Practice in L&D

The first theme of the book is ‘Directions’. This theme concerns the present and potential future expectations that L&D professionals may face in their practice. Chapter 1 is about ‘Developing professional practice in L&D’. In the first section, I discuss what is ‘professionalism’ and what it means for L&D professionals in terms of their development. In this chapter, I argue that expectations of L&D from senior management are growing. L&D professionals need to be able demonstrate ability to influence decision making by developing new competencies that enable them to provide senior management with new insight, which in turn increases L&D’s strategic credibility. In examining the diverse activities and tasks that L&D professionals currently, and may be expected to undertake in the future, four roles emerge; capacity and capability builders, boundary spanners, consultants and change agents. Capacity building primarily concerns creating space, time, and cultivating the right environment for the workforce to develop, which can be a challenge given how fire-fighting appears to be prevalent in many organizations today. Capability building involves enhancing knowledge, developing skills and competencies of the workforces, whilst boundary spanning involves networking and growing partnerships within and outside the organization. ‘Being a consultant’ is briefly touched upon as it is further discussed in Chapter 5, whilst the role of a change agent involves instigating and managing change. This chapter concludes with a discussion of twelve important knowledge, skill and capability areas that L&D professionals must develop to advance their practice.