Why sharing leadership in healthcare matters

Hands together in a circle

By Dr Lisa Aufegger, Research Associate

Alongside the inherent challenges of the job itself, working in acute healthcare teams comes with another layer of complexity.

On a regular basis, staff will interact with highly specialised professionals from across different disciplines. This means that team members such as anaesthetists, nurses and surgeons need a high level of shared understanding, not only in relation to their main objective but their roles and responsibilities, too.

Shared leadership (SL) – where leadership working relationships are distributed and team members’ unique roles defined – has been proposed as a way to foster effective team performance in such situations. And it’s the focus of my latest research.

Does shared leadership deserve the hype?

Since its first mention in the psychology and management literature in the mid-1990s, SL has been shown to have a range of positive impacts. These include boosting team effectiveness, efficiency and satisfaction, and greater collaboration and coordination, among many other benefits. Ultimately, this means SL can reduce the likelihood of conflict, both between team members and with tasks and processes themselves.

Surgical settings such as in critical care and trauma resuscitation are multi-professional by nature. This means that SL and accountability may be a critical element in driving improvement in safety and quality, and fostering the culture and commitment required to ensure safer care.

But so far, there’s little scientific evidence on the real benefits of SL in acute healthcare service and delivery. That’s why our group at IGHI’s Patient Safety Translational Research Centre (PSTRC) conducted a recent systematic assessment to explore this area. We wanted to identify and critically assess patterns and behaviours of leadership that are specifically related to SL in acute healthcare settings, and evaluate to what extent SL may benefit and accomplish safer care in acute patient treatment and healthcare delivery.

What behaviours support shared leadership?

We found that SL is first and foremost developed, shaped and sustained by a team environment that has a shared ‘mental model’ (see below). This thinking is made possible through 3 key characteristics: social support between team members, shared situational awareness, and the psychological safety to be empowered to, for instance, speak up.

Teams with a shared mental model have a collective knowledge structure, formed through the understanding of team members’ thinking, which leads to enhanced information processing and planning. It also enables people to better anticipate and respond to the actions and needs of their team members. These thought processes, generating shared ideas, were observed in several key ways including information exchange, defined leadership and responsibilities, and strategic coordination.

Social support creates an environment where team members feel valued and appreciated, work more cooperatively and develop a sense of shared responsibility for team outcomes. And individuals with situational awareness have a greater comprehension of circumstances by perceiving their environment, understanding the significance of situations and forecasting what could happen in the future. Both of these assets were identified by mutual concerns for colleagues’ wellbeing and their ability to cope with the pressure, among various other factors.

Finally, psychological safety refers to a team member’s ability to “speak up” – comment, critique or feedback on something. Alongside situational awareness, this has been shown to boost work quality and benefit patient safety.

To what extent can this model make care safer?

Our early findings suggest that high-performing groups in acute care display more SL behaviour, and that SL contributed to an increase in team satisfaction. This is in line with previous findings in small group research, demonstrating strong links between SL and the quality of measurable and subjective performance, such as coordination activities, goal commitment and overall team satisfaction. But studies on SL and safer care are scarce, and more research is needed in the field of patient treatment and delivery.

Shared leadership: backing up the benefits

We found that overall, healthcare providers believe it’s important to use cooperative attitude and SL to improve the quality of care delivery processes, and that this is crucial to contribute to effective teamwork. SL reduces stress and conflict between team members, and helps them better identify their peers’ capabilities. This creates a distinct competitive advantage.

We still need more research in this area. But these findings suggest that it’s worthwhile to educate healthcare professionals with varying seniority about teamwork and SL, through the lens of shared identity and shared context. This helps to maximise the use of expert skills and knowledge, while minimising the differences between team members.

If you’d like to read more about our review, and the benefits and challenges of implementing SL strategies in acute care, you can find it here.

Dr Lisa Aufegger is a Research Associate in IGHI’s Patient Safety Translational Research Centre.

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