Conducting a good ward round: How do leaders do it?

Area of Science:

• Healthcare Management
• Medical Education
• Teamwork in Medicine

Background:

• Ward rounds (WRs) are critical for patient care but can suffer from medical dominance and suboptimal resource use.
• Effective interprofessional collaboration during WRs is essential for safe and timely patient care progression.

Purpose of the Study:

• To examine leadership behaviors that support effective interprofessional ward rounds (WRs).
• To identify factors enabling interprofessional collaboration and decision-making in WRs.

Main Methods:

• A mixed-method appreciative inquiry (AI) approach was used.
• Data collected through ethnographic observations (73 hours), structured observations (348 patient reviews), AI conversations, and interviews with 71 participants.

Main Results:

• Leadership in good WRs facilitates effective use of expertise and time, and clear communication.
• Four distinct phases, akin to a predictable script, were identified for orchestrating contributions during patient reviews.
• The leadership expertise is largely tacit knowledge, supported by the metaphor of a conductor leading musicians.

Conclusions:

• Ward round leadership is crucial for coordinating diverse expertise and optimizing time.
• The identified leadership activities, like a conductor's role, are transferable to various healthcare settings.
• Improving the understanding and articulation of this tacit leadership knowledge can enhance learning and practice.