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

Clair Merriman1,2, Della Freeth1,2,3

  • 1Insitute of Health Sciences Education, Queen Mary University of London, London, UK.

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|February 27, 2022
PubMed
Summary

Effective ward round (WR) leadership ensures optimal use of time and expertise. Skilled coordination, like a conductor, enhances interprofessional collaboration and patient care progression, improving safety and efficiency.

Keywords:
interprofessionalleadershiptacit knowledgeward round

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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.