Leadership delegation, team efficacy and resilience in critical care: a simulation-based study

Area of Science:

• Critical Care Medicine
• Team Dynamics
• Leadership Studies

Background:

• Effective leadership delegation is crucial in high-stakes critical care environments.
• Understanding factors influencing delegation and its impact on team performance is essential for improving patient outcomes.
• Simulated emergency scenarios provide a controlled environment to study complex team interactions.

Purpose of the Study:

• To quantitatively assess leadership delegation within expert critical care teams during simulated emergencies.
• To explore the association between leadership delegation and team efficacy and resilience.
• To identify how scenario difficulty and disruptive events influence delegation patterns.

Main Methods:

• Multicentre, prospective observational study utilizing high-fidelity simulation.
• Involved 30 interprofessional critical care teams (150 participants) across five French university-affiliated simulation centres.
• Assessed leadership delegation, team performance, and self-reported team resilience (satisfaction, engagement, cohesion) using statistical analyses and unsupervised clustering.

Main Results:

• Leadership delegation frequency decreased with increased scenario difficulty (p=0.003).
• Delegations initiated by non-senior physicians increased with more disruptive events (p=0.004).
• Delegation showed moderate correlation with resilience parameters (ρ>0.25) but not patient survival; clustering identified discrepancies between high satisfaction and low performance.

Conclusions:

• Leadership delegation in emergency teams is linked to team resilience, not direct clinical performance.
• Disruptive events prompted leadership emergence from diverse team members, not solely senior physicians.
• Findings highlight the importance of adaptable leadership for team resilience in critical care emergencies.