Cargando…

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

RATIONALE, AIMS AND OBJECTIVES: Ward rounds (WRs) are complex social processes. Done well, WR discussions and decisions contribute to timely, safe, effective progression of care. However, literature highlights medical dominance; marginalisation or absence of other perspectives, safety risks and subo...

Descripción completa

Detalles Bibliográficos
Autores principales: Merriman, Clair, Freeth, Della
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9305892/
https://www.ncbi.nlm.nih.gov/pubmed/35220643
http://dx.doi.org/10.1111/jep.13670
_version_ 1784752427014029312
author Merriman, Clair
Freeth, Della
author_facet Merriman, Clair
Freeth, Della
author_sort Merriman, Clair
collection PubMed
description RATIONALE, AIMS AND OBJECTIVES: Ward rounds (WRs) are complex social processes. Done well, WR discussions and decisions contribute to timely, safe, effective progression of care. However, literature highlights medical dominance; marginalisation or absence of other perspectives, safety risks and suboptimal resource use. This study examined leadership behaviours and what supported good interprofessional WRs, defined as enabling interprofessional collaboration and decision making which progresses patient care in a safe and timely manner. Deepening appreciation of this art should support learning and improvements. METHOD: Mixed‐method appreciative inquiry (AI) into how WRs go well and could go well more often. Context: daily interprofessional consultant‐led WRs in a large adult critical care unit. Data: ethnographic and structured observations (73 h, 348 patient reviews); AI conversations and interviews (71 participants). Inductive iterative analysis shaped by Activity Theory. Participants: 256 qualified healthcare professionals working in the unit. RESULTS: Leadership of good WRs supported (and minimized contradictions to): making good use of expertise and time, and effective communication. These three key activities required careful and skilled orchestration of contributions to each patient review, which was achieved through four distinct phases (a broadly predictable script), ensuring opportunity to contribute while maintaining focus and a productive pace. This expertise is largely tacit knowledge, learnt informally, which is difficult to analyse and articulate oneself, or explain to others. To make this easier, and thus support learning, we developed the metaphor of a conductor leading musicians. CONCLUSIONS: Whilst everyone contributes to the joint effort of delivering a good WR, WR leadership is key. It ensures effective use of time and diverse expertise, and coordinates contributions rather like a conductor working with musicians. Although WR needs and approaches vary across contexts, the key leadership activities we identified are likely to transfer to other settings.
format Online
Article
Text
id pubmed-9305892
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher John Wiley and Sons Inc.
record_format MEDLINE/PubMed
spelling pubmed-93058922022-07-28 Conducting a good ward round: How do leaders do it? Merriman, Clair Freeth, Della J Eval Clin Pract Original Papers RATIONALE, AIMS AND OBJECTIVES: Ward rounds (WRs) are complex social processes. Done well, WR discussions and decisions contribute to timely, safe, effective progression of care. However, literature highlights medical dominance; marginalisation or absence of other perspectives, safety risks and suboptimal resource use. This study examined leadership behaviours and what supported good interprofessional WRs, defined as enabling interprofessional collaboration and decision making which progresses patient care in a safe and timely manner. Deepening appreciation of this art should support learning and improvements. METHOD: Mixed‐method appreciative inquiry (AI) into how WRs go well and could go well more often. Context: daily interprofessional consultant‐led WRs in a large adult critical care unit. Data: ethnographic and structured observations (73 h, 348 patient reviews); AI conversations and interviews (71 participants). Inductive iterative analysis shaped by Activity Theory. Participants: 256 qualified healthcare professionals working in the unit. RESULTS: Leadership of good WRs supported (and minimized contradictions to): making good use of expertise and time, and effective communication. These three key activities required careful and skilled orchestration of contributions to each patient review, which was achieved through four distinct phases (a broadly predictable script), ensuring opportunity to contribute while maintaining focus and a productive pace. This expertise is largely tacit knowledge, learnt informally, which is difficult to analyse and articulate oneself, or explain to others. To make this easier, and thus support learning, we developed the metaphor of a conductor leading musicians. CONCLUSIONS: Whilst everyone contributes to the joint effort of delivering a good WR, WR leadership is key. It ensures effective use of time and diverse expertise, and coordinates contributions rather like a conductor working with musicians. Although WR needs and approaches vary across contexts, the key leadership activities we identified are likely to transfer to other settings. John Wiley and Sons Inc. 2022-02-27 2022-06 /pmc/articles/PMC9305892/ /pubmed/35220643 http://dx.doi.org/10.1111/jep.13670 Text en © 2022 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons Ltd. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Papers
Merriman, Clair
Freeth, Della
Conducting a good ward round: How do leaders do it?
title Conducting a good ward round: How do leaders do it?
title_full Conducting a good ward round: How do leaders do it?
title_fullStr Conducting a good ward round: How do leaders do it?
title_full_unstemmed Conducting a good ward round: How do leaders do it?
title_short Conducting a good ward round: How do leaders do it?
title_sort conducting a good ward round: how do leaders do it?
topic Original Papers
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9305892/
https://www.ncbi.nlm.nih.gov/pubmed/35220643
http://dx.doi.org/10.1111/jep.13670
work_keys_str_mv AT merrimanclair conductingagoodwardroundhowdoleadersdoit
AT freethdella conductingagoodwardroundhowdoleadersdoit