مقاله انگلیسی رایگان در مورد رهبری در شرایط بحرانی: ادغام در سیلوها – امرالد 2017

Consider the way status epilepticus is managed in the emergency department (ED). This is a life-threatening condition in which several epileptic seizures occur in succession without recovery of consciousness. It is treated with a very well-known algorithm, which would be familiar to health-care practitioners within emergency settings. A relatively predictable collective response to this condition implies that everyone within a health-care team is working with a shared understanding of what the situation involves and what each other’s role is. This has also been called “cognitive coordination” (Foss and Lorenzen, 2009) or a “shared mental model (Haig et al., 2006) that can be derived from prior experience”. However, add the fact that the child patient has been the victim of a trauma, and the whole situation may take an unexpected turn. The complication requires new health-care providers to join the emergency care team – such as a trauma surgeon and an intensivist – wanting perhaps to prioritize the trauma injuries over the status epilepticus. We can see that, as the case becomes more complicated, so does the need for overall coordination of the individual physicians – otherwise leaders in their specific, unique tasks in the intervention – to ensure a shared mental model and to optimize care and patient outcome. Who should be the overall leader in such situations, that is, the “first among equals”? We define leadership as explicit guidance to ensure team coordination. Crisis situations in medicine are relatively prone to errors. In pediatric emergencies, communication breakdowns and deficient leadership are estimated to contribute to as many of 70 per cent of perinatal deaths and injuries (Hunziker et al., 2011). Preventable errors in the way people work together in medical crisis situations are a regular occurrence (Teixeira et al., 2007). Studies have found that between 22 and 38.6 per cent of trauma patients suffered a clinical error, and the same percentage has been at risk of a preventable error (Chua et al., 2009; Pucher et al., 2013; Sugrue et al., 2008). In the high-intensity environment of crisis management, research is needed in the relationship between coordination and leadership – what people need to work together effectively. In general, up to 80 per cent of clinical errors have been found to stem from failures of care coordination – that is, aligning tasks between individuals or teams (Østergaard, et al., 2004; Woolf et al., 2004). Most trauma-related deaths occur in the ED during the resuscitation phase (Gruen et al., 2006). Thus, crisis situations in medicine, although relatively infrequent, pose a significant threat to patient safety. When these situations occur, patient outcome is critically dependent on the effective and timely intervention by a coordinated interprofessional team (including, among others, doctors, nurses and respiratory therapists) and an interdisciplinary team (physicians from different disciplines such as emergency medicine [EM], anesthesia and otolaryngology – head and neck surgery [OTL-HNS]) (Marsch et al., 2004; Eppich et al., 2008).