“Maybe I’m not that approachable”: using simulation to elicit team leaders’ perceptions of their role in facilitating speaking up behaviors

Abstract

Background Simulation research that seeks to solve the problem of silence among interprofessional teams has focused almost exclusively on training subordinate team members to be more courageous and to speak up to team leaders using direct challenge scripts despite the great interpersonal cost. Consequently, the existing literature overemphasizes the responsibility of subordinate team members for speaking up and fails to consider the role and responsibilities of team leaders in sustaining silence. The purpose of this study is to identify and describe the subtle behaviors and actions of team leaders that both promote and discourage speaking up. Methods This study used a simulation-primed qualitative inquiry approach. Obstetricians (OB) at one academic center participated in an interprofessional simulation as an embedded participant. Five challenge moments (CM) were scripted for the OB involving deliberate clinical judgment errors or professionalism infractions. Other participants were unaware of the OB embedded participant role. Thirteen iterations were completed with 39 participants. Twelve faculty members completed a subsequent semi-structured interview. Scenarios were videotaped; debriefs and interviews were audio-recorded and transcribed verbatim. Data were analyzed using an inductive thematic approach. Results After participating in an interprofessional simulation, faculty participants reflected that being an approachable team leader requires more than simply avoiding disruptive behaviors. We found that approachability necessitates that team leaders actively create the conditions in which team members perceive that speaking up is welcomed, rather than an act of bravery. In practice, this conceptualization of approachability involves the tangible actions of signaling availability through presence, uncertainty through thinking aloud, and vulnerability through debriefing. Conclusions By using faculty as embedded participants with scripted errors, our simulation design provided an ideal learning opportunity to prompt discussion of the subtle behaviors and actions of team leaders that both promote and discourage speaking up. Faculty participants gained a new appreciation that their actions create the conditions for speaking up to occur before critical incidents through their verbal and non-verbal communication.

Complex decision making in an intensive care environment: Perceived practice versus observed reality

“…Established hierarchies and expectations may impact a team member's willingness to communicate or clarify missing information. Research of interprofessional collaborative practice patterns supports this hypothesis 25 …”

“…Research of interprofessional collaborative practice patterns supports this hypothesis. 25 In addition to training clinicians in team-based models of care, the findings elicit several challenging questions regarding educational practices. As evidenced by the size and location of the node for teaching (TEACH) in Figure 1, educational statements and behaviours were common and embedded in the decision making processes.…”

How do residents respond to uncertainty with peers and supervisors in multidisciplinary teams? Insights from simulations with epistemic fidelity

“…Our study design supports the use of simulations with epistemic fidelity to prompt reflection about navigating authentic scenarios. Additionally, our study design of simulation-primed qualitative inquiry further supports the merits of using simulation with deliberate attention to epistemic fidelity to explore team dynamics [ 19 ].…”

“…If we are to change this perception, then we need to promote a learning environment where the expression of uncertainty is an expectation of training rather than a perceived major interpersonal risk. As emphasized in other team contexts [ 6 , 18 , 19 ], this requires effort on the part of supervisors to create an environment that fosters and reinforces expressing uncertainty, by emphasizing the ways in which positive responses to uncertainty can enhance patient safety, help resolve the uncertainty, and provide an opportunity for learning. The active role of supervisors to engage in behaviors that demonstrate the ideals of an environment has been proposed to foster communication skills, such as “speaking up” behaviors [ 19 ].…”