What attributes define excellence in a trauma team? A qualitative study

Background: Hospital trauma teams consist of a diverse spectrum of health care professionals who work together to deliver quality care. Although the qualities of a well-performing trauma team are often believed to be self-evident, there is little objective information about the most desirable personal and professional characteristics associated with quality trauma care. The aim of this study was to determine the traits and characteristics deemed of greatest value for a trauma team leader and a trauma team member in the adult trauma care setting. Methods: Semistructured interviews were conducted with trauma team leaders and trauma team members at a tertiary Canadian trauma centre. Standard qualitative research methodology was used. Interviews were recorded, transcribed and analyzed via an inductive analysis approach. Results: Thematic saturation was achieved after 5 interviews, and 6 further interviews were conducted to ensure that a breadth of trauma care disciplines were included. Six attributes were identified to be of greatest value for trauma team leaders: communication, role clarity, experience, anticipation, management and decisiveness. Four attributes were identified to be of greatest value for trauma team members: engagement, efficiency, experience and collaboration. We further characterized the language defining the ranking of performance for each of these attributes. Conclusion: Results of this qualitative study involving an experienced and diverse spectrum of trauma team practitioners provide insight into the characteristics that are critical to establishing a "good" trauma team. These findings can be used to inform future determinations of the quality of trauma teams, the education of trauma practitioners and continuing medical education training and assessment tools.

Contexte: Les équipes de traumatologie des hôpitaux sont formées de professionnels de la santé de divers horizons qui travaillent ensemble pour offrir des soins de qualité. Bien que les attributs d'une bonne équipe de traumatologie soient souvent vus comme étant évidents, il existe peu de données objectives sur les caractéristiques personnelles et professionnelles les plus fortement associées à des soins traumatologiques de qualité. Cette étude avait pour but de déterminer les traits et caractéristiques les plus recherchés chez les chefs et les membres d'équipes de traumatologie pour adultes. Méthodes: Nous avons mené des entrevues semi-structurées auprès de chefs et de membres d'équipes de traumatologie, dans un centre tertiaire de traumatologie canadien. Une méthode de recherche qualitative standard a été utilisée. Les entrevues ont été enregistrées et transcrites, puis analysées selon une approche inductive. Résultats: Le seuil de saturation thématique a été atteint après 5 entrevues, mais nous avons mené 6 entrevues supplémentaires pour garantir une variété dans les disciplines représentées. Six attributs ont été relevés pour les chefs d'équipe de traumatologie : communication, clarté du rôle, expérience, anticipation, gestion et esprit de décision. Quatre attributs ont été relevés pour les membres de l'équipe : engagement, efficacité, expérience et collaboration. Pour chaque attribut, nous avons caractérisé avec précision les termes définissant la qualité des soins prodigués. Conclusion: Les résultats de cette étude qualitative, qui rassemblait des professionnels de la traumatologie expérimentés et d'horizons diversifiés, mettent en lumière les caractéristiques essentielles à la mise en place d'une « bonne ¼ équipe de traumatologie. Ils pourront servir dans l'évaluation des équipes, dans la formation des praticiens et à la création de cours et d'outils d'évaluation pour l'éducation médicale continue.

The Preferred Attributes of a Trauma Team Leader: Evidence From a Discrete Choice Experiment.

OBJECTIVE: Leaders of a pediatric trauma team are tasked with managing rapidly changing diagnostic and treatment challenges, while ensuring the entire team functions effectively to produce optimal patient outcomes. An effective trauma team leader is often thought to be self-evident, and there is little formal literature identifying the leadership characteristics and attributes associated with optimal trauma team performance. The purpose of this study was to elicit the trauma team leader traits and characteristics deemed of greatest utility by members of the pediatric trauma team. DESIGN, SETTING, PARTICIPANTS: Members of the pediatric trauma team at British Columbia Children's Hospital were asked to participate in a semistructured interview to identify trauma team leader attributes associated with maximal team performance. Using the attributes, we constructed a discrete choice experiment (DCE). DCEs, developed in the economics and market research setting, allow participants to express preferences among finite alternatives, with subsequent statistical analysis that allows quantitative comparison of the utility of selected attributes. RESULTS: After interviewing 21 trauma team practitioners, 6 themes were identified as being most important for trauma team leadership. The developed DCE was administered to 64 members of the trauma team. Analysis of the DCE revealed the most important attributes were collaboration, strong communication, and decisiveness. The attribute of least utility was experience. The specific leadership qualities that provided the most utility to the trauma team included "actively involves input for team" (mean utility [MU]: 0.70; standard error [SE]: 0.11) and "concise communication, at times closed-loop" (MU: 0.52; SE: 0.09). "Hesitant and unclear communication" (MU: -0.88; SE: 0.09) and "often indecisive" (MU: -0.68; SE: 0.10) were deemed most detrimental (negative utility) to the team's function. CONCLUSIONS: This study is novel in applying a strategy to identify and quantify the relative value of trauma team leader attributes. When designing education initiatives for pediatric trauma care teams, defining trauma team quality metrics, and providing continuing medical education for the team leader, it is essential to incorporate preferred leadership characteristics. Crisis resource management skills benefit greatly from an understanding of the preferred attributes, as defined and evaluated by other trauma team members.