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

Objective To quantitatively assess leadership delegation in expert critical care teams during simulated emergency scenarios, and to explore its association with team efficacy and resilience. Design Multicentre, prospective observational study using high-fidelity simulation. Three critical care scenarios of increased difficulty were developed, each incorporating carefully calibrated expected and disruptive events. Setting Five university-affiliated simulation centres in France. Participants 30 interprofessional teams (150 participants), each composed of a senior physician, resident, nurse, healthcare assistant and medical student, all having worked together clinically. Main outcome measures Occurrence and characteristics of leadership delegation following events; team performance as evaluated by external experts; self-reported team member satisfaction, engagement and cohesion; statistical associations using sparse Partial Least Squares and unsupervised clustering. Results Delegation occurred less frequently with increased scenario difficulty (p=0.003 for comparison between scenarios). In contrast, delegations initiated by team members other than the senior physician were more frequent in scenarios with a higher number of disruptive events (p=0.004). Delegation was moderately correlated with resilience parameters (team satisfaction, engagement and cohesion parameters, typically ρ>0.25) but showed no association with simulated patient survival. Clustering revealed a mismatch in some team members between high satisfaction and low performance. Conclusions Delegation in emergency teams was associated with team resilience rather than with clinical performance. Disruptive events led to leadership coming from other team members than the leaders.