Teamwork and Leadership in the Critical Care Unit

  • Tom W. ReaderEmail author
  • Brian H. Cuthbertson
Part of the Respiratory Medicine book series (RM, volume 18)


Effective multidisciplinary teamwork and team leadership have been shown as essential for the safe management of patients in intensive care medicine (ICM). Solutions to improve teamwork and leadership have been developed, but with mixed success. It is observed that to improve teamwork in ICM, interventions must reflect (1) the demands and constraints of ICM, and how they influence team behaviour and (2) the specific teamwork skills and behaviours that are associated with safe patient care. Research in ICM shows that effective team leadership is the key determinant of team functioning, and that interventions should focus on enhancing leadership. Yet, simply applying leadership solutions developed in other domains (e.g. aviation) is not appropriate. Specifically, the flow and nature of work, and the changeable and complex construction of teams, means that tools for improving and assessing leadership need to be designed to reflect the very specific constraints of ICM.


Teamwork Leadership Training Error Communication 


  1. 1.
    Salas E, Bowers C, Edens E. Improving teamwork in organizations: applications of resource management training. Mawah: LEA; 2001.Google Scholar
  2. 2.
    O’Connor P, Campbell J, Newon J, Melton J, Salas E, Wilson K. Crew resource management training effectiveness: a meta-analysis and some critical needs. Int J Aviat Psychol. 2008;18:353–68.CrossRefGoogle Scholar
  3. 3.
    Bell ST. Deep-level composition variables as predictors of team performance: a meta-analysis. J Appl Psychol. 2007;92:595–615.PubMedCrossRefGoogle Scholar
  4. 4.
    Burke CS, Stagl K, Salas E, Pierce L, Kendall D. Understanding team adaptation: a conceptual analysis and model. J Appl Psychol. 2006;91:1189–207.PubMedCrossRefGoogle Scholar
  5. 5.
    Paris C, Salas E, Cannon-Bowers J. Teamwork in multi-person systems: a review and analysis. Ergonomics. 2000;43:1052–75.PubMedCrossRefGoogle Scholar
  6. 6.
    Vincent C. Patient safety. London: Elsevier; 2006.Google Scholar
  7. 7.
    Gawande AA, Studdert D, Zinner M, Brennan TA. Analysis of errors reported by surgeons at three teaching hospitals. Surgery. 2003;133:614–21.PubMedCrossRefGoogle Scholar
  8. 8.
    Flin R, Maran N. Identifying and training non-technical skills for teams in acute medicine. Qual Saf Health Care. 2004;13(Suppl 1):80–4.Google Scholar
  9. 9.
    Reader T, Flin R, Lauche K, Cuthbertson B. Non-technical skills in the intensive care unit. Br J Anaesth. 2006;96:551–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Bion J, Heffner JE. Challenges in the care of the acutely ill. Lancet. 2004;363:970–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Reader T, Cuthbertson B, Decruyenaere J. Burnout in the ICU: potential consequences for staff and patient well-being. Intensive Care Med. 2008;34:4–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Donchin Y, Gopher D, Olin M, et al. A look into the nature and causes of human errors in the intensive care unit. Crit Care Med. 1995;23:294–300.PubMedCrossRefGoogle Scholar
  13. 13.
    Walker S, Brett S. Oiling the wheels of intensive care to reduce “machine friction”: the best way to improve outcomes? Crit Care Med. 2010;38(10 Suppl):S642–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Valentin A, Bion J. How safe is my intensive care unit? An overview of error causation and prevention. Curr Opin Crit Care. 2007;13:697–702.PubMedCrossRefGoogle Scholar
  15. 15.
    Pronovost PJ, Thompson D, Holzmueller C, et al. Toward learning from patient safety reporting systems. J Crit Care. 2006;21:305–15.PubMedCrossRefGoogle Scholar
  16. 16.
    Baggs JG, Schmitt MH, Mushlin AI, Mitchell PH, Eldrege DH, Oakes D. Association between nurse-physician collaboration and patient outcomes in three intensive care units. Crit Care Med. 1999;27:1991–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Shortell SM, Zimmerman JE, Rousseau DM, et al. The performance of intensive care units: does good management make a difference? Med Care. 1994;32:508–25.PubMedCrossRefGoogle Scholar
  18. 18.
    Pronovost PJ, Berenholtz SM, Ngo K, et al. Developing and pilot testing quality indicators in the intensive care unit. J Crit Care. 2003;18:145–55.Google Scholar
  19. 19.
    Huang D, Clermont G, Sexton J, et al. Perceptions of safety culture across the intensive care units of a single institution. Crit Care Med. 2007;35:165–76.PubMedCrossRefGoogle Scholar
  20. 20.
    Salas E, Wilson-Donnelly K, Sims D, Burke CS, Priest H. Teamwork training for patient safety: best practices and guiding principles. In: Carayon P, editor. Handbook of human factors and ergonomics in health care and patient safety. Mahwah: LEA; 2007. p. 803–22.Google Scholar
  21. 21.
    Thomas EJ, Sexton J, Helmreich RL. Discrepant attitudes about teamwork among critical care nurses and physicians. Crit Care Med. 2003;31:956–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Morgeson F, DeRue D, Karam E. Leadership in teams: a functional approach to understanding leadership structures and processes. J Manag. 2010;36:5–39.Google Scholar
  23. 23.
    Bion J, Fox-Kirk W. Eighteenth century mindsets, twenty-first century challenges: the physician as team player. Crit Care Med. 2009;37:1288–9.CrossRefGoogle Scholar
  24. 24.
    Reader T, Flin R, Cuthbertson B. Factors affecting team communication in the intensive care unit. In: Nemeth C, editor. Improving healthcare team communication: building on lessons from aviation and aerospace. Aldershot: Ashgate; 2008. p. 117–34.Google Scholar
  25. 25.
    Malhotra S, Jordan D, Shortliffe EH, Patel V. Workflow modeling in critical care: piecing together your own puzzle. J Biomed Inform. 2007;40:81–92.PubMedCrossRefGoogle Scholar
  26. 26.
    Manser T. Teamwork and patient safety in dynamic domains of healthcare: a review of the literature. Acta Anaesthesiol Scand. 2009;53:143–51.PubMedCrossRefGoogle Scholar
  27. 27.
    Reader T, Flin R, Mearns K, Cuthbertson B. Developing a team performance framework for the intensive care unit. Crit Care Med. 2009;35:1787–93.CrossRefGoogle Scholar
  28. 28.
    Kim J, Neilipovitz D, Cardinal P, Chiu M, Clinch J. A pilot study using high-fidelity simulation to formally evaluate performance in the resuscitation of critically ill patients: The University of Ottawa Critical Care Medicine, High-Fidelity Simulation, and Crisis Resource Management I Study. Crit Care Med. 2006;34:2167–74.PubMedCrossRefGoogle Scholar
  29. 29.
    Ottestad E, Boulet J, Lighthall G. Evaluating the management of septic shock using patient simulation. Crit Care Med. 2007;35:769–75.PubMedCrossRefGoogle Scholar
  30. 30.
    Thomas EJ, Sexton J, Lasky R, Helmreich RL, Crandell D, Tyson J. Teamwork and quality during neonatal care in the delivery room. J Perinatol. 2006;26:163–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Stockwell D, Slonim A, Pollack M. Physician team management affects goal achievement in the intensive care unit. Pediatr Crit Care Med. 2007;8:840–5.Google Scholar
  32. 32.
    Nembhard I, Edmondson AC. Making it safe: the effects of leader inclusiveness and professional status on psychological safety and improvement efforts in health care teams. J Organ Behav. 2006;27:941–66.CrossRefGoogle Scholar
  33. 33.
    Flin R, O’Connor P, Crichton M. Safety at the sharp end. A guide to non-technical skills. Aldershot: Ashgate; 2008.Google Scholar
  34. 34.
    Reader T, Flin R, Cuthbertson B. Communication skills and error in the intensive care unit. Curr Opin Crit Care. 2007;13:732–6.PubMedCrossRefGoogle Scholar
  35. 35.
    Reader T, Flin R, Mearns K, Cuthbertson B. Interdisciplinary communication in the intensive care unit. Br J Anaesth. 2007;98:347–52.PubMedCrossRefGoogle Scholar
  36. 36.
    Reader T, Flin R, Mearns K, Cuthbertson B. Team situation awareness and the anticipation of patient progress during ICU rounds. BMJ Qual Saf. 2011;20:1035–42.PubMedCrossRefGoogle Scholar
  37. 37.
    Endsley M. Towards a theory of situation awareness in dynamic systems. Hum Factors. 1995;37:32–64.CrossRefGoogle Scholar
  38. 38.
    Wright M, Endsley M. Building situation awareness in healthcare teams. In: Nemeth C, editor. Improving healthcare team communication. Aldershot: Ashgate; 2008. p. 97–114.Google Scholar
  39. 39.
    Patel V, Zhang J, Yoskowitz N, Green RA, Osman RS. Translational cognition for decision support in critical care environments: a review. J Biomed Inform. 2008;41:413–31.PubMedCentralPubMedCrossRefGoogle Scholar
  40. 40.
    Gurses A, Xiao Y. A systematic review of the literature on multidisciplinary rounds to design information technology. J Am Med Inform Assoc. 2006;13:267–76.PubMedCentralPubMedCrossRefGoogle Scholar
  41. 41.
    Stanton N, Salmon P, Walker G, Baber C, Jenkins D. Human factors methods: a practical guide for engineering and design. Aldershot: Ashgate; 2005.Google Scholar
  42. 42.
    Reader T, Cuthbertson B. Teamwork and team training in the ICU: where do the similarities with aviation end? Crit Care. 2011;15:313–9.PubMedCentralPubMedCrossRefGoogle Scholar
  43. 43.
    Fackler J, Watts C, McHugh A, Miller T, Crandall B, Pronovost P. Critical care physician cognitive task analysis: an exploratory study. Crit Care. 2009;13:R33.PubMedCentralPubMedCrossRefGoogle Scholar
  44. 44.
    Raduma-Tomàs M, Flin R, Yule S, Williams D. Doctor’s handovers in hospitals: a literature review. BMJ Qual Saf. 2011;20:128–33.PubMedCrossRefGoogle Scholar
  45. 45.
    Reader T, Flin R, Cuthbertson B. Team leadership in the intensive care unit. The perspective of specialists. Crit Care Med. 2011;39:1683–91.PubMedCrossRefGoogle Scholar
  46. 46.
    Sexton J, Thomas EJ, Helmreich RL. Error, stress and teamwork in medicine and aviation: cross sectional surveys. Br Med J. 2000;320:745–9.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of Social PsychologyLondon School of EconomicsLondonUK
  2. 2.Department of Critical Care MedicineSunnybrook Health Sciences CentreTorontoCanada

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