Insitute of Health Sciences Education, Queen Mary University of London, London, UK.
Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK.
J Eval Clin Pract. 2022 Jun;28(3):411-420. doi: 10.1111/jep.13670. Epub 2022 Feb 27.
RATIONALE, AIMS AND OBJECTIVES: Ward rounds (WRs) are complex social processes. Done well, WR discussions and decisions contribute to timely, safe, effective progression of care. However, literature highlights medical dominance; marginalisation or absence of other perspectives, safety risks and suboptimal resource use. This study examined leadership behaviours and what supported good interprofessional WRs, defined as enabling interprofessional collaboration and decision making which progresses patient care in a safe and timely manner. Deepening appreciation of this art should support learning and improvements.
Mixed-method appreciative inquiry (AI) into how WRs go well and could go well more often.
daily interprofessional consultant-led WRs in a large adult critical care unit.
ethnographic and structured observations (73 h, 348 patient reviews); AI conversations and interviews (71 participants). Inductive iterative analysis shaped by Activity Theory.
256 qualified healthcare professionals working in the unit.
Leadership of good WRs supported (and minimized contradictions to): making good use of expertise and time, and effective communication. These three key activities required careful and skilled orchestration of contributions to each patient review, which was achieved through four distinct phases (a broadly predictable script), ensuring opportunity to contribute while maintaining focus and a productive pace. This expertise is largely tacit knowledge, learnt informally, which is difficult to analyse and articulate oneself, or explain to others. To make this easier, and thus support learning, we developed the metaphor of a conductor leading musicians.
Whilst everyone contributes to the joint effort of delivering a good WR, WR leadership is key. It ensures effective use of time and diverse expertise, and coordinates contributions rather like a conductor working with musicians. Although WR needs and approaches vary across contexts, the key leadership activities we identified are likely to transfer to other settings.
在一家大型成人重症监护病房中，每天都有顾问主导的多学科查房。
对如何做好且更频繁地做好查房（即促进患者安全及时治疗的多学科协作和决策）进行了混合方法的欣赏式探究。
在该病房工作的 256 名合格医疗保健专业人员。
良好查房的领导作用支持（并最小化了与以下方面的矛盾）：充分利用专业知识和时间，以及有效沟通。这三个关键活动需要仔细而熟练地协调每个患者查房的贡献，这是通过四个不同的阶段（一个大致可预测的脚本）来实现的，确保有机会做出贡献，同时保持关注和富有成效的节奏。这种专业知识主要是隐性知识，是通过非正式学习获得的，很难对其进行分析和自我表达，也很难向他人解释。为了使这一点变得更容易，并支持学习，我们开发了一个指挥家带领音乐家的隐喻。
虽然每个人都为提供良好查房的共同努力做出了贡献，但查房领导是关键。它确保了时间和多样化专业知识的有效利用，并协调了贡献，就像指挥家与音乐家合作一样。尽管查房的需求和方法在不同的环境中有所不同，但我们确定的关键领导活动可能会转移到其他环境中。
