Within the veterinary emergency and critical care setting, leadership is likely to be dynamic, ultra-adaptive, shared and situational. Leadership within this setting is not solely reserved for those in positions of responsibility. Each member of the team is required to feel prepared to ‘step up’ to lead in the moment, this may be in response to a patient requiring resuscitation or to ensure that tasks are assigned and completed.

Team leadership is about directing and coordinating the activities of team members; encouraging them to work together; assessing performance; assigning tasks; developing team knowledge, skills and abilities; motivating; planning and organizing; and establishing a positive team atmosphere (Salas et al. 2004).

Effective leadership has been shown to be crucial for maintaining safe performance in the workplace (Hofmann and Morgeson 2004; Glendon et al. 2006). When researching the attributes of effective team leaders, NASA found that appropriate assertiveness, communication of task responsibilities and expected norms, involving all resources, establishing authority, modelling appropriate behaviour and balancing responsibility were all required within the role.

Leadership is recognised as an important non-technical skill which has been widely researched. Flin, O’Connor and Crighton (2008) suggested that it can be broken down into four skills elements; effective leaders should be able to use authority when necessary, maintain standards, plan and prioritise, and manage workload and resources. In addition to NASA and Flin, O’Connor and Crighton’s research, it is recognized that many other attributes are required by leaders, including excellent communication skills, empathy, compassion, kindness, self-awareness, good situational awareness, humility and the ability to sustain emotional wellbeing.

The journey to becoming a confident leader may begin with exploring personal core values and comparing them to workplace core values to ensure that they are aligned, realizing personal strengths and weaknesses, and considering the theories and styles of leadership. It is also important to develop understanding and practice vital skills which will ensure that all team members have the ability to lead with confidence. Such skills include:

• Aspiring to create and maintain psychological safety and trust within their teams to ensure that each member of the team feels safe to raise questions, concerns and give feedback. Amy Edmondson describes psychological safety as “a shared belief that the team is safe for interpersonal risk taking.” It was identified by Google as the most important aspect of building a successful team as part of a two-year study ‘Project Aristotle’ and was found to underpin the other four key dynamics required for high-performing teams: dependability, structure and clarity, meaning of work, and impact of work. Through developing an understanding of the importance of psychological safety comes a comprehension of what it means to be human and how our emotions can be hijacked due to the perception of a threat causing a primal response. By understanding how this process occurs we can support those we are leading to ensure that interventions are implemented which can reduce the occurrence of this response and ensure that patients are not adversely affected by the cognitive limitations of those caring for them.
• Becoming an excellent communicator through practicing active listening, compassion, empathy, humility and appropriate assertiveness. Compassionate leadership is described by the King’s Fund as ‘building connection across boundaries, ensuring that the voices of all are heard in the process of delivering and improving care.’ Compassionate leadership means creating the conditions; through consistently listening, understanding, empathizing and helping, to make it possible to have tough performance management and courageous conversations when needed. Compassionate leadership ensures a collective focus and a greater likelihood of shared responsibility for ensuring high-quality care.
• Understanding how to delegate successfully, engage and motivate others, and manage time efficiently are key skills for leaders which must be developed over time. Recognising the importance of shared leadership, the concept of distributing leadership roles and responsibilities across a team, rather than restricting them to those in a position of authority (Ballantyne 2019), acknowledges the increasing complexity and rapid evolution that practices and processes undergo and encourages team members to lead in the areas that they demonstrate excellence in.
• Appreciating that the veterinary emergency critical care setting is described as an ‘ultra-adaptive’ environment (Vincent and Amalberti 2016) and as such requires a particular approach if risk of avoidable harm to patients is to be reduced to an acceptable minimum. When it comes to leadership this requires all members of the team, particularly those in decision-making roles, to be able to continuously assess the environment and utilize situational leadership. This approach ensures that methods such as delegation, coaching and directing are used appropriately and dynamically as required. It is also a means of ensuring that the needs of the task and the team are considered and met accordingly. Also associated with the discussion of leading in a dynamic environment is how to clarify roles when emergency and unexpected events occur. As there cannot be a procedure/protocol for every situation, there needs to be a clear communication structure that ensures clarity of responsibility and decision-making in challenging and complex situations.

References

1.  Ballantyne H. 2019. Leadership for frontline veterinary nurses: the theory. Veterinary Nursing Journal. 2019;34(3):69–71.

2.  Edmondson AC. 2018. The Fearless Organization: Creating Psychological Safety in the Workplace for Learning, Innovation, and Growth. John Wiley & Sons; 2018.

3.  Flin R, O’Connor P, Crichton M. Safety at the Sharp End: A Guide to NTS. 2013.

4.  Glendon AI, Clarke S, McKenna E. Human Safety and Risk Management. CRC Press; 2016.

5.  Hofmann DA, Morgeson FP. 2004. The role of leadership in safety. re:Work, Google, Project Aristotle. Available at https://rework.withgoogle.com.

6.  Salas E, Burke CS, Stagl KC. Developing teams and team leaders: strategies and principles. Leader Development for Transforming Organizations: Growing Leaders for Tomorrow. 2005:325–355.

7.  The Kings Fund. Compassionate and inclusive leadership. www.kingsfund.org.uk/topics/organisational-culture/compassionate-inclusive.

8.  Vincent C, Amalberti R. Safer Healthcare: Strategies for the Real World. Springer Nature; 2016:157.