Narrative content themes and subthemes
| Theme: Static leadership relationships (n=131) | Definition |
|---|---|
| Subthemes | |
| Facilitated by supportive dialogue or behaviours (n=25) | Leaders are perceived to take part in supportive behaviours or dialogue through revealing fallibility, listening, accommodating, being fair, responsive or showing empathy |
| Inhibited by unsupportive behaviours or lack of dialogue (n=21) | Leaders are perceived to be unsupportive and lack dialogue with followers. This is carried out through them being unfair, not admitting fallibility, not listening, being unresponsive or lacking empathy |
| Abusive (n=21) | Abuse was constructed through the actions of leaders including undermining, verbal abuse, physical abuse, humiliation and/or criticism |
| Inhibiting team-working (n=14) | Participants described instances of poor team working, often with conflict/disagreement being described or a lack of inclusivity |
| Conflictive decision-making (n=12) | Trainees described those perceived to be leaders in conflict/disagreement with each other about patient care |
| Fostering constructive team-working (n=8) | Team-working was described that was collaborative and perceived to be conducive to good patient care |
| Ineffective due to unclear role definition (n=7) | Described when there was a perceived lack of leadership or when too many people were trying to take on the leadership role |
| Effective, based on clearly defined roles (n=6) | Roles here were defined often as a result of having time to prepare for the situation. For example, a multiple trauma coming into accident and emergency |
| Identified through traditional clinical roles (n=6) | For example, Doctor as leader, nurse as follower |
| Collective decision-making (n=5) | Sharing group goals, all team members working towards the same goal and with an appropriate allocation of tasks |
| Identified through traditional hierarchies (n=4) | The most senior person present was seen to automatically take the lead. Assumed through traditional hierarchies |
| Effective, based on practiced protocols (n=2) | This often related to cardiac arrest scenarios in which protocols are practiced and the scenario is seen to ‘run’ ‘smoothly’ due to repeated practice of these scenarios |
| Theme: Emergent leadership relationships (n=40) | Definition |
| Subthemes | |
| Facilitated by individual knowledge or experience (n=21) | An individual will ‘step into’ leadership based on previous experience or knowledge. Leadership can sometimes come from unexpected sources and does not necessarily follow traditional hierarchies |
| Facilitated by lack of engagement of expected leader (n=9) | Trainees described being ‘pushed into’ a leadership role due to lack of engagement of a perceived leader. Sometimes the perceived leader can ‘hand leadership back to the junior’. Trainees are not actively seeking to take on leadership but sometimes circumstance requires them to do so |
| Facilitated by systems and protocols (n=5) | For example, trainees used protocol to support a change in clinical care and take on leadership |
| Facilitated by timing (n=3) | Owing to the timing of incidents, trainees take on leadership for example, at night |
| Inhibited by lack of knowledge or experience (n=1) | Trainees describe an individual who ‘steps into’ the leadership role but is unable to take on that role due to lack of experience or knowledge |
| Inhibited by systems and protocols (n=1) | Where systems do not allow leadership to emerge (eg, consultant to consultant referral systems.) Often this was linked to perceptions of traditional medical hierarchies |