Leadership in the prehospital setting - a systematic review
Parkhe, Emma (2021)
Parkhe, Emma
2021
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Julkaisun pysyvä osoite on
https://urn.fi/URN:NBN:fi:amk-202201191446
https://urn.fi/URN:NBN:fi:amk-202201191446
Tiivistelmä
Background: In the prehospital setting, issues such as staff retention call for improved leadership strategies. This study on prehospital leadership offers a new area of exploration in a setting characterized by complexity and unpredictability. Leadership is influencing or coordinating the actions of a group of people towards a common goal, in a non-coercive way. Effective leadership in healthcare settings has been shown to decrease patient mortality by encouraging, retaining and supporting experienced staff. The aim of the study was to synthesize the quality of evidence of prehospital leadership by examining current methods of delivering leadership in the prehospital setting and its impact on patient safety as well as staff satisfaction.
Method and results: The databases of Embase, PubMed, Cochrane, Medline and CINAHL were searched and yielded 3833 results of which 18 met the eligibility criteria and were reviewed. The results were synthesised using a narrative approach. Five studied the perceptions of prehospital clinical leadership in various contexts, two compared the perception of prehospital staff applying different leadership models to practice. Two looked at paramedics’ experiences of communication and relationship with management. One examined how leadership is learnt throughout the paramedic career and another looked into the concept of informal prehospital leadership. Three studies looked at specific interventions provided by enhanced care teams providing clinical leadership and skills on scene, another studied the components of team leadership or membership in the prehospital setting. One study explored the role of the prehospital training leader whereas another examined the leadership framework in a UK national ambulance service.
Discussion: All the included studies highlight the presence of paramedic engagement in leadership at different levels. Prehospital leadership is most commonly found in the context of patient-facing practice but also discussed on a tactical scene command and strategic national level. Competence and credibility appear at the core of prehospital leadership resulting in staff empowerment as well as encouragement. It appears that a shared leadership model is favourable and there is a consensus around prehospital leadership and its positive impact on staff engagement, -satisfaction and patient safety.
Method and results: The databases of Embase, PubMed, Cochrane, Medline and CINAHL were searched and yielded 3833 results of which 18 met the eligibility criteria and were reviewed. The results were synthesised using a narrative approach. Five studied the perceptions of prehospital clinical leadership in various contexts, two compared the perception of prehospital staff applying different leadership models to practice. Two looked at paramedics’ experiences of communication and relationship with management. One examined how leadership is learnt throughout the paramedic career and another looked into the concept of informal prehospital leadership. Three studies looked at specific interventions provided by enhanced care teams providing clinical leadership and skills on scene, another studied the components of team leadership or membership in the prehospital setting. One study explored the role of the prehospital training leader whereas another examined the leadership framework in a UK national ambulance service.
Discussion: All the included studies highlight the presence of paramedic engagement in leadership at different levels. Prehospital leadership is most commonly found in the context of patient-facing practice but also discussed on a tactical scene command and strategic national level. Competence and credibility appear at the core of prehospital leadership resulting in staff empowerment as well as encouragement. It appears that a shared leadership model is favourable and there is a consensus around prehospital leadership and its positive impact on staff engagement, -satisfaction and patient safety.