Leading on the edge: The nature of paramedic leadership at the front line of care

Markers of cognitive skills important for team leaders in emergency medical services: a qualitative interview study

Background

Cognitive skills and other non-technical skills are key for emergency medical services (EMS); however, there have been a limited number of their markers identified. This study aims to identify markers of cognitive skills—situation awareness and decision making—important for team leaders in EMS. The focus is on any markers of cognitive skills that are associated with quality and safety at EMS work.

Method

In-depth semi-structured interviews were conducted with 20 EMS team leaders (10 EMS physician team leaders and 10 paramedic team leaders) and analysed by the structured approach utilising the known framework of cognitive skill elements.

Results

The data analysis revealed a set of 50 markers falling into elements of situation awareness (gathering information, interpreting information, anticipating states), elements of decision making (identifying options, implementing decisions, re-evaluating decisions), and an additional cognitive element (maintaining standards). These markers represented cognitive processes, acts, and communications, therefore, some of them can be observable and others rather unobservable. The identified markers were not too specific, applicable mostly in various challenging situations with patients’ medical problems and in EMS team leaders working in ground ambulances in urban and rural/remote areas.

Conclusion

The findings provide a better understanding of EMS team leaders’ cognitive skills, and can aid in the development of assessment and training tools suited particularly to them.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12873-022-00629-1.

Exploring the impact of decentralized leadership on knowledge sharing and work hindrance networks in healthcare teams

This paper adopts an explanatory sequential mixed method design to explore the impact of decentralized (vs. centralized) leadership on cross-functional teams' resource exchanges at a long-term care facility in Canada. In the quantitative phase, social network analyses were used to examine the direct and moderated effects (via leader–follower relationship quality; LMX) of the presence of formal decentralized leaders on: (1) knowledge sharing, and (2) work hindrance networks within cross-functional healthcare teams. In the qualitative phase, team members were interviewed regarding the impact of their decentralized leaders. Collectively, the findings suggest that the presence of a decentralized leader may enhance knowledge sharing and safeguard against work hindrance behaviors in cross-functional healthcare teams. However, these effects are contingent on the situation (e.g., LMX quality and status-based hierarchies). Implications for research and healthcare practice are discussed.

Continuing Education for Prehospital Healthcare Providers in India - A Novel Course and Concept

BACKGROUND

Emergency medical services (EMS) in India face enormous challenges in providing care to a geographically expansive and diverse patient population. Over the last decade, the public-private-partnership GVK EMRI (Emergency Management and Research Institute) has trained over 100,000 emergency medical technicians (EMTs), with greater than 21,000 currently practicing, to address this critical gap in the healthcare workforce. With the rapid development and expansion of EMS, certain aspects of specialty development have lagged behind, including continuing education requirements. To date, there have been no substantial continuing education EMT skills and training efforts. We report lessons learned during development and implementation of a continuing education course (CEC) for EMTs in India.

METHODS

From 2014 to 2017, we employed an iterative process to design and launch a novel CEC focused on five core emergency competency areas (medicine and cardiology, obstetrics, trauma, pediatrics, and leadership and communication). Indian EMT instructors and providers partnered in design and content, and instructors were trained to independently deliver the CEC. Many challenges had to be overcome: scale (>21,000 EMTs), standardization (highly variable skill levels among providers and instructors), culture (educational emphasis on rote memorization rather than practical application), and translation (22 major languages and a few hundred local dialects spoken nationwide).

LESSONS LEARNED

During the assessment and development phases, we identified five key strategies for success: (1) use icon-based video instruction to ensure consistent quality and allow voice-over for easy translation; (2) incorporate workbooks during didactic videos and (3) employ low-cost simulation and case discussions to emphasize active learning; (4) focus on non-technical skills; (5) integrate a formal training-of-trainers prior to delivery of materials.

CONCLUSION

These key strategies can be combined with innovation and flexibility to address unique challenges of language, system resources, and cultural differences when developing impactful continuing educational initiatives in bourgeoning prehospital care systems in low- and middle-income countries.

Non-technical skills in paramedicine: A scoping review

This scoping review aims to identify which non-technical skills have been empirically identified in the literature, to create the first list of empirically identified non-technical skills for paramedics and allied health personnel. A five-stage scoping literature was undertaken in March 2020. The search retrieved a total of 4756 citations. A total of 93 studies met the inclusion criteria and were analyzed for data charting. A total of 26 non-technical skills were identified in the literature. The top five non-technical skills included decision-making (33%, n = 31), communication (24%, n = 23), empathy (17%, n = 16), leadership (12%, n = 12), and ethics (10%, n = 10). Furthermore, only five studies investigated the assessment or measurement of non-technical skills. This scoping review identified 26 non-technical skills that had been investigated in the paramedic literature to create the first list of empirically based desirable non-technical skills for a paramedic. Subsequently, research can then begin to focus on identifying the link that these have to paramedic practice and patient safety.

Priorities and challenges for health leadership and workforce management globally: a rapid review

BACKGROUND

Health systems are complex and continually changing across a variety of contexts and health service levels. The capacities needed by health managers and leaders to respond to current and emerging issues are not yet well understood. Studies to date have been country-specific and have not integrated different international and multi-level insights. This review examines the current and emerging challenges for health leadership and workforce management in diverse contexts and health systems at three structural levels, from the overarching macro (international, national) context to the meso context of organisations through to the micro context of individual healthcare managers.

METHODS

A rapid review of evidence was undertaken using a systematic search of a selected segment of the diverse literature related to health leadership and management. A range of text words, synonyms and subject headings were developed for the major concepts of global health, health service management and health leadership. An explorative review of three electronic databases (MEDLINE®, Pubmed and Scopus) was undertaken to identify the key publication outlets for relevant content between January 2010 to July 2018. A search strategy was then applied to the key journals identified, in addition to hand searching the journals and reference list of relevant papers identified. Inclusion criteria were independently applied to potentially relevant articles by three reviewers. Data were subject to a narrative synthesis to highlight key concepts identified.

RESULTS

Sixty-three articles were included. A set of consistent challenges and emerging trends within healthcare sectors internationally for health leadership and management were represented at the three structural levels. At the macro level these included societal, demographic, historical and cultural factors; at the meso level, human resource management challenges, changing structures and performance measures and intensified management; and at the micro level shifting roles and expectations in the workplace for health care managers.

CONCLUSION

Contemporary challenges and emerging needs of the global health management workforce orient around efficiency-saving, change and human resource management. The role of health managers is evolving and expanding to meet these new priorities. Ensuring contemporary health leaders and managers have the capabilities to respond to the current landscape is critical.