Follower-ship

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Much has been written on the subject of team leadership and crew-resource management particularly in a resuscitation situation.

It incorporates concepts such as a shared mental map, clear standardised language, role delineation, standard-operating procedures, situational awareness, delegation, workload distribution and read-back.

However, effective leadership can only occur with responsive and communicative team members.   Good follower-ship is just as important as good leadership.  Much more than being able to carry out tasks efficiently, members should not just be passively carrying out instructions.  They also need to alert the leader to evolving developments that threaten the function and goals of the team.

For junior staff, learning to being a good follower is a pre-requisite before assuming the responsibility of leadership.

A follower needs to consider these questions

  • Who is the current leader?
  • Am I aware of the progress of the situation?
  • Do I know the overall goal and plan?  What timeframes and deadlines should they be reached?
  • Do I know my team?
  • Is everyone communicating effectively?  Is anybody contributing to unnecessary noise?  How can I improve this?
  • Do I know my tasks?  Have I been given a task I am unable to perform?  Does the leader know?
  • Do I know everyone else’s task?  Do I know the priority of each task?
  • Do I know when I need help?  Is there someone that can help me?  How can they help me?  Does the leader know if I am struggling to complete my task safely or on time?
  • Do I disagree about the diagnosis, management or priorities?
  • Have I communicated my disagreement to the leader?
  • Do I know what else needs to be done?
  • Has the leader got another task for me?
  • Can I assist someone with their task?
  • Can I assist the leader with his tasks?
  • Is there something which is preventing the team from functioning effectively?  Can I help solve it?
  • Am I getting in the way?  How do I prevent someone else getting in the way?
  • Do I know when my involvement is complete?

A good follower needs to be able to articulate their concerns to the team

Find some scripted examples below to illustrate this:

  • “There are a lot of instructions being given at the moment.  Can I ask who is actually leading this resus?”
  • “Team Leader, there is a lot of noise and I am having trouble hearing your instructions”
  • “Team leader, the FAST scan is negative, would you like me to look at anything else before I move the machine away?”
  • “Team leader, the blood pressure is still 60/ after the fourth unit of blood.  What do you want to do next”
  • “Team leader, there is evidence of cardiac tamponade on the ultrasound.  Do you want me to call the cardiothoracic surgeon?.  Do you want me to open the thoracotomy tray?”
  • “Airway doctor, “We have just lost the capnograph trace, is there a problem up there?”
  • “Is my cricoid pressure helping.  Do you want me to give me some BURP instead?”
  • “I have a Grade IV view.  I’m going blind for one try.  If it doesn’t work, crike him next for the sats drop any further…”
  • “Linda, I am the airway nurse and have got the trolley set up.  Shall we go through the Airway Checklist one more time “
  • “Team leader, I don’t think I will be able to get a 16G cannula in, would a 18G do?.  Do you want someone else to look before I ruin the vein”
  • “Sarah, the sats are falling, do you want to start bagging again?”
  • John ‘Watch out when you step back from the patient, the infusion line is right behind you’
  • “Team leader, do you want me to put on the femoral traction first or set up for a chest tube”
  • “Team leader, the patient is becoming more responsive on the ventilator.  Are you sure you still want hypertonic saline”
  • “Team leader, I have called the orthopaedic surgeon.  He says he is caught up in theatre.  Do you want me to contact her consultant?”
  • “Craig, is there anything I can do to help you with the chest drain insertion?”
  • “Team leader, the surgical consultant has just arrived.  Do you want to me to brief him while you continue to direct the resuscitation”
  • “Sally, can you help me move some of these trolleys away to make more room for the next procedure”
  • “Team Leader, the art line has been calibrated with a MAP of 50mmHg, do you want us to make preparation for transport now?”
  • “Team leader, I have completed all my tasks.  Is there anything else for me to do?”

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