title: Leadership structures in emergency care settings: a study of two trauma centers.
abstract: BACKGROUND
  Trauma resuscitation involves multidisciplinary teams under surgical leadership in most US trauma centers. Because many trauma centers have also incorporated emergency department (ED) physicians, shared and cross-disciplinary leadership structures often occur. Our study identifies leadership structures and examines the effects of cross-disciplinary leadership on trauma teamwork.
  
  
  METHODS
  We conducted an ethnographic study at two US Level-1 trauma centers, one of which is a dedicated pediatric trauma center. We used observation, videotaping and interviews to contextualize and classify leadership structures in trauma resuscitation. Leadership structures were evaluated based on three dimensions of team performance: defined leadership, likelihood of conflict in decision making, and appropriate care.
  
  
  RESULTS
  We identified five common leadership structures, grouped under two broad leadership categories: solo decision-making and intervening models within intra-disciplinary leadership; intervening, parallel, and collaborative models within cross-disciplinary leadership.
  
  
  CONCLUSIONS
  Most important weaknesses of different leadership structures are manifested in inefficient teamwork or inappropriate patient care. These inefficiencies are particularly problematic when leadership is shared between physicians from different disciplines with different levels of experience, which often leads to conflict, reduces teamwork efficiency and lowers the quality of care. We discuss practical implications for technology design.
authors.affiliation: School of Communication and Information, Rutgers University, 4 Huntington Street, New Brunswick, NJ 08901, USA. aleksarc@rutgers.edu
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Sarcevic
authors.forename: Ivan
authors.initials: I
authors.lastname: Marsic
authors.forename: Lauren J
authors.initials: LJ
authors.lastname: Waterhouse
authors.forename: David C
authors.initials: DC
authors.lastname: Stockwell
authors.forename: Randall S
authors.initials: RS
authors.lastname: Burd
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration*; D004632:Emergency Medical Services / Q000458:organization & administration*; D007857:Leadership; D017146:Models, Organizational; D010348:Patient Care Team / Q000458:organization & administration*; D012151:Resuscitation; D014193:Trauma Centers / Q000458:organization & administration*; D014481:United States