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 / Spring 2005 / Issue 38(originally published by Booz & Company)


Recent Studies

Distributed leadership, shareholder value in family-owned firms, R&D strategy, and other topics of interest.

Distributed Leadership
Katherine J. Klein ([email protected]), Jonathan C. Ziegert ([email protected]), Andrew P. Knight ([email protected]), and Yan Xiao ([email protected]), “A Leadership System for Emergency Action Teams: Rigid Hierarchy and Dynamic Flexibility.” Click here.

Photograph by Bruce Weller
It’s hard to imagine an environment more demanding of leaders than a trauma resuscitation unit at a top medical facility. A victim of a shooting, stabbing, or car crash arrives by helicopter or ambulance and is immediately surrounded by a team of doctors, nurses, and technicians. Their job is to stabilize, diagnose, and treat the patient as quickly as possible. Any mistake or delay can be fatal.

If that isn’t tough enough, several members of the trauma resuscitation team probably have never worked together before. Furthermore, throughout the day and night, the team’s composition will change as members finish their shifts and are replaced by newcomers.

How should such teams be led? That is the question addressed by Katherine J. Klein, a management professor at the University of Pennsylvania’s Wharton School of Business; Jonathan C. Ziegert, a visiting scholar at Wharton; Andrew P. Knight, a Wharton doctoral student; and Yan Xiao, a professor and lead researcher at the University of Maryland’s School of Medicine.

These researchers spent more than 10 months observing trauma resuscitation teams in action at the University of Maryland Shock Trauma Center (STC) in Baltimore, a world-renowned urban medical facility treating 7,000 patients a year. Although they were studying a health-care center, the researchers’ goal was to determine leadership models under different conditions. Their findings challenge conventional ideas.

Traditional theory views leaders as clearly identifiable individuals whose main responsibility is to enhance the motivation and commitment of followers. It is assumed leaders have a stable and long-term relationship with subordinates. But according to Professor Klein and her colleagues, such notions of leadership “appear increasingly inapt” for high-performing multidisciplinary teams. These include the trauma teams they studied and other emergency service providers, such as firefighters and the military. (The research was partly funded by the U.S. Army Research Institute.) Parallels exist as well with interdisciplinary teams in business, for example, groups developing software or cancer drugs, participating in complex engineering projects, or operating such time-sensitive businesses as airlines and restaurants.

An STC trauma resuscitation team typically has six members: an attending surgeon, who has the most trauma and surgery expertise and experience; a surgical fellow, a doctor who has recently completed residency and is doing an additional year’s training in STC; one or more surgical or emergency medical residents, doctors who have completed medical school but not their residency; an anesthesiologist; a registered nurse; and a trauma technician.

When the researchers started the project, they assumed that each team had a single, specified leader. “We were wrong,” they note. “Not only does leadership not reside in a single person, it does not reside in a single position.”

Instead, the researchers identified a leadership system in which the “active leadership role” shifts between three different team members: the attending surgeon, the fellow, and the admitting resident. The surgeon has seniority and can step in at any point if he or she feels the patient is in jeopardy. At other times, however, the surgeon may be content to let the less-experienced doctors call the shots, allowing them to gain vital skills and to develop their own judgment without endangering patients. The aim, according to the authors, is to give junior colleagues “enough rope to hang themselves, but not enough to hang the patient.”

This threefold leadership system provides several important benefits for the trauma unit. First, it accommodates frequent changes in team composition. Second, it creates redundancy, so that if one leader lacks the knowledge to direct patient care, another is available. This raises the quality of patient care. Finally, the system allows relatively inexperienced leaders to develop leadership skills in a supportive environment.

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