281 - In-house medical teams and their patients benefit from an approachable on-call physician

Publication Number: 1267.281

Arieh Riskin, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Israel institute of Technology, Haifa, Israel, Haifa, Hefa, Israel; Yarden Riskin, Texas A&M University, Mays Business School, College Station, TX, United States; Peter Bamberger, Tel Aviv University, Haifa, Hefa, Israel

Background: Leader approachability -- defined as the degree to which leaders are inclusive, respectful, and attentive to member questions and inputs - has been posed to promote a safe and supportive working environment, facilitating members' inquisitiveness, participation and speaking up. Moreover, such behavior should encourage the kind of critical reflexivity, feedback-seeking and experimentation; processes central to team learning and performance.

Objective: To explore how the approachability of senior physicians impacts team cooperation, learning and performance.

Design/Methods: 45 Israeli NICU teams, who participated in one day simulation-based workshops, were randomly assigned to either an "approachable" or "non-approachable" on-call physician, with their leader's approachability described to them via a script read at the beginning of the day and before each of 4 simulation scenarios. Judges (senior neonatologists or nurses), watched teams from a separate control room and rated team performance, teamwork and active team learning using a structured questionnaire. Manipulation check showed that the participants rated (on a scale of 1-5) the approachability of their leader consistent with their assigned condition (Mean approachable 3.90±0.31 vs. non-approachable=3.05±0.39) (p <.001).

Results: Diagnosis, overall therapy, teamwork and active learning were better in teams exposed to the "approachable" leader (Table). Mediation analysis indicated that leader approachability had a significant indirect effect on team performance via both information sharing directly, as well as sequentially via active learning (Figure).

Conclusion(s): Approachable team leaders facilitate information sharing which both directly and indirectly (via team active learning processes) impacts both team diagnostic performance and overall care management. Although leader non-approachability may have beneficial long-run implications for medical leadership development and independence (which remains to be determined), the current findings suggest that any such benefits are likely to come at the cost of short-term team performance and patient safety.

Table. Clinical performance, teamwork and learning.
Diagnosis, overall therapy, teamwork and active learning were better in teams exposed to the "approachable" leader.

Mediation analysis
Mediation analysis indicated that leader approachability had a significant indirect effect on team performance via both information sharing directly, as well as sequentially via active learning.