Introduction

The scenarios in this suit, Diamonds, are designed to facilitate discussion about teamwork, communication and culture within teams. The answers to these scenarios are less prescriptive than those in the other suits because there is not the same level of professional consensus on the underlying principles compared to the scenarios that are more explicitly linked to an ethical topic. Therefore, this reader is used to support all of the cards in this suit.

All these scenarios are based around a common framework.

‘You are to lead a new multi-national hospital to be deployed as part of the UN Peacekeeping mission. The personnel will have a one-week training period in the capital of the country before deploying to set up the hospital in a remote and austere location. Three countries have agreed to provide personnel working to you representing the ‘lead nation’ though you will report to the multinational UN HQ’.

Effective teamwork is an essential pre-requisite to safe healthcare. Relationships with colleagues is a core element of medical ethics. The World Health Organisation website on patient safety has some excellent material on factors that impact on patient safety including teamwork, communications and culture. Rosen et al’s paper provides a good introductory review of the subject, covering the characteristics of individuals and teams, processes and cultures for effective teams, and the evidence of benefits from investment and training of teams towards clinical outcomes, and team and organisational health. The US Fundamentals of Military Medicine from the Textbook of Military Medicine Series has a number of chapters on leadership and ethics in military medicine that are highly relevant. This is a substantial subject, and so these scenarios and this reader are designed to merely introduce the subject and provide signposts to further reading.

Leadership – personal and within a team

All armed forces invest significant resources in developing teams and their leaders. This includes the processes in initial training, especially for officers, and subsequent career development for all ranks. As part of your discussion, you might review these and discuss how the armed forces develop organisational values and standards as the foundations for personal and team behaviours. You might also consider how leadership is taught, as well as any frameworks or principles that are used to communicate leadership ideas. The Further Reading provides links on this topic.

‘Protected Characteristics’ - age, disability, gender reassignment, race, religion or belief, sex, sexual orientation, marriage and civil partnership, and pregnancy and maternity

Many countries have laws that protect sections of society with ‘protected characteristics’ from discrimination. At a personal level, this means organisations must have policies and procedures that protect both patients and healthcare workers with these characteristics. This includes protection from being treated worse than someone without the characteristic (direct discrimination) and protection from being disadvantaged due to the characteristic (indirect discrimination). Consider the policies that apply regarding discrimination in your organisation and how you might respond if a patient, colleague or subordinate reported discrimination or misbehaviour.

Ethical principles:

WMA INTERNATIONAL CODE OF MEDICAL ETHICS at: https://www.wma.net/policies-post/wma-international-code-of-medical-ethics/

A PHYSICIAN SHALL behave towards colleagues as he/she would have them behave towards him/her.

World Health Organisation. Patient Safety. At: https://www.who.int/patientsafety/education/en/

Rosen MA, DiazGranados D, Dietz AS, et al. Teamwork in healthcare: Key discoveries enabling safer, high-quality care. Am Psychol. 2018;73(4):433-450. doi:10.1037/amp0000298

Fundamentals of Military Medicine. The Borden Institute. At: https://www.cs.amedd.army.mil/borden/bookDetail.aspx?ID=a875991f-3640-4cab-afa5-66f02f917333

Leadership and Leadership Development in Health Care:

The Evidence Base. 25 February 2015. Faculty of Medical Leadership and Management, The King’s Fund and the Center for Creative Leadership. At: https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/leadership-leadership-development-health-care-feb-2015.pdf accessed 10 Feb 20

Healthcare leadership model. NHS Leadership Centre. At: https://www.leadershipacademy.nhs.uk/resources/healthcare-leadership-model/ accessed 20 Apr 20.

Kline R. Leadership in the NHS. BMJ Leader 2019;3:129-132. http://dx.doi.org/10.1136/leader-2019-000159 Podcast at: https://soundcloud.com/bmjpodcasts/why-inclusion-and-diversity-are-key-to-great-teams

The Army Leadership Code. An Introductory Guide. British Army. 2015. At: https://www.army.mod.uk/media/2698/ac72021_the_army_leadership_code_an_introductory_guide.pdf

The Defence Leadership Framework: Growing Leaders at all Levels. 12 Mar 2010. Department of Defence, Australia. At: https://www.defence.gov.au/publications/docs/DLFBooklet.pdf accessed 10 Apr 2020