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Shared leadership in tertiary care: design of a simulation for patient safety decision-making in healthcare management teams
  1. Lisa Aufegger1,
  2. Emma Soane2,
  3. Ara Darzi1,
  4. Colin Bicknell1
  1. 1 (NIHR) Imperial Patient Safety Translation Research Centre, Imperial College London, London, UK
  2. 2 Department of Management, London School of Economics and Political Science, London, UK
  1. Correspondence to Lisa Aufegger, Patient Safety Translational Research Centre, Imperial College London, London W2 1NY, UK; l.aufegger{at}


Introduction Simulation-based training (SBT) on shared leadership (SL) and group decision-making (GDM) can contribute to the safe and efficient functioning of a healthcare system, yet it is rarely incorporated into healthcare management training. The aim of this study was design, develop and validate a robust and evidence-based SBT to explore and train SL and GDM.

Method Using a two-stage iterative simulation design approach, 103 clinical and non-clinical managerial students and healthcare professionals took part in an SBT that contained real-world problems and opportunities to improve patient safety set within a fictional context. Self-report data were gathered, and a focus group was conducted to address the simulation’s degree of realism, content, relevance, as well as areas for improvement.

Results Participants experienced the simulation scenario, the material and the role assignment as realistic and representative of real-world tasks and decision contexts, and as a good opportunity to identify and enact relevant tasks, behaviours and knowledge related to SL and GDM. Areas for improvement were highlighted with regard to involving an actor who challenges SL and GDM; more preparatory time to allow for an enhanced familiarisation of the content; and, video debriefs to reflect on relevant behaviours and team processes.

Conclusions Our simulation was perceived as an effective method to develop SL and GDM within the context of patient safety and healthcare management. Future studies could extend this scenario method to other areas of healthcare service and delivery, and to different sectors that require diverse groups to make complex decisions.

  • Leadership
  • Decision-Making
  • Simulation
  • Health Management
  • Patient Safety

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  • Contributors LA, ES, AD and CB conceptualised this research. LA collected and analysed the data. The manuscript was written by LA with contributions from all authors. All authors have read and approved the manuscript.

  • Funding This article represents independent research supported by the NIHR Imperial Patient Safety Translational Research Centre and the NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Care. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

  • Competing interests None declared.

  • Map disclaimer The depiction of boundaries on the map(s) in this article does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. The map(s) are provided without any warranty of any kind, either express or implied.

  • Ethics approval The research was granted ethical approval by the Imperial College Joint Research Compliance Office (16IC3469), UK, and was conducted according to ethical guidelines of the British Psychology Society. Written informed consent was obtained from all participants, and no payment was given in exchange for participation.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement The data that support the findings of this study are not publicly available. Because of the nature of the informed, written consent and ethical restrictions, data distribution is not permitted. However, the SBT material is freely available for anyone (researcher, healthcare manager, practitioner, etc) who wishes to use it for academic, non-commercial purposes. The content, including each figure and table in the SBT supplemental file, was created by the authors and are not based on real-life data. Pictures in online supplemental file were accessed from websites that are free from copyright restrictions, such as URLs: and

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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