Leadership delegation, team efficacy and resilience in critical care: a simulation-based study

Lara Poitrin (), Sophie Le Bris (), Emmanuel Rineau (), Dominique Savary, Ludovic Martin, Merce Jourdain (), Tom Alcouffe, Jeremie Riou (), Dominique Martin () and Nicolas Lerolle ()
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Lara Poitrin: CREM - Centre de recherche en économie et management - UNICAEN - Université de Caen Normandie - NU - Normandie Université - UR - Université de Rennes - CNRS - Centre National de la Recherche Scientifique, CHU Angers - Centre Hospitalier Universitaire d'Angers, LEGO - Laboratoire d'Economie et de Gestion de l'Ouest - UBS - Université de Bretagne Sud - UBO EPE - Université de Brest - IMT - Institut Mines-Télécom [Paris] - IBSHS - Institut Brestois des Sciences de l'Homme et de la Société - UBO EPE - Université de Brest - UBL - Université Bretagne Loire - IMT Atlantique - IMT Atlantique - IMT - Institut Mines-Télécom [Paris]
Sophie Le Bris: LEGO - Laboratoire d'Economie et de Gestion de l'Ouest - UBS - Université de Bretagne Sud - UBO EPE - Université de Brest - IMT - Institut Mines-Télécom [Paris] - IBSHS - Institut Brestois des Sciences de l'Homme et de la Société - UBO EPE - Université de Brest - UBL - Université Bretagne Loire - IMT Atlantique - IMT Atlantique - IMT - Institut Mines-Télécom [Paris]
Emmanuel Rineau: CHU Angers - Centre Hospitalier Universitaire d'Angers
Dominique Savary: CHU Angers - Centre Hospitalier Universitaire d'Angers
Ludovic Martin: CHU Angers - Centre Hospitalier Universitaire d'Angers
Merce Jourdain: Université de Lille, RTD - Recherche translationnelle sur le diabète - U 1190 - Institut Pasteur de Lille - Pasteur Network (Réseau International des Instituts Pasteur) - INSERM - Institut National de la Santé et de la Recherche Médicale - Université de Lille - CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
Tom Alcouffe: CHU Angers - Centre Hospitalier Universitaire d'Angers
Jeremie Riou: CHU Angers - Centre Hospitalier Universitaire d'Angers
Dominique Martin: CREM - Centre de recherche en économie et management - UNICAEN - Université de Caen Normandie - NU - Normandie Université - UR - Université de Rennes - CNRS - Centre National de la Recherche Scientifique
Nicolas Lerolle: CHU Angers - Centre Hospitalier Universitaire d'Angers

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Abstract: Objective: To quantitatively assess leadership delegation in expert critical care teams during simulated emergency scenarios, and to explore its association with team efficacy and resilience. Design: Multicentre, prospective observational study using high-fidelity simulation. Three critical care scenarios of increased difficulty were developed, each incorporating carefully calibrated expected and disruptive events. Setting: Five university-affiliated simulation centres in France. Participants: 30 interprofessional teams (150 participants), each composed of a senior physician, resident, nurse, healthcare assistant and medical student, all having worked together clinically. Main outcome measures: Occurrence and characteristics of leadership delegation following events; team performance as evaluated by external experts; self-reported team member satisfaction, engagement and cohesion; statistical associations using sparse Partial Least Squares and unsupervised clustering. Results Delegation occurred less frequently with increased scenario difficulty (p=0.003 for comparison between scenarios). In contrast, delegations initiated by team members other than the senior physician were more frequent in scenarios with a higher number of disruptive events (p=0.004). Delegation was moderately correlated with resilience parameters (team satisfaction, engagement and cohesion parameters, typically ρ>0.25) but showed no association with simulated patient survival. Clustering revealed a mismatch in some team members between high satisfaction and low performance. Conclusions: Delegation in emergency teams was associated with team resilience rather than with clinical performance. Disruptive events led to leadership coming from other team members than the leaders.

Keywords: Team Performance; Simulation; Resilience; Leadership; Interprofessional Collaboration; Emergency Medicine; Delegation; Critical Care (search for similar items in EconPapers)
Date: 2026
Note: View the original document on HAL open archive server: https://hal.science/hal-05586088v1
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Published in BMJ Open, 2026, 16 (3), pp.e109624. ⟨10.1136/bmjopen-2025-109624⟩

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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-05586088

DOI: 10.1136/bmjopen-2025-109624

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