Leadership in the intensive care unit: an international perspective

Introduction Leadership in the intensive care unit (ICU) is complex due to patient acuity, time-sensitive decision-making and multidisciplinary team interaction. The purpose of this study was to identify and describe themes of effective leadership in the ICU, as expressed by international critical care leaders. Methods This qualitative study was informed by a constructivist paradigm. Data were collected during three focus groups at the XXVIII Foro Internacional de Medicina Crítica, an annual international meeting in Mexico. Participants included 22 leaders representing Mexico, the USA, Canada and the European Union. About 40% were women and all served in leadership roles with half serving in national or international leadership roles. Data were analysed using reflexive thematic analysis. Results Five themes were developed to inform our understanding of effective ICU leadership: intentional verbal and non-verbal communication fosters trust and respect; team culture, mentorship and social support shape leadership effectiveness; personal affect should be managed through emotional intelligence; effective ICU leadership is adaptive and context-dependent; institutional structures influence equity, opportunity and leadership representation. Conclusions Our findings suggest that emotional intelligence is a central component of ICU leadership development, alongside institutional structures that support equity, mentorship, professional development and a positive team culture.