Parent perceptions of early prognostic encounters following children’s severe traumatic brain injury: ‘Locked up in this cage of absolute horror’

OBJECTIVE: Little guidance exists for discussing prognosis in early acute care with parents following children’s severe traumatic brain injury (TBI). Providers’ beliefs about truth-telling can shape what is said, how it is said, and how providers respond to parents. METHODS: This study was part of a large qualitative study conducted in the USA (42 parents/37 families) following children’s moderate to severe TBI (2005 to 2007). Ethnography of speaking was used to analyse interviews describing early acute care following children’s severe TBI (29 parents/25 families). RESULTS: Parents perceived that: a) parents were disadvantaged by provider delivery; b) negative outcome values dominated some provider’s talk; c) truth-telling involves providers acknowledging all possibilities; d) framing the child’s prognosis with negative medical certainty when there is some uncertainty could damage parent-provider relationships; e) parents needed to remain optimistic; and, f) children’s outcomes could differ from providers’ early acute care prognostications. CONCLUSION: Parents blatantly and tacitly revealed their beliefs that providers play an important role in shaping parent reception of and synthesis of prognostic information, which constructs the family’s ability to cope and participate in shared decision-making. Negative medical certainty created a fearful or threatening environment that kept parents from being fully informed

Fat cats and thin followers: excessive CEO pay may reduce ability to lead

The large discrepancy between the pay of chief executive officers (CEOs) and their subordinates within organizations is attracting increasing attention and controversy. While there is evidence that this pay disparity may be contributing to rises in societal income inequality (and thus the range of associated social ills), there is little understanding of the impact of pay disparity on CEOs’ abilities to effectively lead their organizations. Drawing on the social identity approach to leadership, we argue that as the pay of CEOs increases relative to their followers, these followers will be less likely to identify with their CEOs as “one of us.” This, in turn, should undermine followers’ willingness to be influenced by the CEO: to follow their lead. We discuss two recent studies that provide the first test of these claims. These studies provide archival and experimental evidence that high CEO pay reduces followers’ identification as well as their perceptions that the CEO is a charismatic identity leader. In sum, then, this work suggests that high CEO pay may directly impair their capacity to perform their core function of leading their organization