Creating Leaders Around You

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Creating Leaders Around You

• International Collaboration for Excellence in
  Critical Care Medicine

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• The acute care hospital is the most complex
  organization to lead and manage.
• This complexity is compounded by academic
  missions and by an increasingly broad range of
  single and multi-site organizations,
  public/private mix of providers and a highly
  professional and autonomous cadre of knowledge
  workers.

Peter Drucker
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Objectives

• What is leadership?
• Why is leadership v. management needed in
  critical care?
• What are key attributes of a leader?

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Integrating Definition
Leadership involves a social influence process
whereby intentional influence is exerted by one
person over other people to structure the
activities and relationships in the group
organization.
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• Managers
• Are oriented toward stability

• Get people to do things more efficiently

• Leaders
• Are oriented toward innovation

• Get people to agree about what things should be
  done

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Can You Think of Some Leadership Examples?
Patton and Caesar.
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Can You Think of Some Leadership Examples?
Lincoln and Socrates
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Can You Think of Some Leadership Examples in
Healthcare?

• Albert Schweitzer
• James Burke?

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Case Study

• Mr. B, was a 75 year-old male referred for pre-op
  assessment before surgery for liver resection
• He WAS high-risk for peri-operative
  cardiovascular events ? prescribed a
  beta-blocker.
• He WAS badly nourished.

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Case Study

• Mr. B did not fill his prescription.
• Neither family doctor or surgeon received
  pre-op consultation note until after surgery.
• CCAC not aware so nutritional supplementation at
  home not begun.
• Long case surgical team forget to put in a
  feeding tube.

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Case Study

• ICU not aware bed required unable to accommodate
  ? agency nurse contracted to monitor Mr. B
  overnight in PARU
• Admitted to ICU 24 h later, hypotensive.
• No DVT prophylaxis for 34 h.
• ICU course complicated by MI prolonged weaning.

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What Evidence SaysShould Happen

• ?-blockers before high risk surgery
• DVT prophylaxis
• Feeding (enteral parenteral),
• Skin management,
• Antibiotic impregnated CV catheters,
• Consent and procedures

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An Issue of SAFETYWhat Should The Critical
Care Leader Do?
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Safety in the Auto Industry

• Congress grills Ford, Firestone, NHTSA
• Execs say they acted quickly on tire failures
• By Thomas A. Fogarty, USA TODAY

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Managing Cars
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Safety in the Auto Industry
GM Announces Safer Airbags Execs say they acted
quickly to install on new cars By Thomas A.
Fogarty, USA TODAY
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Good To Great
Level 5 leadership self-effacing, quiet,
reserved, even shy - a paradoxical blend of
personal humility and professional will. First
who... then what People are not your most
important aspect - the right people are. Confront
the brutal facts maintain faith that you can
and will prevail in the end, regardless of
difficulties AND at the same time have the
discipline to confront the most brutal facts of
your current reality.
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The Hedgehog Concept
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Good To Great
A culture of discipline When you combine a
culture of discipline with an ethic of
entrepreneurship, you get the magical alchemy of
great performance Technology accelerators never
used technology as the primary means of igniting
a transformation. The flywheel and the doom loop
transformations never happen in one fell
swoopbuild momentum until a point of
breakthrough, and beyond
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Another Problem

• You are the ICU Director. You are approached by
  the CEO who asks that the CC Service develop an
  outreach program
• He just returned from an international meeting on
  redesigning health care and he heard an
  Australian speaker talk about this.

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Good things to be doing
See the big picture Lind up the ducks Have a sidebar
Get on the same page Move goal posts Put it on the back/front burner
Touch base Dip your toes in the water Table it for later
Get a handle on it Build a straw man Get more bang for your buck
Take it and run with it Make a no-brainer decision Set aggressive but achievable goals
Keep ahead of the game Shorten launch curves Manage from the top down
Think outside the box Embrace change Manage expectations
Swing for the fence Do a sanity check Take a temperature check
View it from thirty thousand feet Get buy-in Press the flesh
Get back to basics Put it to bed Reach out
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Does Your Unit Have a Vision?

• Leaders provide a clear vision direction.
• Achieving a vision implies change. Leaders must
  understand the nuances and best practices of the
  change process. They must know how to build
  consensus.

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Pointing the Direction

• If we understand our reality, we can see where we
  need to go.
• Confidence and authenticity come from
  demonstrated knowledge.

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Have You Set Stretch Goals?

• Leaders set and celebrate goals
• Goals should make people stretch, but they must
  also be achievable. when the goal is reached,
  celebrate!

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Do You Identify problems?

• Leaders openly identify problems.
• Anticipate and acknowledge issues and then
  effectively deal with needed change.
• They build trust by openly admitting mistakes
  rather than assigning blame.

• Developing an ability to predict, embrace and
  better manage change are absolutely imperative.
  Web source.

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Do You Help Others as Leaders?

• Leaders cultivate leadership by empowering
  others.
• Your job is to set clear goals,
• If you pick the right team, you dont need to
  tell them what to do. Build self-directed teams
  of responsive and thoughtful colleagues.

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Leaders Communicate

• They increase communication and encourage others
  to do likewise, all day, every day.
• People hardly ever complain of over-communication
  .
• See things from others points of view and say
  so.
• Speak to be understood, and not misunderstood.
  Listen. Wait. Listen. Question for clarity and
  understanding.

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Leaders Learn

• Leadership and learning are indispensable to each
  other.
• John F. Kennedy
  (1917 - 1963), speech
  prepared for delivery in Dallas the day of his
  assassination, November 22, 1963

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Why Do We Resist Change?Why Do We Resist
Showing Leadership?
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Healthcare CEOs Admit They Miss/Ignore
Opportunities to Mentor Effectively

• CEOs miss mentoring opportunities, create
  short-term leadership roles and fail to evaluate
  future leaders.
• HCOs have financial constraints and short-term
  focus and they lack leadership commitment and
  identification/development of future leaders.

Witt/Kieffer Survey
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More Work Needed to Improve Overall Future Leader
Development in Health Care

• Healthcare CEOs believe graduate education plays
  the most effective mentoring role.
• Purposeful one-on-one mentoring and assuming
  personal responsibilities for mentoring can help
  future executives including women and minority
  leaders - grow.

Witt/Kieffer Survey
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What Would They have Done?

• Albert Schweitzer
• James Burke

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The ICU Business
Care Integration???
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• Management is doing things right
• leadership is doing the right things.
• Peter Drucker

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• Start with the premise that the function of
  leadership is to produce more leaders, not more
  followers.
• Ralph Nader