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Leadership
Dave Caesar
Clinical Director for Emergency Medicine, RIE & SJH
Preconceptions
Overview
Background & training Personal context / work environment 3 strata of leadership in clinical settings What makes these challenging How these settings could be effectively led Commonality of factors
The small team
25 yr old man falls from a 3rd floor window at 9pm on a Saturday
An ambulance is called, they retrieve him to the ED
You are leading a team of 1 other doctor and 2 nurses to receive this patient
He is barely conscious, has a very weak pulse, and looks ghostly white
Situation 15mins after arrival
You have a patient with 2 time-critical life-threatening conditions (at least)Lung injury and low oxygen levelsMajor blood loss from unstable pelvic #
How do you lead this situation? What do you need to have / know / access?
Small team clinical leadership Situational awareness:
Personal traits / knowledge base Transfer of (clinical) data
Directly & indirectly (from team)
Ability to process
Decision-making ability: Understanding what you still need to know Balancing risks to achieve correct course of action
Communicating command and decisions Can rely on “rank” but better with credibility
Small team leadership
High-end requirements Pre-empting natural progression Time-efficient manoeuvres Managing multiple cases Optimising team performance by good task delegation
Disasters Asking wrong (clinical) questions Not receptive to team data / feedback Acting on wrong answers (internally or externally) Not acting at all
The Big team
You come out of the resuscitation room in the ED to find 20 majors cases waiting to be seen, with a wait of over 1 hour, and a queue of 30 minors patients with a wait of 3 hours.
You have a team of 3 senior trainees and 6 junior trainees, and 9 nursing staff for the department.
Big team leadership Presence x 2 Accessibility Situational awareness
Departmental activity and how to prioritise ptsAllocating appropriate tasks to the right staffHospital activity and where / how to get helpCalling for back-up (if it exists)
Communicating your plan
Big team leadership
Desirables Calm under fire Reasonable Knowing when to pull which triggers Knowing when to compromise Getting the team to work more effectively than the sum of their
parts
Less effective Shroud-waving Conspicuous by absence (even if working behind the scenes)
Counteracting perceptions
The lumbering organisation
You are then summoned to explain your Department’s poor performance against national standards to the Board
They want solutions They have no extra money
Strategic leadership
Essential Must start with “the vision” + believe it Engage in senior tier processes Understanding political context / priorities Solutions should be:
Stepwise Reasonable Achievable Measurable somehow Matched to organisational + service priorities Show relative value or be last resort
Strategic leadership
Desirable Vary focus between present and vision Make sure present and vision is always connected, however
convoluted Communicate “the vision” regularly (up + down) Get buy-in from your team Determination with flexibility
Less good No engagement No communication No change No improvement
Personal traits?
Personal traits
Insight Personal strengths / weaknesses How you are perceived
Personal motivation Patient / client centred “Inverse” working arrangements
Perspective Adjacent systems Reasonable appreciation of all risks Political
Credibility Be right more often than not Be grounded
Summary
Lots of scales & versions of leadership All require “the vision” and belief in it Effective leadership achieves
Commonality of purpose Synergy of individuals’ unique strengths Optimistic and motivated workplace Change and improvement culture Better outcomes
Questions / discussion
Thank you
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