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Creating Leaders Around Creating Leaders Around YouYou
International Collaboration for Excellence in Critical Care
Medicine
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“ “ The acute care hospital is the most The acute care hospital is the most complex organization to lead and complex organization to lead and
manage.” manage.”
““This complexity is compounded by This complexity is compounded by academic missions and by an academic missions and by an
increasingly broad range of single and increasingly broad range of single and multi-site organizations, public/private multi-site organizations, public/private
mix of providers and a highly mix of providers and a highly professional and autonomous cadre of professional and autonomous cadre of
knowledge workers.”knowledge workers.”
Peter DruckerPeter Drucker
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ObjectivesObjectives
• What is What is leadershipleadership??
• Why is Why is leadershipleadership [v. [v. managementmanagement] ] needed in critical care?needed in critical care?
• What are key attributes of a What are key attributes of a leader?leader?
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LeadershipLeadership involves a social influence involves a social influence
process whereby intentional influence is process whereby intentional influence is
exerted by one person over other people exerted by one person over other people
to structure the activities and to structure the activities and
relationships in the group organization.relationships in the group organization.
Integrating DefinitionIntegrating Definition
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ManagersManagers::
• Are oriented toward Are oriented toward stability stability
LeadersLeaders::
• Are oriented toward Are oriented toward innovationinnovation
• Get people to do things Get people to do things more efficiently more efficiently
• Get people to agree about Get people to agree about what things should be donewhat things should be done
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Can You Think of Some Can You Think of Some Leadership Examples?Leadership Examples?
Patton and Caesar.
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Can You Think of Some Can You Think of Some Leadership Examples?Leadership Examples?
Lincoln and Socrates
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Can You Think of Some Can You Think of Some Leadership Examples in Leadership Examples in
Healthcare?Healthcare?
Albert SchweitzerAlbert Schweitzer
James Burke?James Burke?
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Case Study
• Mr. B, was a 75 year-old male referred Mr. B, was a 75 year-old male referred for pre-op assessment before surgery for pre-op assessment before surgery for liver resection:for liver resection:
– He WAS “high-risk” for peri-operative He WAS “high-risk” for peri-operative cardiovascular events cardiovascular events prescribed a prescribed a beta-blocker. beta-blocker.
– He WAS badly nourished. He WAS badly nourished.
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Case Study
• Mr. B did Mr. B did notnot fill his prescription. fill his prescription.
• Neither family doctor or surgeon Neither family doctor or surgeon received pre-op consultation note received pre-op consultation note until until afterafter surgery. surgery.
• CCAC not aware so nutritional CCAC not aware so nutritional supplementation at home not begun.supplementation at home not begun.
• Long case – surgical team “forget” to Long case – surgical team “forget” to put in a feeding tube.put in a feeding tube.
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Case Study
• ICU not aware bed required; unable to ICU not aware bed required; unable to accommodate accommodate agency nurse agency nurse contracted to monitor Mr. B overnight in contracted to monitor Mr. B overnight in PARU PARU
• Admitted to ICU 24 h later, hypotensive. Admitted to ICU 24 h later, hypotensive.
• No DVT prophylaxis for 34 h.No DVT prophylaxis for 34 h.
• ICU course complicated by MI & ICU course complicated by MI & prolonged weaning.prolonged weaning.
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What “Evidence” Says…What “Evidence” Says…Should HappenShould Happen
-blockers before -blockers before high risk surgery high risk surgery
• DVT prophylaxisDVT prophylaxis
• Feeding (enteral; Feeding (enteral; parenteral),parenteral),
• Skin management,Skin management,
• Antibiotic Antibiotic impregnated CV impregnated CV catheters,catheters,
• Consent and Consent and proceduresprocedures
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An Issue of SAFETY:An Issue of SAFETY:
What Should The Critical What Should The Critical
Care Leader Do?Care Leader Do?
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Safety in the Auto IndustrySafety in the Auto Industry
Congress grills Ford, Firestone, Congress grills Ford, Firestone, NHTSANHTSA
Execs say they acted quickly on tire Execs say they acted quickly on tire failuresfailures
By Thomas A. Fogarty, USA TODAY
Managing CarsManaging Cars
Assembly Assembly SupplieSupplierr
DeliveryDelivery SalesSales
DesigDesignn
Safety in the Auto IndustrySafety in the Auto Industry
GM Announces Safer AirbagsGM Announces Safer AirbagsExecs say they acted quickly to install on Execs say they acted quickly to install on
new carsnew carsBy Thomas A. Fogarty, USA TODAY
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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.
““Good To Great”Good To Great”
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What You Can Be Deeply passionate
About
The Hedgehog ConceptThe Hedgehog Concept
What Can You Be The Best In the World At?
What Drives Your Economic
Engine
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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 swoop…build momentum until a point of breakthrough, and beyond
Good To GreatGood To Great
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Another ProblemAnother Problem
• You are the ICU Director. You are You are the ICU Director. You are approached by the CEO who asks that approached by the CEO who asks that the CC Service develop an “outreach” the CC Service develop an “outreach” programprogram
• He just returned from an international He just returned from an international meeting on “redesigning” health care meeting on “redesigning” health care and he heard an Australian speaker and he heard an Australian speaker talk about this.talk about this.
Good things to be doingSee 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 Does Your Unit Have a Vision?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 DirectionPointing 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” Have You Set “Stretch” Goals?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?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 Do You Help Others as Leaders?Leaders?
• Leaders cultivate leadership by empowering others.
– Your job is to set clear goals,
– If you pick the right team, you don’t need to tell them what to do. Build self-directed teams of responsive and thoughtful colleagues.
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Leaders CommunicateLeaders 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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Leadership and learning are Leadership and learning are indispensable to each other. indispensable to each other.
John F. KennedyJohn F. Kennedy (1917 - 1963), speech prepared for (1917 - 1963), speech prepared for delivery in Dallas the day of his assassination, delivery in Dallas the day of his assassination, November 22, 1963November 22, 1963
Leaders LearnLeaders Learn
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Why Do We Resist Change?
Why Do We Resist Showing Leadership?
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• 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.
Healthcare CEOs Admit They Healthcare CEOs Admit They Miss/Ignore Opportunities to Mentor Miss/Ignore Opportunities to Mentor
EffectivelyEffectively
Witt/Kieffer Survey
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• 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.
More Work Needed to Improve More Work Needed to Improve Overall Future Leader Development in Overall Future Leader Development in
Health CareHealth Care
Witt/Kieffer Survey
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What Would They have Done?What Would They have Done?
• Albert SchweitzerAlbert Schweitzer
• James BurkeJames Burke
The ICU “Business”The ICU “Business”
INPUT #1 OUTPUT #1Processes
ConversionINPUT #2 OUTPUT #2
CareCare Integration??? Integration???
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Management is doing things right;Management is doing things right;
leadership is doing the right things. leadership is doing the right things.
Peter Peter DruckerDrucker
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Start with the premise that the Start with the premise that the function of leadership is to function of leadership is to produce more leaders, not more produce more leaders, not more followers. followers.
– Ralph NaderRalph Nader
