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Excerpts from Bryce Taylor's "Effective Medical Leadership"


Bryce Taylor
Bryce Taylor

This is the second in a series of excerpts from Bryce Taylor's outstanding book "Effective Medical Leadership", reprinted with the gracious permission of the University of Toronto Press. Ed.

Over the past twenty-five years I have admittedly developed ways of being, of doing things, and of working with the people in my environment. Every person alive has various effects on different people; there are character traits that may be attractive to some and at the same time repulsive to others. You won't please everyone all the time, and your actions will certainly not be welcomed either universally or continually. Nevertheless, I have developed some habits and biases that I personally feel have made the journey a little smoother and more effective, for me anyway.

The Way You Are

Be Positive

You will face many challenges, and some days you will appear to be flitting from one crisis to another. This is the ultimate challenge of a medical leader - to keep your eye on the ball while the fans in the stands are hurling a variety of objects onto the field, trying to disrupt the game. My old anaesthetic colleague David Bevan labelled these people bomb-throwers, referring to individuals who from the back seat of a lecture hall will often hurl insults or controversy, from a distance, always ready to make a quick exit. As a medical leader you must remain optimistic and forward thinking despite interruptions; after all, your responsibility is to move towards the vision. While you are being optimistic, however, you must be frank and forthcoming; your colleagues have a right to know the truth about the challenges that face you, them, and the organization.

There's also something to remember about the perceived negativism of some colleagues. Excellence has a price, and to achieve excellence we must always look for areas of improvement; as we strive to improve, we may sound as though we're discontented. We will always be unsatisfied with our current lot because that's how we progress, but we remember that the discontent, if managed appropriately, can be a positive catalyst for change. A good medical leader will appreciate those reminders of potential improvement and should let the disgruntled know that their continued input is valued.

Be Consistent, Truthful, Honest

I hesitate to document such obvious characteristics as consistency, truthfulness, and honesty, which are really attributes that every person on the planet should profess and strive for. The reason for articulating them here is that without them you will fail miserably as a medical leader. I have seen superbly talented doctors who continue to succeed and be recognized nationally and internationally for their outstanding contributions, but who lack total honesty and truthfulness and who certainly have not been consistent in their behaviour. On the international stage where individuals are seen intermittently, their prominence may not be affected by their inconsistent behaviour back home. But the medical leader who is on the job 24/7 and is not true to these character traits will not last a month in maintaining respect.

When respect is lost, effectiveness is lost.

Be Appreciative

As a medical leader you will have a lot to be thankful for, and you should show that thanks every time you get a chance. At meetings, verbal acknowledgments of the contributors, including the organizers, are much appreciated and may even be a factor in a person's willingness to put in the same time and effort the next year. Frequent email recognition is the easiest way to thank someone and should be encouraged to a degree. Remember, however, that a repetitive method that is copied to many begins to sound vacuous and meaningless, so you should try to think of more novel ways to thank your colleagues. A small token such as a book, a tie, a scarf, or a bottle of wine, depending on the recipient's habits, may be just the right way to say, 'A job well done,' or 'Much appreciated.' I personally favour the handwritten note. If I receive a note that has taken time, thought, and effort, I am inclined to save it, simply because I value it so much. To me, this gesture ranks up there with the handwritten messages that acknowledge wedding gifts, in that they are the most personal expressions of feelings and appreciation. Unlike the wedding example, however, a handwritten note from a medical leader is entirely unexpected and, therefore, all the more poignant.

Be Human, and Admit It

In the course of my life, I have often had to eat my words, and I must confess that I have always found it a wholesome diet. - Winston Churchill

You will gain tremendous trust if you repeatedly confirm the fact that you are human. Look for the counsel of others, from the first meeting with each of your colleagues to every meeting with the CEO. If you have done something egregious, or made a bad decision that could have been avoided, say you're sorry.

A well-known study in Detroit (89) looking at the propensity of patients and families to enter into lawsuits found that a policy of saying 'I'm sorry' for an unfavourable clinical outcome resulted in a significant decline in the number of lawsuits brought against that organization. Just as patients forgive and accept apologies, so too do colleagues. The recent changes in law have stipulated that saying you're sorry does not constitute an admission of guilt or culpability.


NEW CEO: Be Fair, But Not Too Fair

In 1998, near the end of Doctor D's tenure as president and CEO of UHN, there were concerns about the ability of the Neuroscience Program to adequately and safely care for its growing referral base of complex neurological patients who required intensive care. Doctor Q, the head of neurology, and I, in my then role of acting director of surgical services, analysed the patient flow, the needs of the program, and the overall expenditures in Neurosciences, which was one of our so-called priority programs of the organization at that time (along with Transplantation, Oncology, and Cardiac Sciences).

We discovered not only that there was a definite need for more level-two ICU beds, nurse practitioners, and clinical associates, but also that the Neuroscience Program received a significantly lower level of funding than all the other programs.

Doctor Q and I went to Doctor D with a carefully laid-out plan describing all the needs and long-term implications, along with the financial comparators of the other programs. We were delighted when he signed off on the spot, realizing that he had probably disadvantaged, unwittingly, the Neuroscience Program in comparison with other programs. Doctor D had been an internationally prominent academic neurosurgeon and chair of the university's division of neurosurgery for ten years prior to coming to UHN.

Know Your Facts

As a medical leader you are being watched and listened to constantly, occasionally with admiration, sometimes with resentment, often with the most critical eye. Despite the fact that you shouldn't be afraid to show your ignorance, there are some facts that you should have at your fingertips and on the tip of your tongue.
The following should be your mantras:

  • The mission
  • The vision
  • The values of your organization, and of your department or division if they differ slightly from the larger expressions

If your hospital places a value on patient-centred care (which one doesn't?), you should be able to regurgitate every dimension of that care. The coloured emergency codes in your hospital should be obvious to every living being who works there, but you have to know them instantly if asked. The responses to fire, such as the acronym REACT (Remove occupants, Enclose area, Activate alarm, Call emergency number, and Try to fight fire) for the evacuation routes, and the building- related issues all must be second nature to you. You must know the geography of your institution and be able to direct patients wherever they want to go. You should tour the hospital intermittently to familiarize yourself with areas that you seldom visit; this is in some ways your home, and your interest in knowing a lot about it is a reflection of the pride and responsibility you have for it. You should know apparently insignificant details like the cost of parking, and the members of the food court and their contributions to your organization - they all count.

Be Impartial, But Not Too Impartial

You start as the leader of a specific group of clinicians, and you are an inveterate supporter of and an advocate for that group's welfare. As you take on more senior responsibilities, you're faced with the problem of favouring your home team, be it endocrinology, general surgery, orthopaedics, or hematology.

Occasionally, as a medical leader you will advantage yourself, and that is clearly unacceptable, as demonstrated in the story of the division head who assigned himself more operating time than anyone else. More often than not, however, medical leaders are so worried about the optics of what they do that they place at a disadvantage the interest areas that they're concerned about favouring.


Don't Be Afraid to Show Your Ignorance

Ask questions incessantly. Everyone in the organization knows more than you do about some subject. You didn't get to the leadership position by knowing everything. It goes without saying that in areas for which you have direct responsibility you must study, read, meet, call, and go to any lengths to gather and store information, becoming an expert in the areas you need to be an expert. In addition, there will be numerous opportunities for you to demonstrate your thirst for knowledge and your desire to learn something from a colleague, and as a result to enrich your relationships with others in the hospital organization. Nothing is more appreciated than a medical leader saying to someone, 'Thanks for telling me that. That's very useful information.' Don't be afraid to take someone else's idea and run with it. It may even be a vision that results in substantive change.

University of Toronto Press 2010
ISBN 978-1-4426-4200-3; 240 pp

(89) Robbennolt, J.K. Apologies and Legal Settlement: An Empirical Examination. Mich Law Rev 102 (2004): 460-516

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