Excerpts from Bryce Taylor's "Effective Medical Leadership"
THE CHARACTER OF A LEADER
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.
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SITUATION 10.1
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.
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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.
WHAT YOU DO
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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