Last month Steven Yule was kind enough to talk with me about their January 2016 paper in the JACS: Surgeon’s Leadership Styles and Team Behavior in the Operating Room. Dr. Yule explained that a transformational leader is a leader who converses with his team at crucial aspects before, during and after the procedure to assure that everyone is aware of his thoughts and concerns and vice versa. This is not necessarily the same as the type of leader who engages in unrelated conversational topics which have no real bearing on the case itself (that may help in relaxing the team if it is carried out in a productive manner, but likely will lead to distractions if not done in a productive manner- See my conversation with Anna Wheelock regarding distractions in the OR). He also alleviated my anxiety by assuring me that any leader who is already transactional (task focused) can learn to become more transformational. Transformational leadership is more conducive to team efforts and resident learning so it is in all our best interest to learn.
As a follow-up to that conversation, I talked with Caprice Greenberg about her investigations into communication styles as they relate to effective or ineffective leadership in the hospital. Her focus is working with established surgeons on performance improvement in the areas of technical, interpersonal / cognitive skills and stress recognition / management (yes! Right up my alley).
Dr. Greenberg reinforced the idea that transactional leadership is a basic component of surgeon personality and transformational leadership is layered on top of this. As noted in the study, the surgeons who empowered the team appropriately, were more effective. These are the surgeons who establish rapport at beginning, shared decision making, engaged all members (residents and techs). One example was they wrote everyone’s name on the white- board to assure they knew everyone in the room. This tends to be the totally opposite perspective most surgeons hold, whereby they express that it is the not their responsibility to know who is in the room, but the hospital’s responsibility to give them the same team all the time. Dr. Greenberg expressed that we need to share this so we can improve all aspects in the OR. It is a subtle act that turns out to have profound implications. Turns out, that we all complain about having new people in the room and how that negatively affects the flow. Successful businesses use this staff rotation to an advantage for new ideas, fresh perspectives, etc. In actuality teams that work together all the time have a tendency to stop communicating; they assume so much that they stop asking questions and sooner or later things fall thru the cracks. New players don’t assume anything- they ask!
Another problem area we discussed was standardization of error reduction protocols as a huge potential problem… we take everything for granted, but in reality if it is not personalized then we missed the opportunities to detect problem areas. (Why do sports teams do better when they have been together for a long period of time? Maybe do not have to be as adaptable, not as reactive. Or maybe in reality their performance declines as team membership becomes stagnated- a question for another profession another day). There are things about medicine that makes it more complicated than other systems. There are similarities but we need to dive deeper and collaborate with others to design our system. For example: hospital leadership never asks the question of “Why is person getting angry” and what are the implications for downstream tasks by that surgeon. If we don’t ask those questions and simply apply outside standardized non-personalized protocols, we miss the point (see Doug Paul’s Paper on upstream and down-stream errors). From here we began to discuss handoff pitfalls and strategies in medicine that work when designed by the people who use them in lieu of designs by organizational staff who do not practice in the area the protocol was meant for (brought back memories from a paper published in October by Pugh et al “People like to say patient safety is so paramount, and ‘if only we were more like the commercial aviation business.’ Well, yes, but if taking care of patients were the same as commercial aviation, I would never operate, because pilots don’t fly into a storm…. The reality of being in an ICU is they get three admissions at once and they are ALL really sick… so I don’t think (eliminating interuptions) should be mandated, because it could potentially NOT make things worse for that patient, but make things worse for the other patients also under your care.”).
I look forwards to future conversations on this topic.
KENNETH A. LIPSHY, MD, FACS
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