Leadership Skills in Emergency MedicineThe Elephant in the Room!

ObjectivesObjectives

• To understand the essentials of leadershipTo understand the essentials of leadership and leadership development in Emergency MedicineMedicine

• To illustrate these principles with practical examples from our specialtyexamples from our specialty

• To push the envelope in your thinking b t l d hiabout leadership

DisclosuresDisclosures

• nonenone

Three casesThree cases

• 48 yo female – given RSI- unable to48 yo female given RSI unable to intubate/ventilate – sats dropping

• Swissair Flight 333 has crashed off• Swissair Flight 333 has crashed off Peggy’s Cove – potential 240 victimsD t h i ll f d i i t i• Dept chair calls for advice – intensive care physician gave KCL to patient to ease pain

d ff i lti i “ if l” d thand suffering resulting in “merciful” death

LeadershipLeadership

• Examples outside of health careExamples outside of health care• Qualities to aspire to

E l ithi H lth C d• Examples within Health Care and Emergency Medicine

• Some practical examples

Nelson MandellaNelson Mandella

• Clear visionClear vision• Value based• Active listenerActive listener• Mentor and teacher

Wilfred LaurierWilfred Laurier

• Art of compromiseArt of compromise and dialogue

• “sunny ways”y y• Skilled orator

The OfficeThe Office

• VisionVision• Trust• CommunicationCommunication• Micromanagement• Active listening• Active listening

The Vision thingThe Vision thing

• Not just wordsNot just words• Inspire others• Simple messageSimple message• Values based

Leadership and managementLeadership and management

• Clinical expertise• SchedulingScheduling• AFP negotiations• Policies/procedures• Policies/procedures• Capital equipment• Time management• Time management• Meeting management

Leadership and managementLeadership and management

RecruitmentRecruitmentNew programsInnovative practiceInnovative practice

modelsAcademic developmentAcademic developmentmentorship

Leadership Challenges in E M di iEmergency Medicine

• OvercrowdingOvercrowding• Recruitment

N d l f• New models of care• Funding• Academic development• Hospital/health system change/mergerHospital/health system change/merger

Key Attributes of LeadersKey Attributes of Leaders

• VisionaryVisionary• Reflective

Ch i ti• Charismatic• Dynamic• Flexible• AdaptableAdaptable

Key Attributes of LeadersKey Attributes of Leaders

• Internal self awarenessInternal self awareness• Strong values

T t• Trust• Active listening• Coping with change

Change ManagementChange Management

• Leadership and management skillsLeadership and management skills• Inspire and coach

L d b l• Lead by example• Plan, organize,measure,control• Be flexible

How Do I learn to be a leader?How Do I learn to be a leader?

• MentorshipMentorship• Practice

R i l d hi lit t• Review leadership literature• Selected courses• journal• Get a coach?Get a coach?

Case examplesCase examples

• A previously stable academic ED after aA previously stable academic ED after a long negotiation has achieved an AFP that will be a tool to further academicwill be a tool to further academic development

• After 12 months a new government• After 12 months, a new government reduces the academic component, and there is lukewarm support from thethere is lukewarm support from the hospital and university

ActionsActions

• Detailed re-negotiation of AFP?Detailed re negotiation of AFP?• Academic job action?

Cli i l d ti ?• Clinical care reductions?• Other?

Case Example #2Case Example #2

• Long standing ED physician has ongoingLong standing ED physician has ongoing disruptive behaviour

• Recent escalation with event on night shift• Recent escalation with event on night shift with nursing and resident staff

ActionsActions

• Specific reviewSpecific review• Regular 360 review

R i il d ?• Remove priviledges?• Other actions?

Back to the CasesBack to the Cases

Three casesThree cases

• 48 yo female – given RSI- unable to48 yo female given RSI unable to intubate/ventilate – sats dropping

• Swissair Flight 333 has crashed off• Swissair Flight 333 has crashed off Peggy’s Cove – potential 240 victimsD t h i ll f d i i t i• Dept chair calls for advice – intensive care physician gave KCL to patient to ease pain

d ff i lti i “ if l” d thand suffering resulting in “merciful” death

Case 1Case 1

• Crisis resource managementCrisis resource management• Situational awareness

P bl l i f i di id l• Problem solving for an individual case

Case 2Case 2

• Follow disaster planFollow disaster plan• Mobilize resources

L d b l• Lead by example• Organizational techniques• Media management

Case 3Case 3

• Facts of caseFacts of case• Discipline physician

R t CEO/B d• Report up CEO/Board• Disclosure to family• Deal with staff and physicians• Develop standardized protocolsDevelop standardized protocols

Case 3 – What really happenedCase 3 What really happened

• Physician disciplinedPhysician disciplined• No requirement for College to be informed

F il t i f d• Family not informed• Staff not happy

Case 3Case 3

• Six months laterSix months later…..

P li t d h i i h d h• Police arrested physician- charged her with murder

• CEO and board ran for cover• VP med lost his jobj

Emergency Medicine – Training G d f L d hi R lGround for Leadership Roles

• Hospital CEO – Barry McClellan TimHospital CEO Barry McClellan, Tim Rutledge

• VP medical Jim Worthington• VP medical – Jim Worthington• Provincial Coroner- Andy McCallum• Provincial Registrar – Rocco Gerrace• Dean – Faculty of Medicine – David y

Walker

Reading ListReading List

• Good to Great – Jim CollinsGood to Great Jim Collins• Leading Change – John Kotter

L W lk t F d N l M d ll• Long Walk to Freedom – Nelson Mandella• Wilfred Laurier – Andre Pratte• Leadership is an Art – Max De Pree