Leadership

Dave Caesar

Clinical Director for Emergency Medicine, RIE & SJH

Preconceptions

Overview

Background & training Personal context / work environment 3 strata of leadership in clinical settings What makes these challenging How these settings could be effectively led Commonality of factors

The small team

25 yr old man falls from a 3rd floor window at 9pm on a Saturday

An ambulance is called, they retrieve him to the ED

You are leading a team of 1 other doctor and 2 nurses to receive this patient

He is barely conscious, has a very weak pulse, and looks ghostly white

Situation 15mins after arrival

You have a patient with 2 time-critical life-threatening conditions (at least)Lung injury and low oxygen levelsMajor blood loss from unstable pelvic #

How do you lead this situation? What do you need to have / know / access?

Small team clinical leadership Situational awareness:

Personal traits / knowledge base Transfer of (clinical) data

Directly & indirectly (from team)

Ability to process

Decision-making ability: Understanding what you still need to know Balancing risks to achieve correct course of action

Communicating command and decisions Can rely on “rank” but better with credibility

Small team leadership

High-end requirements Pre-empting natural progression Time-efficient manoeuvres Managing multiple cases Optimising team performance by good task delegation

Disasters Asking wrong (clinical) questions Not receptive to team data / feedback Acting on wrong answers (internally or externally) Not acting at all

The Big team

You come out of the resuscitation room in the ED to find 20 majors cases waiting to be seen, with a wait of over 1 hour, and a queue of 30 minors patients with a wait of 3 hours.

You have a team of 3 senior trainees and 6 junior trainees, and 9 nursing staff for the department.

Big team leadership Presence x 2 Accessibility Situational awareness

Departmental activity and how to prioritise ptsAllocating appropriate tasks to the right staffHospital activity and where / how to get helpCalling for back-up (if it exists)

Communicating your plan

Big team leadership

Desirables Calm under fire Reasonable Knowing when to pull which triggers Knowing when to compromise Getting the team to work more effectively than the sum of their

parts

Less effective Shroud-waving Conspicuous by absence (even if working behind the scenes)

Counteracting perceptions

The lumbering organisation

You are then summoned to explain your Department’s poor performance against national standards to the Board

They want solutions They have no extra money

Strategic leadership

Essential Must start with “the vision” + believe it Engage in senior tier processes Understanding political context / priorities Solutions should be:

Stepwise Reasonable Achievable Measurable somehow Matched to organisational + service priorities Show relative value or be last resort

Strategic leadership

Desirable Vary focus between present and vision Make sure present and vision is always connected, however

convoluted Communicate “the vision” regularly (up + down) Get buy-in from your team Determination with flexibility

Less good No engagement No communication No change No improvement

Personal traits?

Personal traits

Insight Personal strengths / weaknesses How you are perceived

Personal motivation Patient / client centred “Inverse” working arrangements

Perspective Adjacent systems Reasonable appreciation of all risks Political

Credibility Be right more often than not Be grounded

Summary

Lots of scales & versions of leadership All require “the vision” and belief in it Effective leadership achieves

Commonality of purpose Synergy of individuals’ unique strengths Optimistic and motivated workplace Change and improvement culture Better outcomes

Questions / discussion

Thank you