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 3 rd 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 levels  Major 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 pts  Allocating appropriate tasks to the right staff  Hospital activity and where / how to get help  Calling 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