What is a Leader? “Leadership is not about personality; it’s about behavior – an observable set of skills and abilities.” Model the Way Inspire a Shared Vision Challenge the Process Enable Others to Act Encourage the Heart The Leadership Challenge: Kouzes and Posner

Are Managers Leaders? A manager is someone who: Plans and budgets Organizes and allocates resources Controls and solves problems A leader is someone who: Shows a direction Aligns and influences Motivates and inspires!

Designated Leaders Managers first Assigned role and accountabilities Manage resources Establish clear goals (shared vision) Facilitate open communication Anticipate and solve problems Conflict resolution!!

Situational Leaders Any team member who has the skills to manage the situation “The principle role of a situational leader is to mobilize and support the Situational Awareness of the team.”

Tools for Situational Leaders Briefing: Who is on the team? Goals? Roles and Responsibilities? Plan of care? Staff? Resources? Huddle: “touch-base”; Emerging events. Concerns! Outcomes/Contingencies? Resources? Debrief: Process Improvement; Informal after event; Improve teamwork, improve outcomes “What should we do differently next time?”

The team: Ben, ENT surgeon Ron, Anesthesiologist Mary, OR RN, ENT lead Abby, OR RN, orienting Naomi, OR LPN The list: BMT, 2 ½ years Tonsillectomy X 2, 4 years, 6 years Partial Glossectomy (R), 54 years Tonsillectomy X 2, 16 years, 21 years NSR, 46 years

Partial Glossectomy (R) Male, 54 years old Heavy smoker, heavy drinker Squamous cell cancer larynx (extensive) Cancer base of tongue (for excision) Heavy beard Very poor dentition

Concerns… Equipment issues ‘Uncommon’ intra-oral surgery Risk of damage to teeth Feasibility of endotracheal tube placement How to secure the endotracheal tube Pathology

The Briefing Mary: Assembled the team Discussed equipment (airway, surgical, pathology) We visualized the laryngeal mass Discussed airway management plan(s)

Partial Glossectomy (R) Very careful examination of teeth prior to induction Small endotracheal tube, tied not taped No throat pack Surgeon placed Bite Block Uneventful dissection/closure Extubated awake in the OR To PAR with O2 by facemask 6LPM

Adverse Event: the Huddle 5 minutes after arriving in PAR, the patient removed the Bite Block Mary: Assembled the team in the OR, immediately We discussed the incident and factors contributing We discussed how to prevent recurrence She wrote up a PSLS

Process Improvement: the Debrief Mary: Assembled the team Discussed feasibility of process improvement ideas Wrote up recommended changes to ‘the count’ Captured other ideas as suggestions

Leadership is about…. Having a vision of what is possible… Maintaining ‘situational awareness’ “Stepping up” to support situational awareness Maintaining communication and team processes Innovation Breaking down the barriers!