Neonatal and Fetal Physiology

SURGERY

College of Medicine Mariano Marcos State

University
2015-2016

CHAPTER 1: Fundamental Principles of Leadership

Training in Surgery

I.
II.
III.
IV.
V.

Outline
Introduction
Definitions of Leadership
Fundamental Principles of Leadership
Leadership Styles
Formal Leadership Training Programs in Surgery

necessarily want to go, but where they ought to

be.
o
Leadership does not always have to come from a
position of authority
Former American president John Quincy Adams:
o
If your actions inspire others to dream more,
learn more, do more, and become more, you are a
leader.
Leadership:
o
process of using social influence to enlist the aid
and support of others in a common task
Fundamental Principles of Leadership

Reference
Schwartzs Principles of Surgery 10th ed

A.

Introduction
Historically:
o
Surgeons have sole responsibility to pt
o
Exercise absolute authority in OR
o
Uses command-and-control style of leadership
Modern:
o
evolved from single providerbased care toward a
team based approach
o
req collaborative leadership skills
Modern healthcare systems:
o
imperative that sx training programs include
formal instruction on leadership principles and
skills to cultivate their trainees leadership
capabilities
Critical leadership success factors:
o
mastery of visioning
o
communication
o
change management
o
emotional intelligence
o
team building
o
business skills
o
personnel management
o
systems thinking
The ability of emotional intelligence was fundamental to
their success and its absence the cause of their failures,
regardless of medical knowledge

Vision
o
first and most fundamental principle
o
providing direction and purpose to the
constituency/people
o
surgeons are driven by a powerful vision: that the
surgical care will improve patients lives
o
Joseph Lister (19th century)

changed the practice of sx with the

application of Pasteurs germ theory

introduced the modern era of sterile

technique
o
Emil Theodor Kocher

first to master thyroidectomy

Nobel Prize in Physiology or Medicine

in 1909
o
Michael E. DeBakey

dev't groundbreaking procedures in

CV sx

invented the Dracon graft, an

artificial artery for arterial bypass
operations
o
Dr. Frederick Banting

youngest recipient of the Nobel Prize

in Physiology or Medicine

discovered insulin
o
Leaders must learn to develop visions to provide
direction for their team

B.

Willingness
o
represents the active commitment of the leader
toward their vision
o
A surgical leader must be willing to:

lead

commit to lifelong learning

communicate effectively

resolve conflict

6 Core Competencies by Accreditation Council for Graduate

Medical Education (ACGME)
o
patient care
o
medical knowledge
o
practice based learning and improvement
o
interpersonal and communication skills
o
professionalism
o
systems-based practice

To lead

Definitions of Leadership
Former First Lady Rosalynn Carter:
o
A leader takes people where they want to go. A
great leader takes people where they dont

Zooombie Notes | NI Tabaniag| MMSU-COM | Class of 2019

A key characteristic of all great leaders

is the willingness to serve as the leader
Ex: Dr. Martin Luther King. Jr. and
Steve Jobs

To learn

willingness to commit to continuous

learning
To communicate effectively

Neonatal and Fetal Physiology

communication errors - one of the

most common causes of medical error
miscommunication - leading cause of
sentinel events (Joint Commision)
A strong correlation exists bet comm
and pt outcomes
learn to communicate in an open,
universally understood manner and
remain receptive to any team
members concerns
Time Out protocol:
- used to ensure open communication

To resolve conflict

always remain objective and seek

personal flexibility and self-awareness

Reflection critical component of

learning conflict resolution skills

Introspection allows to understand

the impact of own actions and biases

Objectivity - basis of effective conflict

resolution

Modern conflict resolution techniques

- based on objectivity, willingness to
listen, and pursuit of principle based
solutions

Abundance Mentality model

- attempts to achieve a solution that
benefits all involved

Fault-finding Model
- identifies sides as right or wrong

History and Physical model of

conflict resolution
- based on the 7 steps of caring for a
surgical pt: (1) history
(2) lab/studies
(3) differential dx
(4) assessment/plan
(5) pre-op preparation
(6) operation
(7) post-op care
C.

A.

Time Management
o
done by by setting priorities and making choices
to achieve goals
o
Parkinsons Law by Cyril Northcote Parkinson

work expands to fill the time available

for its completion

Time Allocation Techniques:

Prioritized List (ABC technique)

indivs list and assign relative values to
their tasks

Time Management Matrix

Technique - plots activities on two
axes: importance and urgency

The 6 Areas of Interest

Leadership Styles
Coercive
o
demands immediate compliance
o
command and control style
o
advantages: in time of crisis to deliver clear,
concise instruction

Zooombie Notes | NI Tabaniag| MMSU-COM | Class of 2019

disadvantages: erodes sense of responsibility,

motivation, sense of participation in a shared
vision, and performance
used when: emergency

B.

Authoritative
o
focuses on mobilizing the team toward a common,
grand vision
o
allows freedom to innovate, experiment, and
devise own means
o
most effective
o
leaders display self-confidence, empathy, and
proficiency in initiating new ideas and leading
people in a new direction
o
used when: shift in paradigm

C.

Affiliative
o
creates harmony and builds emotional bonds
o
requires employment of empathy, building
relationships, and emphasis on communication
o
gives positive feedback
o
can allow poor performance to go uncorrected if
too little constructive/critical advice is given
o
used when: motivating people during stressful
situation

D.

Coaching
o
focuses on developing people for the future
o
leadership through mentorship
o
advantages: helps people identify their
weaknesses and improve their performance,
builds team capabilities
o
disadvantages: does not work well when team
members are defiant and unwilling to change or
learn, or if the leader lacks proficiency

E.

Democratic
o
forges consensus through participation
o
listens to and values each members input
o
disadvantages: not the best choice in an
emergency situation, when time is limited, or
when teammates cannot contribute informed
guidance to the leader
o
used when: most appropriate when it is important
to obtain team consensus, quell conflict, or create
harmony

F.

Pacesetter
o
sets high standards for performance and
exemplifies them
o
identify poor performers and demand more from
them
o
does not build skills but take over the task himself
or delegate the task to another team member
o
disadvantage: can easily become micromanagers
with difficulty delegating tasks lead to burn out
o
used when: obtaining high-quality results and if
there is a motivated, capable team

Formal Leadership Training Programs in Surgery

Neonatal and Fetal Physiology

A.

leadership workshops created

extracurricular leadership programs for physicians with MBA
or management program
multiple leadership skills workshops for chief residents
hosted by ACGME
o
target: pediatricians, family practitioners, and
psychiatrists
Annual 3-day leadership conference led by American College
of Surgeons
o
focus: leadership attributes, consensus devt, team
bldg, conflict resolution, and translation of
leadership principles into clinical practice
an innovative leadership curriculum first implemented in
1999taught general surgery trainees collaborative leadership
skills
participation in 18-hour-long modules based on the
leadership principles and skills (see Table 1-2)
o
measured using tools: Multifactor Leadership
Questionnaire (MLQ), social skills inventory,
personality inventory, and internal strength
scorecard
Multifactor Leadership Questionnaire (MLQ)
o
a well-validated instrument that objectively
quantifies leadership beliefs and self-perceived
outcomes across medical and nonmedical
disciplines
o
based on this, passive-avoidant style of leadership
is more often used
o
can be used to track progress toward more
effective, collaborative styles of leadership
Mentoring

Zooombie Notes | NI Tabaniag| MMSU-COM | Class of 2019

active process by which an experienced, empathetic

person guides another indiv in the devt and selfrecognition of their own vision, learning, core
competencies, and professional development
Halstead
o
established the concept of a surgical mentor
who directly provided the trainees with
professional and technical guidance
o
goal: to develop surgeons who would go on
to become outstanding leaders and
innovators in the field
Modern mentorship implies a partnership bet the
mentor and the mentee
Responsibilities of an effective mentor summarized by
Barondess:
o
requires empathy, maturity, self-confidence,
resourcefulness, and willingness to commit
time and energy to another
o
must be able to offer guidance for a new and
evolving professional life, to stimulate and
challenge, to encourage self-realization, to
foster growth, and to make more
comprehensible the landscape in which the
protg stands
one of the major goals of a mentor:
o
to assess the aptitudes and abilities of the
mentee with regard to the appropriateness of
their vision for their surgical career
benefits of mentoring to the mentors themselves:
o
refinement of own personal leadership skills
and a strong sense of satisfaction and
accomplishment