Leadership in Surgery

Educational Objectives

The goal of this program is to improve the practice of surgery through excellence in leadership skills. After hearing and assimilating this program, the clinician and surgeon will be better able to:

1. Differentiate between authoritative and collaborative leadership styles.
2. List the qualities of an emotionally intelligent leader.
3. Explain the difference between coaching and mentoring.

Summary

Effects of poor leadership in the United States: surveys by Gallup and the Engagement Institute show that ≈50% of the work force in US are not engaged; ≈50% of them want to leave their jobs; ≈25% change jobs annually; 17% of workers are actively searching for other jobs and 46% are passively searching; disengaged employees cost organizations ≈500 billion dollars per yr

Historical context: historically, white men (eg, George Washington, Winston Churchill) have been leading the Western world; similarly, in surgery, Dr. Schwartz, Dr. Sabiston, and Dr. Shires are examples of male leaders; recently, Germany, New Zealand, Finland, Israel, and India have had women leaders; in surgery, the first 4 American College of Surgeons (ACS) presidents were men; recently Patricia Numann, Valerie Rusch, Julie A. Freischlag, and Barbara Bass have now been given the same honor; Patricia Roberts, Tracy Hull, and Ann Lowry have been president of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and other societies; this has also occurring with the Association of Coloproctology of Great Britain and Ireland; Angelita Habr-Gama of Brazil and April Roslani of Malaysia are honorary fellows of ACS; April Roslani recently became the dean at the University of Malaya Medical School in Kuala Lumpur

Definitions of leadership: Martin Chemers — the process of social influence in which an individual can enlist the aid and support of others in the accomplishment of a common task; Dwight Eisenhower — the art of getting someone else to do something one wants done because the other person wants to do it; Joanne Ciulla — a complex moral relationship between people based on trust, obligation, commitment, emotion, and a shared vision of the good; Warren Bennis — the capacity to translate vision into reality; Fred Smith — an individual getting others to work for him or her when those others are not obligated

Attributes of good leaders: leaders are intelligent, empathetic, caring, nonjudgmental, confident, and they have a vision; capable of influencing, building consensus, getting people to collaborate, and delegating effectively; require social skills, and must possess drive

Leadership styles: authoritative leaders — mobilize individuals toward their vision with authority; appropriate in emergent situations, eg, sudden bleeding in surgery when time is critical; however, in nonemergent settings, followers can be disengaged from this leadership style if there is disagreement with the leader’s vision; collaborative leaders — encourage participation through shared values, and discussion of opinions and ideas; eg, to increase the surgeons’ number of relative value units (RVUs) from 10,000 to 11,000, or decrease the time people have in their clinic slots from 30 min to 15 min; collaborate and explain problems; offer support with, eg, scribe or physician assistant (PA) to work faster; not feasible in cases of emergency; delegative leaders — the leaders are motivated for the goal and must be accepting of the delegate’s better ideas; eg, to structure the clinic templates, the goals, and need for increased RVUs; examples of delegating to an intern include requesting them to lyse adhesions while standing ready to scrub along; situational leaders — have clear expectations and input from the group, adjusting leadership style to develop and engage the team for the current situation; leader does not use coercion and authority except in extreme situations; select the right, motivated people for the job; recognize that individuals have different visions for work and life; have enough emotional intelligence to listen and understand individuals’ motivations; continuously coach and appreciate individuals; criticize constructively (eg, ask open-ended questions)

Strategies for leaders: give directions to individuals who need help; assist them in finding solutions; delegate and resist the temptation to micromanage; micromanagement hinders succession planning and team building; micromanaging leads to disengagement within the team; keep checking the team’s progress with open-ended questions; do not bypass intrateam authority; maintain self-control and integrity; give concrete messages and abide by them; stay resilient and continue coaching even when the team members fail; value the team’s opinion; emotionally intelligent leaders communicate empathetically, individually, and in groups, by telephone, email, text, in person, or video; sensitive issues should not be discussed by text or email, but in person instead; a surgeon leader must cooperate and collaborate with other departments, eg, imaging, pathology, gastroenterology, administration, and nursing staff, and all members of the health care team; recruit and retain people with integrity and honesty; prioritize diversity, equity, and inclusion; evidence shows that the surgeons provide better patient care through diverse ideas from an inclusive, equitable team

Empathy vs sympathy: empathy is the capacity to understand or feel what another person is experiencing, from their frame of reference; sympathy is a feeling of concern for somebody; this is from one’s own point of view; “empathy is saying ‘I feel your pain’ and sympathy is saying ‘I am sorry you are in pain;’” a leader should be empathetic

Understanding goals and values of others: assess each individual’s goals as measurable, and achievable; goals should be specific; ask other person what success (eg, an academic appointment, better patient satisfaction, an increased salary) “looks like” to them; when the individual explains accomplishment of the stated goal would feel, eg, excited, accomplished, pleased, it is then possible to help them achieve it; help an individual succeed while maintaining their values (eg, family, integrity, honesty, accountability, altruism, loyalty, success, nurturing, monetary, recognition); never judge people for their values

Conflict management: destructive conflict implies an unbending attitude to conflict; constructive conflict requires empathy for what is essential to other individuals; solutions are created together; address the problem and never withdraw from a conflict situation; ensure both conflicted parties reach their goals; a collaborative leader has a high goal for relationships and a high goal for personal vision; ensuring everyone’s academic success achieves the goal for relationships and mentoring them leads to an academically successful department

Coaching and mentoring: coaching means supporting another individual to identify or achieve a specific personal or professional goal; help enhance another individual’s skills to maximize their achievement; executive coaching means teaching leaders to be better leaders pre-emptively; in contrast, asset-based coaching means helping somebody solve a problem; this is more therapeutic than pre-emptive; asset-based coach enables, facilitates, and challenges with guided reflection on goals and values, rather than commanding; the individual being coached sets the agenda; coach asks questions about the steps to take to achieve the stated goal (eg, becoming an expert in rectal cancer requires joining the accreditation body, meeting with radiologists, pathologists, and marketing department); helpful to allow the coachee to think of solutions; a mentor sets the goals, the mentor shows how things are done, oversees, critiques, and offers very specific advice and constructive criticism; a coach picks up verbal and nonverbal cues, focuses on the strengths, skills, and competencies to help people succeed; applies the SMART problem-solving methods; this includes specific, measurable, actionable, realistic-timeframe solutions using open-ended questions that can help the team member succeed

Informal leadership platforms: organizations, societies, and committees — membership on committees helps to ascend the leadership ladder; surgeons can join many specialty organizations country-wide; complete the work given in committees and deliver excellent assignments on time; this demonstrates the leader’s values; surgeons can also initiate their own committees informally; eg, Raul Rosenthal and Fernando Dip started the International Society for Fluorescence Guided Surgery, Mike Rosen started The International Hernia Collaborative; social media platforms — Twitter, Facebook, Instagram, YouTube, and LinkedIn, if used carefully, are excellent for leaders; important to post and respond carefully; individuals with no official role in their institution or any society have become influencers because of the number of followers who place credence in their work; allows leaders to help careers of people around the world; arguably, many junior members feel more comfortable reaching out to senior members through social media platforms; especially useful in the COVID era

Lead by example: demonstrate clinical, surgical, research, or academic excellence; involve aspiring academics in editorial boards, peer reviews, committees, societies, as co-authors in textbooks, co-investigators in trials, and speakers at meetings; important to be empathetic to the value system of a person

Readings

Clohisy DR et al. Leadership, communication, and negotiation across a diverse workforce: an AOA critical issues symposium. J Bone Joint Surg Am. 2017;99:e60; doi: 10.2106/JBJS.16.00792; Logghe HJ et al. The academic tweet: Twitter as a tool to advance academic surgery. J Surg Res. 2018;226:viii-xii; doi: 10.1016/j.jss.2018.03.049; Moffatt-Bruce S et al. Leadership oversight for patient safety programs: an essential element. Ann Thorac Surg. 2018;105:351-356; doi: 10.1016/j.athoracsur.2017.11.021; Parker SH et al. Surgeons' leadership in the operating room: an observational study. Am J Surg. 2012;204:347-354; doi: 10.1016/j.amjsurg.2011.03.009; Parker SH et al. Towards a model of surgeons' leadership in the operating room. BMJ Qual Saf. 2011;20:570-579; doi: 10.1136/bmjqs.2010.040295; Quirke B. Making the connections: using internal communication to turn strategy into action. (2nd ed). London: Routledge. 2008; doi: 10.4324/9781315249971; Sinskey JL et al. Applying conflict management strategies to the pediatric operating room. Anesth Analg. 2019;129:1109-1117; doi: 10.1213/ANE.0000000000003991; Vu JV et al. Leadership-specific feedback practices in surgical residency: a qualitative study. J Surg Educ. 2020;77:45-53; doi: 10.1016/j.jsurg.2019.08.020.

Disclosures

In adherence to ACCME Standards for Commercial Support, Audio Digest requires all faculty and members of the planning committee to disclose relevant financial relationships within the past 12 months that might create any personal conflicts of interest. Any identified conflicts were resolved to ensure that this educational activity promotes quality in health care and not a proprietary business or commercial interest. For this program, the following has been disclosed: Dr. Wexner is a consultant for Astellas Pharma Inc., Baxter International, Intuitive, Medtronic, Takeda, Stryker; receives royalties from Intuitive, Karl Storz Endoscopy, Medtronic. The planning committee reported nothing to disclose.

Acknowledgements

Dr. Wexner was recorded exclusively for Audio Digest using virtual teleconference software, in compliance with current social-distancing guidelines during the COVID-19 pandemic. Audio Digest thanks the speakers for their cooperation in the production of this program.

ABS Continuous Certification

Successful completion of this CME activity, which includes participation in the evaluation component, enables the learner to earn credit/s toward the CME [and Self-Assessment] requirements of the American Board of Surgery’s Continuous Certification pro

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0 CE contact hours.

Lecture ID:

GS681701

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.