The heart of a good leader

I came across two acronyms for what makes a strong leader, and they both embody the attributes we must aspire to:

H E A R T

Hunger for wisdom
Expect the best
Accept responsibility
Respond with courage
Think: others first

Human - we are all human and if you want to lead others effectively, you must be willing to be vulnerable and let people see that. We all make mistakes and have weaknesses, and if you think they don't see them anyway, you're kidding yourself. When they see the real you, they are more likely to follow. Check out Brian Goldman's TED talk about doctors making mistakes and the pitfalls of a denial culture in medicine.

Empathy - I'll write a separate article about the huge importance of empathy as a doctor, as a leader, and to succeed in life in general. I'm sure you recognise the difference between empathy and sympathy so I won't labour that point. You will connect with people and lead more effectively if you can 'put yourself into the shoes of others' and consider their position when dealing with difficult situations. Here's a wonderful 3 minute animated short about empathy and the qualities that are ingrained in this simple word.

Attitude - attitude isn't about how clever or logical you are, it's 100% emotion. Sometimes we play down the important of attitude, until our team members have a bad one! Attitude is as contagious as herpes and as a leader, you have the highest viral load. OK, so bad analogy there, but spread the good attitude widely. It's fine to be occasionally disappointed or frustrated in front of your team, and in small doses it reveals your humanity. But they need to see your positive passion for medicine, for patient care, human interactions and the rewards of our work as often as possible.

Relationships - people want to be led by someone they know and like. Find ways to connect with your team. A large part of Emotional Intelligence is about human relationship management and I'll definitely be writing more about the huge importance of EQ. Lead from the heart and work on building stronger and more lasting working relationships with others.

Trust - your team needs to know they can rely on you. That your word is good and you follow through on your promises. They want to follow someone they can trust, and that can be you. 

These two acronyms aren't that different when you look at them and ultimately, leaders must bring their heart to work. You can't lead from a distance. Your team will respect you for it and the reward will be their loyalty and commitment to your shared goals.

Discuss...

Three paths to wisdom

How did you gain your wisdom this week?  May all your paths be noble!

 
image.jpg
 

Taking care of business

 
image.jpg

The courage of leadership is giving others the chance to succeed, even though you bear the responsibility for getting things done.

 

Impromptu guidance in the workplace

Skilled impromptu guidance is essential to our teams at work

Skilled impromptu guidance is essential to our teams at work

Make it look easy
Back when I was a Senior House Officer, one afternoon I was doing a forceps delivery under the watchful eye of my Senior Registrar, Sue. During the delivery, she whispered in my ear ‘make it look easy’. I heard what she said, but I was concentrating on my angle of traction. Was the baby descending with each pull? When to cut the episiotomy, and all the other things that rush through your mind when you're learning the craft of assisted delivery. The baby came out beautifully, everyone was happy, and of course I was proud of myself. Another new life safely into the world.

A few weeks later, after we had done a couple more together on our night shift, Sue took me aside in the doctors’ mess and said, ‘Danny, when you do assisted deliveries, the face you pull is scaring the parents!’ Whoa! That stopped me in my tracks. An acutely intense mixture of guilt and embarrassment washed over me. She explained and I suddenly got it; my concentration, grimace, biting of the lip, with the inevitable dose of anxiety was on full show for the parents to see. It must have looked pretty painful - certainly not reassuring when I have their most precious thing in the world in my hands. She taught me to hide my concentration in stressful situations, to always smile and reassure my patient that all will be well.

Sue had given me some gentle advice on more than one occasion and I didn’t get it. Her frank approach that evening was necessary. But her bluntness didn’t come in isolation. She had shown me through lots of other interactions that she cared deeply about my wellbeing. She had given me positive feedback on many occasions and invested significantly in my development. She had invited me over to her house to meet her family and was as caring as any mentor could be. She had my back covered.

Radical candour - care personally, challenge directly
Sue’s approach to guidance exemplified what Kim Scott, a former Director at Google, calls Radical candour. Guidance that occurs at the intersection of caring personally and challenging directly.

 

1.png

Scott calls the x-axis above the ‘willing to piss people off’ axis and the y-axis is about how much you care. When we consistently demonstrate to those we are responsible for that we care deeply for their wellbeing, they can deal with our blunt honesty. Because they know that it comes from a positive place.

Radical candour in our interactions with others doesn’t always come easily. We’ve grown up being told that if you haven’t got something nice to say, then don’t say anything at all. Of course it’s easier to let these opportunities slip by, to not take the time to build the necessary relationships. As leaders, however, the truth is that it’s not only our job to do this, it’s our moral obligation. 

“The source of everything respectable in man, either as an intellectual or a moral being is that his errors are corrigible…. he is capable of rectifying his mistakes, by discussion and experience. Not by experience alone. There must be discussion, to show how experience is to be interpreted…. The whole strength and value of human judgment depends on the property that it can be set right when it is wrong”
— JS Mill, Philosopher, 1916

Less satisfactory approaches
So if radical candour is the right way for us to interact with those in our care, what are the unhelpful ways? How do people get it wrong and what should we be looking out for signs of?

We have all known a doctor who is frankly the worst type of leader. The obnoxious aggressive that berates the RMO in front of the whole ward round, the registrar that criticises the nurse in front of the patient. Unfortunately, if this doctor doesn’t get proper feedback and support, when told that these actions are inappropriate, only the direct challenging will be addressed. Unless they appreciate the importance of caring for our team at work, that person is liable to slip into behaviours that are manipulatively insincere.

The vast majority of leadership mistakes occur in the quadrant of ruinous empathy. No-one wants to tell the person that they have a problem; they may care about the individual concerned, but don’t have the courage or skills to confront them openly about what is going on.

How to do it in practice
What other approaches can we use to ensure that our guidance is given with radical candour? Remember the acronym HIP. Guidance in the workplace must be:

 

Humble
Helpful
Immediate
In person
In private for criticism
In public for praise
 and it doesn’t;
Personalise - critique the action not the individual 

Keep looking after those around you. Show them every day with small, frequent gestures that you care personally and are invested in their growth. And have the courage to provide the guidance they need when the situation arises. All of us need mentors who do this.

Could rudeness in the workplace increase patient mortality?

Sounds extreme? Many of us will have experienced inappropriate behaviour in the workplace. In fact, two thirds of operating room staff have witnessed rude behaviour and nearly one half have been on the receiving end of it. But could it result in increased patient mortality?

RCT of medical rudeness
A recent study ‘The Impact of Rudeness on Medical Team Performance: A Randomised Trial’, published in Paediatrics last September suggests this may indeed be the case. Researchers found that a rude comment from a third party doctor decreased performance of doctors and nurses by more than 50% in an exercise involving a hypothetical life-or-death situation.

“We found that rudeness damages your ability to think, manage information, and make decisions,” said Amir Erez, the author of the study. “You can be highly motivated to work, but if rudeness damages your cognitive system then you can't function appropriately in a complex situation. And that hurts patients.”

For the experiment the researchers gave 24 medical teams - each composed of one doctor and two nurses - an hour to diagnose and treat a simulated case of necrotising enterocolitis. The researcher told the teams that an expert from the United States would be watching their progress via webcam. At the start, the ‘expert’ was conferenced in and a pre-recorded message was played to the teams. Half the teams received a message that said the observer had been watching other teams and was ‘not impressed by the quality of medicine in their country’. Control groups were simply told that he had observed other teams, without any rude comments. Ten minutes into the simulation, another expert recording was played, telling the control group that he hoped the simulation was helping them improve as physicians. The other teams, however, were told that the physicians and nurses he had been observing ‘wouldn’t last a week’ in his department.

The rudeness experienced by half the teams had a profound effect on the outcome. Those who were exposed suffered a severe drop in performance, making incorrect diagnoses, struggled with communication and teamwork, asking for incorrect drugs, demonstrated poor ventilation technique and failed to ask for help at an appropriate time. Overall, the rude comments led to a 52% difference in success at diagnosis and 43% difference in treatment success. The assessment was made by 3 independent assessors who were blind to the study’s thesis. In real world situation, as Erez pointed out, these performance deficits could be the difference between a patient living or dying.

Postponing emotions
Erez expected that the more experienced staff would bounce back from the rude comments and keep working as a team, especially as the situation was an emergency one. “But we found consistently and dramatically that rudeness isn't something people can easily get over,” he says. “It's not something that you can postpone emotionally to a later time because it affects the cognitive system.” You don't even have to be the target of the bad behaviour - merely witnessing rudeness results in cognitive decline.

People spend time and energy processing why rude comments were made to them, and how it affects them, taking crucial mental resources from the task at hand. This lack of focus could literally be life threatening to the patient involved. Previous work by Erez has revealed that rudeness can spread through teams like a virus, resulting in a culture of negativity threatening patient safety.

Call to action
We all need to be aware of the direct and indirect effect this negative behaviour has on our teams, both immediately and - in the longer term - on team functioning and culture. It is our responsibility to not only model positive behaviours, but to call out others who are rude, or think that it is OK to behave in a way that is harmful to our colleagues, teams and patients.

Is this important?
Join the positive leadership movement; talk about the issues
Share with colleagues and share/like on social media so word spreads
Be the change you want to see in our health care systems

Discuss...