Goal Oriented Leadership Leadership Lessons from the Trauma

Goal Oriented Leadership: Leadership Lessons from the Trauma Room J. D. Polk, DO, MS, FACOEP Chief, Clinical Services NASA 6 May 2008 Polk

What we going to talk about? • The art of leading a high performance team under extreme pressure • What leadership style to use in high pressure situations • Setting the goals of the team • Enabling the team to reach the goals • Unspoken leadership • Communication as a key element of leadership • Metrics in evaluating goals as a function of leadership • Power versus Authority • Putting it altogether 6 May 2008 Polk

Leadership • • Is it taught or are you born with it? The answer to this is probably “yes”. Many facets can be taught and practiced. Why from the trauma room? – Simple, …residents come out of medical school with a lot of book knowledge, but little knowledge on how to lead. This is one way we teach them. 6 May 2008 Polk

When is the worse day to be injured in a car accident? July 1 st …the first day of residency 6 May 2008 Polk

“The Trauma Team” 6 May 2008 Polk

6 May 2008 Polk

What was the Goal? • Strategic – Service to the Community, keeping the hospital in the black, academic prestige, etc. • Tactical – Saving the patient’s life. • Operational – Success with the airway, success with the IV, success in surgery, success in the ICU. 6 May 2008 Polk

What is the Goal of YOUR Organization • Strategic – Does your workforce know what the strategic goal of the organization is? Is it in some grandiose strategic plan that sits on a shelf? • Tactical – Does your Division have a clear and concise goal that your employees clearly understand are motivated to achieve? • Operational – Does everyone under your command know their role and how it plays into the success of the organization? 6 May 2008 Polk

Which would you rather see? 6 May 2008 Polk

Airway Breathing Respiratory Therapy Trauma Team Airway Circulation Disability Exposure Nurse Right Nurse Left Patient Practice (SIM) Resident ED DR Train Place people at their strong suit Leader sets the tone 6 May 2008 Team Leader Polk Scribe

What Makes Someone a Good Leader? • Independent of personality • Application of a particular style and expertise at the right moment in time • “Good leader” and “Effective leader” are not synonymous. • “Effective leader” and “Moral leader” are not synonymous. 6 May 2008 Polk

Personification Bob From Accounting On Leadership 6 May 2008 Polk

Leadership Styles • • Situational Leadership Tribal Leadership Selling versus Telling Power versus Authority 6 May 2008 Polk

Situational Leadership 6 May 2008 Polk

Situational Leadership S 1 Stress S 2 or Urgency S 3 S 4 Leadership Style 6 May 2008 Polk

Situational Leadership • S 1 - You must know what you are doing. • S 1 -You can’t fake it. • S 1 -You must memorize, read, internalize, practice, regurgitate, and speak with great authority. • S 4 - They must know what they are doing and you must trust them. • S 4 - They can’t fake it. • S 4 - You must give them full credit for their success. • Repeated success in high stress situations gain you respect and “power”, regardless of the leadership type. 6 May 2008 Polk

Tribal Leadership • People tend to form groups or clicks • An organization or group within a larger organization tends to take on a personality of its own. • Leading an individual may not be as effective as leading the entire group. • You either have to change or mix up the group, or obtain group buy in. 6 May 2008 Polk

Selling versus Telling • Many Chiefs and few indians. • Gaining collective buy-in of the group. • Many people with Power versus Authority – May need to negotiate or have their backing for success • Shareholder status, board members, equal group members 6 May 2008 Polk

Power Versus Authority • Influence • Experience • Many leaders have authority, but not all have power. • Make use of those who have power in your organization (enlistment). 6 May 2008 Polk

Marketing and Leadership • External Marketing- What the hospital says about you, what patients say about you, what nurses say about you, etc. • Internal Marketing. Promotion at a subconscious level. – Take advantage of human mind “sorting” – Can be changed or molded much easier than your personality – “Packaging” 6 May 2008 Polk

Internal Marketing • Important in all aspects and generally regarded as “style” • Military bearing • Medical professionalism • EXTREMELY IMPORTANT WHEN YOU FAIL TO ACHIEVE THE EXPECTED OUTCOME. • Know what how to change your internal marketing. 6 May 2008 Polk

Internal Marketing Example • Making your attributes outweigh any of your potential negatives (due to culture, climate, circumstance). • Pursuit of Happiness – Chris Gardner 6 May 2008 Polk

Communication • 7% Verbal • 38% Tone • 55% Non-verbal • “I didn’t say he stole the money” 6 May 2008 Polk

Empowerment • Make your expectations and the goal known from the start • Empower their ability to reach the goal • Measure the goal with metrics so they can benchmark their achievement • Give them the credit when they succeed 6 May 2008 Polk

Effective Metrics and Leadership • The “United Way” phenomenon – Visible goal – People want to see it over the top – People internalize the success or failure – Links their operational goal with the tactical goal. 6 May 2008 Polk

Suction was turned on and tubes were ready 100% of the time Saw the tube pass through the cords, checked for breath sounds, checked CO 2 detector 100% of the time Performed IV in the antecube on first stick 76% of the time. Respiratory Therapy Trauma Team Airway Nurse Right Nurse Left Performed IV in the antecube on the first stick 85% of the time. Patient Resident ED DR Usually gets stuck with the foley and rectal exam 100% of the time! Team Leader 6 May 2008 Polk Scribe Successfully placed chest tube, central lines, or arterial lines 94% of the time. Records vitals, procedures, times 100% of the time

Metrics • What are the metrics for success in your organization? • Does every team member know their metric and where they are in the success ladder? Can they see it? • If they succeed, is it apparent to them? Are they somehow rewarded? 6 May 2008 Polk

Airway Success • Our goal is 100% success in Airway by the third attempt 6 May 2008 Polk

Putting it altogether • • • State the goals Everyone has a role Enable the cadre Assess measures of success or failure Remediate failures Use of communication and marketing Pick the leadership style appropriate to the situation Be knowledgeable and concise Reward the team for success 6 May 2008 Polk

Photo US Air Force 6 May 2008 Polk