ブックタイトル第43回日本集中治療医学会学術集会プログラム・抄録集

概要

第43回日本集中治療医学会学術集会プログラム・抄録集

－179－SL3Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine, USATodd DormanLeadership models change.Healthcare is not static. Our knowledge continues to grow and diagnosis and treatment change. There is enhanced attentionpaid to patients and families and even specialty foci changes. True to this ever sea of change, leadership models change as well.The historical approach to leadership within health care is akin to the military approach of command and control. An autocratichierarchy existed with physicians exerting absolute control. Problems are typically addressed by finding someone…someoneother than the physician to blame, unless there is a physician-in-training nearby. Although in such a system, staff are extremelydedicated they are not engaged and thus safety is compromised and outcomes are impacted. Physicians frequently do notrecognize the circumstance as problematic as they typically believe that they collaborate in care and in the end it is their role tobe in command. In fact, they usually see the errors that occur as proof that they should exert more control.Unfortunately, optimal care is not delivered; there are frequent communication breakdowns, staff satisfaction falls andundesirable events happen. The historic response is to just blame more, demand more, push harder and fail to see that theapproach has failed. Data from The Joint Commission demonstrates that the majority of errors occur secondary tocommunication failures. The historic approach simply fails to produce the results we all desires for patients and their families.Unfortunately too many physicians can confuse fear for respect. New approaches are clearly needed.The first step is for physicians to understand the difference between management and leadership. Managers have subordinateswhile leaders have followers. Managers tend to be authoritarian while leaders are charismatic. Managers are work focused whileleaders are people focused. Managers struggle to cope with complexity while leaders promote change. Managers administer,maintain and control. Leaders innovate, develop and trust.We all contribute to the problem. As we hire our leaders we tend to look for a hero when we should look for a multiplier.Falsely emboldened with the expectation of heroism, too often we fall to management strategies instead of leadership. We failto become the guiding light for improvement. We fail to recognize that results occur at the speed of relationships. We fail tobecome a serving leader.The newer models of leadership still keep the physician as the leader but replace command and control with approaches thatfoster engagement, communication, and supportive teams. Given that system errors account for the majority of concerns, blameis replaced by approaches that encourage transparency so that individuals can grow and that we all have the opportunity toplay from our strengths.Instead of treating our team members as individual people we have treated them like objects and too often they feel like an “it”.This is worsened when the leader fails to use phrases like we and our and instead uses I and mine. A simple first step of changeis to always ask for input before stating your own opinion. If you truly listen and take into account the information provided, thisdemonstrates value in your team members and helps establish a team culture. It allows us to utilize all of the data streams andperspectives available about the patient which means we are all less like to commit an error. Valued team members stay on theteam longer and so disruption is minimized.Feelings of isolation can be pervasive when team members do not feel valued. Thus approaches that garner engagement andvalue can help mitigate burnout and PTSD. Prevention of loss of experts keeps the team functioning at a higher level.Prevention of loss removes the need to hire replacements. Given the economic impact of replacement is estimated at about twotimesthe base salary, cost savings are also achieved.The historic process of blame creates a persecutor, as someone has to do the blaming. Thus someone must also be the victim.In response, some of us tend to rush in and act like saviors. Unfortunately this tends to keep the victim in the victim role.Instead of rescuing them, we need to help them find a path forward, a new way by working together to solve problems. Such achange allows the leader to avoid being a rescuer and frees them to be a coach. Once we recognize that mistakes are actuallylearning opportunities we can stop persecuting and start teaching.The historic approach taught us to solve problems by finding barriers and knocking them down. The modern approachrecognizes that it is easier to make progress by identifying our strengths and leveraging them. A rule of thumb is to keep thefocus and thus the discussion focused on strengths for about 80% of the time. This allows us to acknowledge that barriers existsand to identify a couple to fix, but keeps the tone very positive and thus our teams more engaged and feeling supported.特別講演 3 2月12日（金）　9：00～9：50　第8会場Leadership