6 May 2008 Polk

Goal Oriented Goal Oriented Leadership: Leadership Leadership: Leadership

Lessons from the Lessons from the Trauma RoomTrauma Room

J.D. Polk, DO, MS, FACOEPJ.D. Polk, DO, MS, FACOEPChief, 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 1st

…the first day of residency

6 May 2008 Polk

““The Trauma Team”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 and 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

Nurse Right

Nurse Left

ED DR

RespiratoryTherapy

Resident

Scribe

Patient

Team Leader

Airway

Breathing

Circulation

Disability

Exposure

Trauma Team

Practice (SIM)

Train

Place people at their strong suit

Leader sets the tone

6 May 2008 Polk

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

BobBobFrom From

AccountingAccountingOn On

LeadershipLeadership

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

StressStress

oror

UrgencyUrgency

Leadership StyleLeadership Style

S4

S1

S3

S2

6 May 2008 Polk

Situational Leadership

• S1- You must know what you are doing. • S1-You can’t fake it. • S1-You must memorize, read, internalize, practice,

regurgitate, and speak with great authority. • S4- They must know what they are doing and you must

trust them. • S4- They can’t fake it. • S4- 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

Airway

Nurse Right

Nurse Left

ED DR

RespiratoryTherapy

Resident

Scribe

Patient

Team Leader

Trauma TeamSuction was

turned on and tubes were ready 100% of the time

Saw the tube pass through the cords, checked for breath sounds, checked

CO2 detector 100% of the time

Performed IV in the antecube on first stick 76% of the

time.

Performed IV in the antecube on

the first stick 85% of the

time.

Successfully placed chest tube, central

lines, or arterial lines 94% of the

time.

Usually gets stuck with the foley and rectal

exam 100% of the time!

Records vitals, procedures, times 100% of the time

6 May 2008 Polk

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

0

10

20

30

40

50

60

70

80

90

100

1st Qtr 2ndQtr

3rd Qtr 4th Qtr

Intubation

LMA

Crico

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