Why we need Anesthesia Leadership in the changing landscape of Healthcare

Colin J.L. McCartneyProfessor and Chair

The Ottawa Hospital and uOttawa

Conflicts of Interest

• None

Are you a natural leader?

A. Yes

B. No

C. Not sure

Why we need leadership

• Canadian healthcare no longer the best

• Changes in Canadian Healthcare looming

• Physicians need to be leading the change

Commonwealth Fund Ranking 2014

Why are anesthesiologists good leaders in medicine?

• Holistic view• Always work in teams• Work right across hospital and university• Think first as a physician and then as

anesthesiologist

Anesthesiology leadership

• Leaders in perioperative care

• Leaders in care of the critically ill

• Leaders in pain medicine

• Leaders in managing teams

• Leaders in quality and safety

What we need in anesthesia

• Grasp the opportunity to lead perioperative care and pain medicine in Canada

• Act like physicians and not only anesthesiologists• Leaders who are involved right across medicine at

both hospital and university levels (if you’re not at the table, you might be on the menu)

• Lead in education and research in the areas above

Barriers to leadership in anesthesia?

A. Lack of mentorshipB. Lack of remunerationC. Lack of opportunitiesD. A+BE. A+B+C

What gives me this platform?

• No training• No previous experience• A passion for best care of our patients: clinical

care, education and research• A belief in challenging the system in a

constructive manner• Being comfortable with discomfort

Role of the Leader

• Develop a vision (with others)• Challenge the status quo• Accept risk (difficult for anesthesiologists!)• Have nobility• Be transparent• Have integrity• Have courage

Who are natural leaders?

• Leaders are “made not born”• Both extroverts and introverts• Not necessarily the person with the title• Leaders at every level of medicine from

undergraduate through to post-certification• A passion for positive change• ”Willingness to get involved” Angela Enright• In Ottawa: Dan Dubois, Leo Jeyeraj, Dan McIsaac,

Jason McVicar, Patrick Wong and many others

leader

Ron Miller: Rovenstine Lecture 2009

• Opportunities in perioperative medicine• Not all current opportunities will be

remunerated well• Importance of research in anesthesia,

perioperative and pain medicine• Answer the big questions• ”we are all trying to find our way but some are

looking at the stars”

What have we done in Ottawa?

• Strategic planning process in 2014-15

• Strategic hiring process “Get the right people on the bus”

• New faculty mentorship process: help our new recruits to academic success

Strategic Planning

Strategic Imperatives

• Enable the best patient outcomes

• Advance the full potential of anesthesiology

• Active Stewardship of Team Members

• Responsible Stewardship of our resources

Enable the Best Patient Outcomes

Advance the Full Potential of Anesthesiology

Active Stewardship of Team Members

Quadruple Aim

Getting the Right People on the Bus

• Set the tone: Strategic planning, Democratization of Process, Maintain momentum

• Careful selection criteria for new faculty• Explicit mention of mentorship planning

process• Formal interview process

Three Criteria for Success

• The Individual: rigorous selection process (two way process)

• Mentorship: three year plan developed with faculty advisor and mentor

• Time: 1 day per week for non-clinical activities

Faculty Mentorship and Development

Multipliers: How the Best Leaders Make Everyone SmarterLiz Wiseman

Benjamin Disraeli 1804-1881

• When I left the dining room after sitting next to Mr. Gladstone, I thought he was the cleverest man in England. But after sitting next to Mr. Disraeli, I thought I was the cleverest woman in England.

Multipliers

Wiseman L et al Academic Medicine 2014

Mission and Guiding Principles: Appoint the Best and Help Them to Success

• “The Department of Anesthesiology at the University of Ottawa is committed to growing as a leading University Department of Anesthesiology, both in Canada, and internationally. Key to this goal is supportive investment in the people who comprise our department. As such, we have created an early career faculty development and mentorship program to enhance the success and development of new faculty to become outstanding academic anesthesiologists. This program aims to provide a supportive, collaborative, and collegial environment to ensure the success of each new faculty member. Inherent in this mission is the explicit recognition that individual success will require Department-wide support and our successes will be shared successes. The aim of this program is to appoint the best and help you to success.”

Mentorship Plan Structure

• Areas for professional development include leadership, scholarship, education and clinical care

• One primary goal or three secondary goals to be achieved

• Goals are to be Specific, Measurable, Attainable, Realistic and Timely (SMART)

• Review at every six months with faculty advisor• Aim to achieve promotion to Assistant Professor at

end of three years

Mentor vs faculty advisor

• Mentor: a trusted colleague who gives confidential advice on career guidance. Not necessarily more senior or in same specialty.

• Faculty advisor: individual who creates and assesses success with academic plan

• My own mentors: Vincent Chan, Joel Katz, Bob Byrick, Brian Kavanagh, Beverly Orser and others

Advice from my mentors

• Pursue your passion• Set goals• Take time to invest in your passion• Find great mentors• Think of others before yourself• Surround yourself with positive people• Look after your health and your family

Advice from my mentors

• Pursue your passion• Set goals• Take time to invest in your passion• Find great mentors• Think of others before yourself• Surround yourself with positive people• Look after your health and your family

Early Results

• Engaged junior faculty• Faculty have requested to join program• Care required with early overload• Care required to maintain environment of

support• Thought required for extension of process

My priorities:

• Departmental strategic plan• Departmental structure to leverage our talents

and contribute to patient care• Pain medicine• CBD and education• Mentorship program• My family and maintain health

What we need in anesthesia

• Grasp the opportunity to lead perioperative care and pain medicine in Canada

• Act like physicians and not only anesthesiologists• Leaders who are involved right across medicine at

both hospital and university levels (if you’re not at the table, you might be on the menu)

• Lead in education and research in the areas above

What we need to do• Step up to lead positive change: get involved• Focus our efforts on others: our patients, our learners

and work with our political leaders• Be critical in a constructive way• Develop our “followership”• Support our provincial and national societies• Support our research and developing the next

generation of great anesthesiologists• Support the leadership structure in medicine to

encourage participation

Are you a natural leader?

A. YesB. NoC. Not sure

Ron Miller: Rovenstine Lecture 2009

• Opportunities in perioperative medicine• Not all current opportunities will be

remunerated well• Importance of research in anesthesia,

perioperative and pain medicine• Answer the big questions• ”we are all trying to find our way but some are

looking at the stars”

Suggested reading:• 5 Levels of Leadership: John Maxwell• Good to Great and the Social Sectors: Jim

Collins• Multipliers: Liz Wiseman• The Advantage: Patrick Lencioni• Churchill: Roy Jenkins