Leading Your Team

David L. Skaggs, MD, MMM

John M. (Jack) Flynn, MD

Mininder S. Kocher, MD, MPH

Kenneth J. Noonan, MD, MHCDS

Michael G. Vitale, MD, MPH

Paul S. Viviano¹

¹Guru:

Compared with the average person, you are probably already an expert in most of the topics of this book, except this one. This chapter may be one of the best opportunities to improve yourself and help your patients. Leading a team is a completely different skill than getting good grades, getting into medical school, or matching into a competitive residency. Self-discipline, intelligence, and drive got you this far, but those qualities alone will not result in optimal patient care. We have all seen extraordinarily talented surgeons get in their own way and fail. Many more surgeons fail, or get into trouble, because of interpersonal skills, not surgical skill or knowledge.

Surgeons freshly out of fellowship or residency have put in their 10 000 hours of medical training but have probably had very little training to lead a team. From their first day on the job, they are then expected to lead teams in the operating room, clinic, and office. A freshly minted surgeon tends to focus on being exceptional in the operating room and may fail to appreciate that their citizenship and the ability to work within a team will be the metric that their new colleagues and coworkers will use to judge them (Fig. 30-1). The stakes are high, and it is easy for a new surgeon to get a reputation as being a jerk. This chapter is aimed at the newly trained surgeon, but some pearls should be found by experienced leaders as well.

Words of Caution for the Truly New Attending

Building your team, like building your practice, takes time and effort. Avoid the pitfall of expecting your team to be like that of your fellowship director’s right from the start. If you are lucky, a nurse or scrub technician who regularly works with your senior partner will volunteer for “junior duty” to take you under their wing. One should be extremely cognizant and appreciative of this gift and ask that person for feedback on how you and your team can improve. It is likely your team will likely include members who are less experienced or less motivated than the best teams. Your team will have no way of knowing your preferences unless you tell them. This is probably best done in writing so that they are both tangible and can be shared with others as there is often more turnover on less established teams. A weekly email to your team regarding your plan for the cases and your anticipated equipment needs is a good start. It is also a good opportunity to share successes such as a preop and postop radiograph of a case that went well. Assume good intentions from your team until proven otherwise.

Although we have arguably the best job on the planet, it can be quite stressful or frustrating at times. Even in your first year of practice when you are dealing with complications, it is unacceptable for you to take your stress out on the team. In order to avoid doing so you need to allow yourself time and opportunity to decompress. You don’t want your entire team going on the emotional roller coaster that the first few years of practice often entail.

—Dr. Lindsay Andras Attending Surgeon, Children’s Hospital Los Angeles, 7 years into practice

Emotional intelligence (EQ) has been shown to be twice as important for effective leadership as IQ and technical skill combined. EQ comprises traits within the domains of self-awareness (e.g., self-confidence, emotional self-awareness), social awareness (e.g., empathy and organizational awareness), self-management (e.g., self-control, adaptability), and relationship management (e.g., influence, conflict management, teamwork, leadership).¹ The good news is that, unlike IQ, EQ can improve over one’s life. In order to improve EQ, one has to want to improve it. One must have a genuine desire to be more empathetic to others, as well as more self-aware and open to change. While EQ may seem a little soft, it has been shown
that of the most predictive factors in success of any military unit is the emotional intelligence of the leader, and EQ is now a focus of leadership training in the military.

Figure 30-1 Surgeons in the operating room view the level of teamwork as much higher than nursing and anesthesia do. (Reproduced from Sexton JB, Thomas EJ, Helmreich RL. Error, stress, and teamwork in medicine and aviation: cross sectional surveys. BMJ 2000;320(7237):745-749; with permission from BMJ Publishing Group Ltd.)