SAEM Chief Resident Leadership Forum

SAEM Chief Resident
Leadership Forum
Leadership vs Management
Carey Chisholm
Indiana University
3 June 2011
• “Crème de la crème”
• Demonstrated some unique skills in
order to be here
• So pat yourself on the back…
• And then realize that our expectations
of this collective group are even higher
So, What’s This About?
Leadership vs Management Roles
Pragmatic advice (hopefully!)
Ideas for personal/professional growth
Springboard for future thought and
"Leaders are made, they are not
born. They are made by hard
effort, which is the price which
all of us must pay to achieve
any goal that is worthwhile."
Vince Lombardi (1913 – 1970)
Which is MORE important?
• Be a good leader?
• Be a good manager?
How many of you are satisfied
with your leadership skills?
How many of you are satisfied
with your management skills?
What’s the difference?
“Lead as though those who will
follow are volunteers…”
Wildspitze, Austria 12,382 ft
Defining your CR “niche”
• “Elected” versus “selected”
– Who are your constituents?
“Academic CR”
“Administrative CR”
– Shifts
– Didactics
• Interviewer?
Your “legacy” will be defined by your
accomplishments during the upcoming
… and how well you groom those who
will follow you in this role!
Your impact as CR is limited only by
your vision, dedication and work
Your “role” is defined by your
program structure and the
leadership – management style
of your PD…
But there still should be ample
opportunity to both lead and
• Name the 5 top leaders in American
• Now name the top 5 managers in
American history…..
Bill Gates, co-founder of Microsoft
Steve Jobs, co-founder of Apple
Larry Page, co-founder of Google
Andrew Carnegie, steel industry
Conrad Hilton, hotel industry
Henry Ford, automobile industry
“Nearly all men can stand
adversity, but if you want to
test a man's character, give him
Abraham Lincoln
Are you a “leader”…
or are you a “manager” ???
What’s the difference?
Who cares????
Leadership vs Management
• Management is “working within the
• Leadership is “working on the system”
• Management is “doing things right”
• Leadership is “doing the right thing”
• You CANNOT be successful as a CR
unless you do both well, and know
when to lead and when to manage.
Leadership vs Management
• “A leader is someone who knows
where to go.”
• “Management skills are how they
actually get there”
Mark Shead, 2007
• Designing vs implementing a plan
• Managers have subordinates
• Leaders have followers
When do you “manage”?
Maintenance of the status quo
Stewardship of resources
Accountability is desired
Consistency is important
Adherence to regulations/protocols or
accreditation standards is impt.
• Task focused
When do you “lead”?
• Change is necessary or desired
– Crisis or Opportunity
• Moral authority: doing the right thing
– Lead by example
• Unique opportunities
• Onerous task
A US President is enjoying
85% approval ratings
• Are they leading or managing?
What’s the difference
between being a “resident”
advocate, and a “residency”
Resident advocate =
immediate needs
Residency advocate =
longitudinal view
Share with constituents
Tap into creativity
Problem solving
– 12 & 2 example
• Promotes ownership
• May decrease complaints
• Some risks – not for the unconfident
CR Toolbox
• Time Management
• Communication
– Written, e-mails
– Verbal
– Unspoken
• Conflict resolution
• Empowerment & Delegation
• Role Modeling
Who works BEST under
Who is a tremendous
• NO ONE!!!!!!
Time Management
• #1 predictor of what you will (won’t)
• “By failing to plan, you’re planning to
• Ultimate stress management tool
• Control, flexibility, productivity
• Ask those in leadership roles…
Time Management Tools
• Calendar
• Task list
– Prioritized
• Contacts
• Available
• Capture “passing items” that
require action or F/U
• Longitudinal projects: “retrograde
• Anticipate specific components for task
• Establish specific time intervals for each
• Build in a 20% buffer
• Longitudinal tracking system
• Every task should have a deadline
• “A goal without a deadline is a dream”
• Look ahead:
– 6 mos (once a month)
– 1 month (once a week)
– 1 week (daily)
• Build in buffers!!!!! Expect the
• Fair & Timely
• Tracked over time
– WE, Holidays, Nights
• Contingency plans
– Tardiness
– Short term absence
– Long term absence
• A well done schedule displeases
everyone equally…..
Scheduling Issues
Handling requests (equitable)
Reward good behaviors
Play to individual’s strengths
Watch ACGME mandates (switches)
Triple the time you think it will take
Kevin Rodgers’ hand-out posted
Front page rule for e-mail
Sit on e-mails written in anger
Listen, take notes
Summarize and paraphrase
Behaviors, not people
Social Media Policy?
“Never Wrestle with a Pig…
• You both get muddy
• And the pig likes it!”
Conflict resolution
• Seek “win – win” resolutions
• Keep track of favors (asked and given)
• If a “non-negotiable” is created by an
outside entity (e.g. ACGME), all parties
• Example IM clinics = EM conferences
• Jim Adams handshake and intro
“Sent-Boxed” (Nick Mohr)
• Track your correspondence
• Organize in retrievable manner
• Helps establish “problem ownership”
Complaints that schedule requests weren’t honored
(multiple requests never answered)
When confidentiality isn’t an
• Impairment
– Substance abuse
– Depression/suicidal
– Specific threats
• Sexual harassment
• “Would you like for me to go with you
to discuss with the PD?”
How many of you have good
delegation skills????
• “No man will make a great leader who
wants to do it all himself or get all the
credit for doing it.”
• “The secret of success lies not in doing
your own work, but in recognizing the
right man to do it”
– Andrew Carnegie
Delegation Skills
Not responsibility or accountability
Clear parameters of task
Time line & check points
Right person for the right job
Accept blame - Bestow credit
Leading by example
Visibility & Accessibility
The “slow walk-through”
Volunteers, not subservients
Schedule is always examined
•Not understanding your role (constituents)
•Not understanding the “chain of command”
•Personal agenda supersedes residency’s
•Poor communication-negotiation skills
•Gossip – Privacy – Confidentiality
What’s in a name?
(establishing “moral imperatives”)
• “Conflict” versus “war”
– “War” implies a change in culture
– Results in a fundamentally different way of
viewing our place in the world
– WW2 versus subsequent “conflicts”
– “War on Terror”
– “War on Poverty” (redistribution of wealth)
• “Medical Error” vs. “Patient Safety”
Use “renaming” judiciously
and purposefully.
Can be an effective method to
motivate others to follow.
Academic CRs
•Don’t be a “know – it – all”
•Teach problem solving skills (not just facts)
•Hone public speaking skills
–Elicit feedback
•Engage and dialogue
•Use mentor(s)
•Trial creative educational modalities
Academic CRs
• Always have a “plan B” for
cancellations and no-shows
• Review content ahead of time
– Even when explicitly requesting topics
• Digital camera
• Capture cases
• CQI, Risk Management
Academic CRs
• Cases uncommon to academic centers
– Transfers, 3rd trimester OB
– Specialty referrals
– Lack of technology
– “When is it impt to come in at 0200 hrs?”
• Teach about ‘plan c’ and ‘plan d’
Administrative CR
• Know your role and resources
• Develop time management skills
• Admin list serve for problem solving
and mentorship
• Practice ‘committee skills’
• Develop relationships with other CRs
Administrative CRs
• Committee skills
– Agenda (highlight prep needs)
– Assure key people attend
– Timeliness (do NOT reward tardy)
– Problem solving, NOT info exchange
– Agenda item status: closed, pending,
deferred, tabled
– Render your opinion last
– Clarify and summarize other’s thoughts
Administrative CRs
Dealing with disrupters
Assign recorder for minutes
Timely distribution of minutes
Strategic placement of controversial
• Showcase other’s efforts
• Praise in public
• Meet face to face
• Ask the hypothetical
– “How would you like for me to
address..?” Bad & GOOD!!
• Invite feedback, collaboration
• Look for opportunities to commend
the residents
• “Thank-you” cards, etc.
YOU define your success or failure
Develop – learn skills for success
Give back more than you take…
…and you’ll take away far more than
you ever dreamed.
• “Give ‘em hell”!!
Final Advice – Serenity Prayer
• Give me the serenity to accept the
things I cannot change
• Give me the strength to change the
things to change the things that I can
• And the WISDOM to know the
Best Wishes!!!