SAEM Chief Resident Leadership Forum Leadership vs Management Roles Carey Chisholm Indiana University 3 June 2011 Congratulations!!!! • “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 development "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” Hybrid? Scheduler? – Shifts – Didactics • Interviewer? Your “legacy” will be defined by your accomplishments during the upcoming year … 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 ethic! 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 manage. Exercise…. • Name the 5 top leaders in American history Exercise • 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 power.” 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 system” • 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” advocate? Resident advocate = immediate needs Residency advocate = longitudinal view Empowerment • • • • Share with constituents Tap into creativity Problem solving Scheduling – 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 pressure? Who is a tremendous multi-tasker? ANSWER • NO ONE!!!!!! Time Management • #1 predictor of what you will (won’t) accomplish • “By failing to plan, you’re planning to fail” • 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 Planning • Longitudinal projects: “retrograde planning” • Anticipate specific components for task completion • Establish specific time intervals for each • Build in a 20% buffer • Longitudinal tracking system Planning • 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 unexpected! Scheduling • 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 Communication • • • • • • 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 aware? • 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 option • 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 • • • • • • • Authority Not responsibility or accountability Clear parameters of task Resources 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 Transparency Problems •Not understanding your role (constituents) •Not understanding the “chain of command” •Personal agenda supersedes residency’s •Disorganization •Poor communication-negotiation skills •Gossip – Privacy – Confidentiality •Favoritism 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” Caveat: 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 items • Showcase other’s efforts • Praise in public Relationships • 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. Summary • • • • 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 difference Best Wishes!!!