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Excerpts from Bryce Taylor's

"Effective Medical Leadership"

Bryce Taylor

“I’ve always had a problem with the oft-used concept “managing people”, as I think a better way of stating the intent might be “managing situations with collaboration and respect”. That said, independent professionals do present unusual challenges in the hospital work environment.”
Bryce Taylor

Managing Medical Professionals
The well-celebrated video advertisement conjured up by Electronic Data Systems (a business and technology services industry, founded by Ross Perot in 1962) and showing images of horsemen herding cats in a wild west setting (see http://theinspirationroom.com/daily/2005/cat-herders-herding-cats/) may come to mind when the concept of managing medical professionals is considered. The presumed lack of control and the antiquated insufficient resources to do the job may be apt in some groups of individuals. However, with regard to the advertisement mentioned, we should remember that cats are wayward and perhaps adventuresome, but relatively harmless.

In the case of medical professionals, the image of a pride of larger cats or a sloth of bears may be more appropriate: these animals may be attracted by pleasures such as raw meat or honey, but the chance of angry retaliation is always present and threatens the zookeeper at all times. Rather than using this predatory image, I prefer to think of my surgical colleagues in a way expressed in one of my yearly ‘state of the union’ addresses, using a flock of migrating birds as a backdrop. These particular geese each had different appearances from one another because their wings were in various distinct configurations. As I said then, ‘This stylized image captures in my mind our surgical family at UHN . Its members all have the capacity to fly, and indeed soar above most others, and in their make-up and behaviour they are free-spirited, independent, and, as you can see, certainly exalt in being different from one another. But at the same time they fly in formation, knowing that by sticking together and acknowledging the power of team in sometimes unpredictable conditions, their performance, and the recognition of that performance, is the best it can be.’

Individuality and personal achievements are supported and encouraged but only in the context of being part of a team that must play by a set of well-described rules.

One of the major features of the professional behaviour of physicians and surgeons is that there is invariably a sense of entitlement. This feeling is pervasive and, on the surgical side, was given even greater impetus by a recent pseudoscientific, published article from Barcelona. From a recent report in the British Medical Journal, researchers at the University of Barcelona found, in a small study, that male surgeons are more attractive to women than are other doctors. The researchers pointed out (and I kid you not) that ‘surgeons spend a lot of time in operating rooms which are cleaner, cooler and have a higher oxygen content than the average medical ward where physicians spend most of their time, which could help surgeons keep their looks.’24

Is there any wonder how over decades a sense of entitlement, especially on the part of surgeons, might evolve?

Professionalism
The old definition of professionals in days gone by was in direct relation to what they were paid for their services; for example, an amateur athlete received compensation only for expenses, and a professional made his or her living from the activity. That sports analogy, of course, has been blown up long ago in both amateur and professional domains, and a much more detailed look at professionalism has occupied especially the medical profession in recent years. Being a professional in the twenty-first century implies the following:

Becoming an expert in a specialized field

Acquiring knowledge and skills that are used to serve patients

Improving those tools on an ongoing basis, as knowledge in the field expands

Having academic qualifications that satisfy standards of the certifying and licensing bodies that are ultimately responsible for the quality of care offered to patients

Evidencing a high quality of work in a specific area

Working to a high standard of integrity and ethical behaviour in the service of patients

The appropriate behaviours expected of us as professionals include the following:

Respect for all individuals with whom we come in contact, including patients, family members, colleagues, and other health care workers

A personal appearance befitting our privilege of caring for patients

Reliability and punctuality in our daily activities

Effective communication with others

Respect of confidentiality with regard to both patient and administrative issues

Honesty, integrity, and empathy in our actions with everyone in the organization

Acceptance of responsibility for our activities in our various roles, including the official transference of that responsibility to others when we are absent

Knowledge of our own limitations, and the ability to seek help as required with decision making, whether patient or management related.

It will be your responsibility as a medical leader to first and foremost be a role model for others in your own personal consistent demonstration of the elements of professionalism. Your patient management must embody all the dimensions of patient-centered care, and your comportment and behaviour must reflect the principles cited above as well as the values held by your organization. Your tougher job will be to uphold those principles if they appear to be violated by your friends and colleagues.

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