Reflections on Leadership and Resilience in Emergency Medicine

Author: Justin Bright, MD (Senior Staff Physician, Henry Ford Hospital, Detroit, @JBright2021) // Edited by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW / Parkland Memorial Hospital)

Your department volumes have outgrown your physical plant.  There is not any additional space to build on, and even if there were, there is not any money budgeted for a new department.  It is clear that both logistical and cultural changes need to occur if the department is going to survive the increased growth.  Who is going to lead that change?

An emphasis on patient experience is taking on a continually increasing importance in your health system.  However, your current Press Ganey scores are low.  There is a directive from the C-suite to improve, but how will you do that?  Who will help create the new vision and drive a change in culture?

A mass casualty incident occurs in your town.  Your emergency department takes on the brunt of the victims.  Who in your department will lead the team through the chaos?  Who will the department look to as the team goes through the debriefing and healing process afterwards?

Who are the people you consider the biggest leaders and influencers of change in our profession?  What traits do they have that seem to make them a natural for their role?  How did they get there?  Perhaps even better questions to ask – what makes some people more engaged in their job? Why do some people bounce back from the stress of our jobs better than others do?  Are there common traits that overlap leadership and resilience?

The first thing I am absolutely certain of – title does not mean leadership.  I don’t think anyone reading this would have to think too hard to come up with an example of someone with a leadership title that really didn’t seem capable of the job.  Leaders embody the very best work ethic that everyone else strives to have.  Leaders set the tone in the department and in the boardroom.  Dr. Randy Pausch in his famous “Last Lecture” challenged everyone to be the Tigger, not the Eeyore.  Be positive. Encourage others. Model ideal behavior.  Be willing to outwork everyone else.  That is the key to being seen as a leader.  Don’t strive to be “President” or “Chairman,” strive to be the first person a nurse mentions when asked who she would take her kids to.  That is the ultimate sign of respect, and no leader can lead without the respect of others.

So how do you get respect?  Respect comes when your colleagues see you as someone who practices with integrity and humility.  People see through those who are disingenuous – acting all-in for the team in public while making moves privately that are self-serving.  Moral character can be sniffed out in pretty short order, and nobody will respect someone that they perceive to be dishonest or only “in it” for themselves.  The best leaders are transparent and fair.  The team knows positive behavior will be celebrated, and detrimental behavior will addressed and corrected.  Leaders are accountable, taking responsibility for failures, and they demand equal accountability from everyone else on the team.  Leaders are very quick to deflect personal acclaim when they are successful.  They recognize that the team is the key to achievement, and the best leaders are downright uncomfortable with individual successes.  Using your role as a leader to make sure colleagues are receiving their due for their role in the success reinforces positive behaviors and makes the rest of the team hungry for more of it.  They will work harder to achieve team goals, and be more willing to follow the direction of a leader they know has their back.

Every single text I’ve read on leadership demonstrates that superior leaders are incredibly confident.  Humility is what makes toeing the fine line of confidence and arrogance possible.  A leader has a natural confidence grown from passion and a knowledge that they will ultimately be successful in achieving their goals.  But confidence is more than that.  The best leaders are confident enough to know that there’s also a time to follow.  They seek outside opinion and ideas without feeling threatened.  A confident leader is comfortable saying “I don’t know” without fear that it makes them seem less capable of their job.  Confidence comes from preparation, exploration, and education.  With it, leaders can make decisive decisions in the face of adversity, and swiftly make decisions to adjust course when things occur unexpectedly.

Leaders are passionate about their objectives.  They have an innate ability to motivate others towards a common goal.  They understand how to achieve buy-in from others. The best leaders clearly communicate directives, giving the rest of the team a clear path to success.  Furthermore, leaders value the role of everyone on the team.  There is no “top-to-bottom” or menial role.  Teams with the best leaders feel like every single role is mission critical to ultimate success.  This comes from publically recognizing team members doing great work.  Members of the team also feel valued because strong leaders delegate essential work and continually develop and retain top talent within the unit.

Resiliency is not the same as leadership, but it seems they have some common overlapping traits.  Most prominent is a refusal to give up when faced with a seemingly insurmountable challenge.  Resilient people know that everybody gets knocked down in life, but it is how you get back up that defines you as a person.  The resilient leaders see challenges where others see obstacles.  What’s more, they thoroughly enjoy the journey of the challenge, sometimes even more than the final success.  As a result, they seem to effortlessly change directions or come up with a new plan when first attempts don’t succeed.  The most resilient people are absolutely certain that they will ultimately succeed in their objective because they will outwork their counterparts and continue to look at a problem from different angles until a solution is apparent.

Those that are successful in the face of adversity have a keen self-awareness.  They know their strengths and weaknesses.  The most resilient and prominent leaders keep the company of great people who are able to supplement the areas of their own perceived weaknesses.  In fact, the best leaders purposely seek the council of people with views or knowledge in direct opposition to their own as a way to make sure the problem is evaluated from all-sides.  With information comes power.  With power comes the will to continue on because a resilient leader knows they have both the information and the work ethic necessary for success.

Resilient leaders refuse to give up because they are so invested in the task at hand.  It is not a blind commitment, but rather a devotion to a principle that they see as being greater than themselves.  It is this altruistic, optimistic attitude that often makes the resilient person one of the most engaged and invested people within the group.  The passion and the desire to help others makes them willing to push through hardships and do whatever it takes to overcome a challenge.  With that success comes fulfillment.  It becomes an addictive cycle of finding ways to overcome challenges and motivate others to do the same, and they feed off the high that comes with the success.

But why are some people wired to be this way, while others are seemingly ill-fitted to be a leader?  Why do some people cave at the first sign of trouble?  Is it innate?  Can resiliency and leadership be learned?  I think the answer lies somewhere in between.  There is no doubt that there are certain personality traits people have while others don’t.  Someone’s ability to see the world as half empty, half full, or glass overflowing has to do with the experiences they have had in their life that ultimately shape their view of it.  Some people are just naturally more charismatic and inspiring than others.  But, I also think there’s a choice to be made in all of us.  I think we choose how hard we are going to work.  We choose at what point we are going to give up.  We choose to recognize others and build them up, and we choose when we are going to break somebody else down.  Everything we do in life has an equal effect on someone or something else.  I think this post demonstrates there are definitely leadership traits we can acquire and make a decision that we are going to improve upon.  Transparency, humility, praising and developing others – these are learned behaviors that earn respect and build political currency necessary to lead.  Mix in some innate passion, and imagine the leader you can be.  Imagine the change you can drive forward.  Imagine an engaged workforce of colleagues as invested as you are.  Imagine the possibilities.  Strive to be the Tigger in your department.  Commit to model ideal behavior.  Who knows, one day perhaps we will be talking about you the way we talk about some of the other great and respected leaders in our field.

References / Further Reading

-Freitas, Robert. “Leadership in Emergency Medicine.” Emergency Department Leadership and Management: Best Principles and Practice. N.p.: Cambridge UP, 2014.

-Heath, Chip, and Dan Heath. Switch: How to Change Things When Change Is Hard. New York: Broadway, 2010.

-Giuliani, Rudolph W., and Ken Kurson. Leadership. New York: Hyperion, 2002.

-Merlino, James. “Leading for Change.” Service Fanatics: How to Build Superior Patient Experience the Cleveland Clinic Way. N.p.: McGraw-Hill, 2014.

-Pausch, Randy. “Last Lecture: Achieving Your Childhood Dreams.” Web. 20 December 2007. Web. 29 March 2016. < https://www.youtube.com/watch?v=ji5_MqicxSo>

-Prive, Tanya. “Top 10 Qualities That Make A Great Leader.” Forbes. Forbes Magazine, 12 Dec. 2012. Web. 15 Mar. 2016. <http://www.forbes.com/sites/tanyaprive/2012/12/19/top-10-qualities-that-make-a-great-leader/#5a161e353564>.

-Farrell, Rachel, “23 Traits of Good Leaders.” CNN. Cable News Network, 03 Aug. 2011. Web. 21 Mar. 2016. <http://www.cnn.com/2011/LIVING/08/03/good.leader.traits.cb/>.

-“Gannett Health Services.” Gannett: Qualities of Resilience. Web. 29 Mar. 2016. <https://www.gannett.cornell.edu/topics/resilience/qualities.cfm>.

-Feloni, Richard. “7 Habits Of Exceptionally Resilient People.” Business Insider. Business Insider, Inc, 05 June 2014. Web. 22 Mar. 2016. <http://www.businessinsider.com/habits-of-resilient-people-2014-6>