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SAEM Chief Resident Leadership Forum
Leadership vs Management Roles
Carey ChisholmCarey Chisholm
Indiana UniversityIndiana University
3 June 20113 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 leader?
• Be a good manager?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”• ““ElectedElected”” versus versus ““selectedselected””
– Who are your constituents?
• ““Academic CRAcademic CR””• ““Administrative CRAdministrative CR””• Hybrid? Hybrid? • Scheduler?Scheduler?
– Shifts– Didactics
• Interviewer?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 Name the 5 top leaders in American historyhistory
Exercise
• Now name the top 5 managers in Now name the top 5 managers in American history…..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 LincolnAbraham Lincoln
Are you a “leader”… or are you a “manager” ???
What’s the difference?
Who cares????
Leadership vs Management
• Management is Management is ““working working withinwithin the the systemsystem””
• Leadership is Leadership is ““working working onon the system the system””
• Management is Management is ““doing doing thingsthings right right””
• Leadership is Leadership is ““doing the doing the rightright thing thing””
• You CANNOT be successful as a CR You CANNOT be successful as a CR unless you do both well, and know unless you do both well, and know when to lead and when to manage.when to lead and when to manage.
Leadership vs Management
• ““A leader is someone who knows A leader is someone who knows where to go.where to go.””
• ““Management skills are how they Management skills are how they actually get thereactually get there””– Mark Shead, 2007
• Designing vs implementing a planDesigning vs implementing a plan
• Managers have subordinatesManagers have subordinates
• Leaders have followersLeaders have followers
When do you “manage”?
• Maintenance of the status quoMaintenance of the status quo
• Stewardship of resourcesStewardship of resources
• Accountability is desiredAccountability is desired
• Consistency is importantConsistency is important
• Adherence to regulations/protocols or Adherence to regulations/protocols or accreditation standards is impt.accreditation standards is impt.
• Task focusedTask focused
When do you “lead”?
• Change is necessary or desiredChange is necessary or desired– Crisis or Opportunity
• Moral authority: doing the right thingMoral authority: doing the right thing– Lead by example
• Unique opportunitiesUnique opportunities
• Onerous taskOnerous task
A US President is enjoying 85% approval ratings
• Are they leading or managing?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 ManagementTime Management
• CommunicationCommunication– Written, e-mails– Verbal– Unspoken
• Conflict resolutionConflict resolution
• Empowerment & DelegationEmpowerment & Delegation
• Role ModelingRole Modeling
Who works BEST under pressure?
Who is a tremendous multi-tasker?
ANSWER
• NO ONE!!!!!!NO ONE!!!!!!
Time Management
• #1 predictor of what you will (won#1 predictor of what you will (won’’t) t) accomplishaccomplish
• ““By failing to plan, youBy failing to plan, you’’re planning to re planning to failfail””
• Ultimate stress management toolUltimate stress management tool
• Control, flexibility, productivityControl, flexibility, productivity
• Ask those in leadership roles…Ask those in leadership roles…
Time Management Tools
• CalendarCalendar
• Task listTask list– Prioritized
• ContactsContacts
• AvailableAvailable
• Capture Capture ““passing itemspassing items”” that that require action or F/Urequire action or F/U
Planning
• Longitudinal projects: Longitudinal projects: ““retrograde retrograde planningplanning””
• Anticipate specific components for task Anticipate specific components for task completioncompletion
• Establish specific time intervals for eachEstablish specific time intervals for each
• Build in a 20% bufferBuild in a 20% buffer
• Longitudinal tracking systemLongitudinal tracking system
Planning
• Every task should have a deadlineEvery task should have a deadline
• ““A goal without a deadline is a dreamA goal without a deadline is a dream””
• Look ahead:Look ahead:– 6 mos (once a month)– 1 month (once a week)– 1 week (daily)
• Build in buffers!!!!! Expect the Build in buffers!!!!! Expect the unexpected!unexpected!
Scheduling• Fair & TimelyFair & Timely• Tracked over timeTracked over time
– WE, Holidays, Nights
• Contingency plansContingency plans– Tardiness – Short term absence – Long term absence
• A well done schedule displeases A well done schedule displeases everyone equally…..everyone equally…..
Scheduling Issues
• Handling requests (equitable)Handling requests (equitable)
• Reward good behaviorsReward good behaviors
• Play to individualPlay to individual’’s strengthss strengths
• Watch ACGME mandates (switches)Watch ACGME mandates (switches)
• Triple the time you think it will takeTriple the time you think it will take
• Kevin Rodgers’ hand-out postedKevin Rodgers’ hand-out posted
Communication
• Front page rule for e-mailFront page rule for e-mail
• Sit on e-mails written in angerSit on e-mails written in anger
• Listen, take notesListen, take notes
• Summarize and paraphraseSummarize and paraphrase
• Behaviors, not peopleBehaviors, not people
• Social Media Policy?Social Media Policy?
“Never Wrestle with a Pig…
• You both get muddyYou both get muddy
• And the pig likes it!And the pig likes it!””
Conflict resolution
• Seek Seek ““win – winwin – win”” resolutions resolutions
• Keep track of favors (asked and given)Keep track of favors (asked and given)
• If a If a ““non-negotiablenon-negotiable”” is created by an is created by an outside entity (e.g. ACGME), all parties outside entity (e.g. ACGME), all parties aware?aware?
• Example IM clinics = EM conferencesExample IM clinics = EM conferences
• Jim Adams handshake and introJim Adams handshake and intro
“Sent-Boxed” (Nick Mohr)• Track your correspondenceTrack your correspondence• Organize in retrievable mannerOrganize in retrievable manner• Helps establish Helps establish ““problem ownershipproblem ownership””
CComplaints that schedule omplaints that schedule requests werenrequests weren’’t honoredt honored
((multiple requests never multiple requests never answered)answered)
When confidentiality isn’t an option
• ImpairmentImpairment– Substance abuse– Depression/suicidal– Specific threats
• Sexual harassmentSexual harassment
• ““Would you like for me to go with you Would you like for me to go with you to discuss with the PD?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
• AuthorityAuthority
• Not responsibility or accountabilityNot responsibility or accountability
• Clear parameters of taskClear parameters of task
• ResourcesResources
• Time line & check pointsTime line & check points
• Right person for the right jobRight person for the right job
• Accept blame - Bestow creditAccept blame - Bestow credit
Leading by example
• Visibility & AccessibilityVisibility & Accessibility
• The The ““slow walk-throughslow walk-through””
• Volunteers, not subservientsVolunteers, not subservients
• Schedule is always examinedSchedule is always examined
• TransparencyTransparency
Problems
•Not understanding your role (constituents)Not understanding your role (constituents)
•Not understanding the Not understanding the ““chain of commandchain of command””
•Personal agenda supersedes residencyPersonal agenda supersedes residency’’ss
•DisorganizationDisorganization
•Poor communication-negotiation skillsPoor communication-negotiation skills
•Gossip – Privacy – ConfidentialityGossip – Privacy – Confidentiality
•FavoritismFavoritism
What’s in a name?(establishing “moral imperatives”)
• ““ConflictConflict”” versus versus ““warwar””– “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 ErrorMedical Error”” vs. vs. ““Patient SafetyPatient Safety””
Caveat:Use “renaming” judiciously
and purposefully.Can be an effective method to
motivate others to follow.
Academic CRs•DonDon’’t be a t be a ““know – it – allknow – it – all””
•Teach problem solving skills (not just facts)Teach problem solving skills (not just facts)
•Hone public speaking skillsHone public speaking skills–Elicit feedback
•Engage and dialogueEngage and dialogue
•Use mentor(s)Use mentor(s)
•Trial creative educational modalitiesTrial creative educational modalities
Academic CRs
• Always have a Always have a ““plan Bplan B”” for for cancellations and no-showscancellations and no-shows
• Review content ahead of timeReview content ahead of time– Even when explicitly requesting topics
• Digital cameraDigital camera
• Capture casesCapture cases
• CQI, Risk ManagementCQI, Risk Management
Academic CRs
• Cases uncommon to academic centersCases 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 Teach about ‘‘plan cplan c’’ and and ‘‘plan dplan d’’
Administrative CR
• Know your role and resourcesKnow your role and resources
• Develop time management skillsDevelop time management skills
• Admin list serve for problem solving Admin list serve for problem solving and mentorshipand mentorship
• Practice Practice ‘‘committee skillscommittee skills’’
• Develop relationships with other CRsDevelop relationships with other CRs
Administrative CRs
• Committee skillsCommittee 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 disruptersDealing with disrupters
• Assign recorder for minutesAssign recorder for minutes
• Timely distribution of minutesTimely distribution of minutes
• Strategic placement of controversial Strategic placement of controversial itemsitems
• Showcase otherShowcase other’’s efforts s efforts
• Praise in publicPraise in public
Relationships• Meet face to faceMeet face to face
• Ask the hypothetical Ask the hypothetical – “How would you like for me to addres
s..?” Bad & GOOD!!
• Invite feedback, collaborationInvite feedback, collaboration
• Look for opportunities to commend Look for opportunities to commend the residentsthe residents
• ““Thank-youThank-you”” cards, etc. 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 Give me the serenity to accept the things I cannot changethings I cannot change
• Give me the strength to change the Give me the strength to change the things to change the things that I canthings to change the things that I can
• And the WISDOM to know the And the WISDOM to know the differencedifference
Best Wishes!!!
