What is a Leader?“Leadership is not about personality; it’s about behavior – an observable set of skills and abilities.”

Model the Way

Inspire a Shared Vision

Challenge the Process

Enable Others to Act

Encourage the Heart

The Leadership Challenge: Kouzes and Posner

Are Managers Leaders?

A manager is someone who:

• Plans and budgets• Organizes and allocates

resources• Controls and solves

problems

A leader is someone who:

• Shows a direction• Aligns and influences• Motivates and inspires!

Designated Leaders

Managers first

Assigned role and accountabilities

Manage resources

Establish clear goals (shared vision)

Facilitate open communication

Anticipate and solve problems

Conflict resolution!!

Situational LeadersAny team member who has the skills to manage the situation

“The principle role of a situational leader is to mobilizeand support the Situational Awareness of the team.”

Tools for Situational LeadersBriefing:Who is on the team?Goals? Roles and Responsibilities?Plan of care? Staff? Resources?

Huddle:“touch-base”; Emerging events. Concerns!Outcomes/Contingencies? Resources?

Debrief: Process Improvement; Informal after event;Improve teamwork, improve outcomes“What should we do differently next time?”

The team:

Ben, ENT surgeon

Ron, Anesthesiologist

Mary, OR RN, ENT lead

Abby, OR RN, orienting

Naomi, OR LPN

The list:

BMT, 2 ½ years

Tonsillectomy X 2, 4 years, 6 years

Partial Glossectomy (R), 54 years

Tonsillectomy X 2, 16 years, 21 years

NSR, 46 years

Partial Glossectomy (R)

Male, 54 years old

Heavy smoker, heavy drinker

Squamous cell cancer larynx (extensive)

Cancer base of tongue (for excision)

Heavy beard

Very poor dentition

Concerns…

Equipment issues

‘Uncommon’ intra-oral surgery

Risk of damage to teeth

Feasibility of endotracheal tube placement

How to secure the endotracheal tube

Pathology

The Briefing

Mary:

Assembled the team

Discussed equipment (airway, surgical, pathology)

We visualized the laryngeal mass

Discussed airway management plan(s)

Partial Glossectomy (R)

Very careful examination of teeth prior to induction

Small endotracheal tube, tied not taped

No throat pack

Surgeon placed Bite Block

Uneventful dissection/closure

Extubated awake in the OR

To PAR with O2 by facemask 6LPM

Adverse Event: the Huddle5 minutes after arriving in PAR, the patient removed the Bite Block

Mary:

Assembled the team in the OR, immediately

We discussed the incident and factors contributing

We discussed how to prevent recurrence

She wrote up a PSLS

Process Improvement: the Debrief

Mary:

Assembled the team

Discussed feasibility of process improvement ideas

Wrote up recommended changes to ‘the count’

Captured other ideas as suggestions

Leadership is about….

Having a vision of what is possible…

Maintaining ‘situational awareness’

“Stepping up” to support situational awareness

Maintaining communication and team processes

Innovation

Breaking down the barriers!