This post, detailing my reflections on clinical retrieval medicine, is the fifth in a series recording my reflections on the twelve months I spent working for Sydney HEMS in prehospital and retrieval medicine. The first post covers medical education – you can find it here. The second covers human factors – you can find it here. The third covers clinical lessons from retrieval medicine – you can find it here. The fourth covers more clinical lessons – you can find it here.
This post is about the leadership lessons I’ve learned during my year of prehospital and retrieval medicine. As a registrar in the service, much like in Emergency Medicine in the UK, the day-to-day clinical work was the same irrespective of whether you were a consultant or registrar.
It would be easy to think, though, that as a registrar you’re not a leader. I think this is a common misconception – that leadership has anything directly to do with seniority. Of course, senior clinicians and practitioners in any service, in any field, find themselves expected to display more leadership traits than more junior employees but I’ve long felt that at heart anyone can step up and be a leader – it just takes a decision to do so.
There are many opportunities to make that decision to lead in the flash-team situations inherent in prehospital and retrieval medicine. I was privileged to witness lots of different situations necessitating clear leadership and some inspiring individuals stepping up to the plate. Below are my reflections on leadership from the year I spent at Sydney HEMS.
Part Five – Leadership
Other people’s bad behaviour represents opportunities to role-model good leadership
Having said that there are opportunities to step up and lead, there are also opportunities to behave in an unacceptable way. I have no doubt you’ll have seen people seize these with both hands, no matter what field of medicine (or any other field, to be honest) you work in. What I realised last year was that when you see people behaving badly, you have an opportunity to sink to their level or to rise above. There’s a great opportunity to role model leadership when others are failing in front of you.
You might remember back in post two I referred to some bad behaviour when a consultant (not a HEMS consultant, I should add!) swore at me down the phone in the middle of a job. I realised this was an opportunity to whinge and bitch and make everyone’s life harder – but for some strange reason I decided that this was also an opportunity to role model how leaders deal with difficult people. In a department where I didn’t really know anyone, I kept the mood light, was extra polite (lots and lots of please and thank you) – and when the consultant called to apologise later, I made sure I very clearly thanked him for taking the time to apologise to me in earshot of his colleagues. It could have been a really uncomfortable experience in that consultant’s department – but it felt awesome. It’s definitely something I plan to try to stick to in future.
When you’re greeted with hostility, keep calm and stay polite
This related in part to the point above but is a bit more practical. Interestingly, I wrote this list before hearing Jenny Rudolph’s WTF talk at dasSMACC which has a lot of common ground here (I’ll add the link when the talk is published on the smacc site). It’s easy to meet hostility with hostility but that rarely improves anything. Instead, stay calm and polite and listen – try to align yourself with the hostile party’s common ground. The simplest way to do this is to articulate shared goals (“We obviously both want what’s best for this patient, so let’s focus on that and on making that happen.”)
“Welfare checks” on team members who have had a difficult job are about more than just clinical debrief
Some clinical cases are horrible. The act of calling for a chat (if you can’t do it face to face) to offer support in addition to a quick clinical debrief is invaluable. Lots of experience of this from the HEMS consultants, who are brilliant, and from the other staff on base. Done well with genuine love and concern for your colleagues, this can really build a healthy and supportive culture.
The Holy Trinity of work/life balance
Pay, rostering, annual leave. Get these things right to keep your team happy – then you’ll find they work above and beyond what you ask of them. These things aren’t always within your direct power as an employee but concern and advocacy when an element of the Holy Trinity is not working as it should can be very powerful. These three components have what is probably a disproportionate effect on your employees’ happiness; do not underestimate their importance.
Give good positive feedback
Giving genuine, sincere and specific positive feedback is a rare skill. Identify those who do it well and learn from them (I’m looking at you, Libby Hanrahan!). I’ve been really attuned to this since working with Libby who makes it seem effortless. This particular reflection is part of my new project 🙂
— Natalie May (@_NMay) June 30, 2017
Time taken to explain to other people involved in patient care is not time wasted
Sometimes you just want to get stuff done and the “why?” question can be really frustrating (parents, I’m sure, will particularly relate to this). But this is another great opportunity to step up into leadership. The genuine “why?” represents a learner identifying an area of lack of knowledge; a good leader will support those who are seeking self-improvement and this is a really easy way to do just that. And if you don’t know – be honest, and learn together.
Listen to all the voices
Sometimes those with the least experience are better at seeing the bigger picture. One of the most powerful moments of learning I saw happened during a sim session: we ran a burns sim in which an elderly patient with multiple comorbidities sustained significant burns from a house fire. There was a little clinical uncertainty about the best path of care for him, completely appropriately, but that was complicated by his agitation and non-compliance. It was the observing medical student who, during the debrief, asked why the staff didn’t just address the thing the patient was obviously agitated about – we were able to direct that question back to the simulated patient, still in character, who agreed that had he felt listened to he would have calmed down straight away. A great reminder that the patient voice matters and that no-one is too junior to chip in a great idea – good leaders will listen to everyone.
Be grateful, say thanks
Do it often. I’ve written about this before – but appreciating those you work with is really key to the hearts-and-minds approach outside the service and enjoyment of your work inside it.
Help your colleagues out wherever possible
One of the lovely things about this particular job is how hard people work to help one another out; the paramedics role model this in an awe-inspiring way. If a job comes in, those going on it have stuff to do. Some of that is stuff you can do to help them out, even if you’re not going on the job yourself. This becomes even more important when jobs run late, beyond shift changeover, and you’re the person taking over: you can be the person who sits around watching TV (or goes to bed!) or you can be the colleague who waits up for those who’ve had an extra long day and helps them get fed, watered and home as soon as they can. Please – be the team player. It makes everyone’s life better.
Never underestimate the value of stopping writing the email and picking up the phone instead
Nowadays we use a lot of electronic communication – emails, text messages and WhatsApp, for example. But some things are quicker and more effective to sort if you just pick up the phone. I tend to forget this is an option but I saw it a lot at Sydney HEMS.
A phonecall can make a huge difference, even when the problem is sorted
I try hard not to whinge too much but I found myself in a situation (over something not all that important really) that had become overly complicated and political. It was sorted out pretty quickly, but what was lovely was when one of the consultants (Ian Ferguson – thank you!!) who was aware of the situation called me, knowing it was sorted, to have a collective whinge about how crappy it was. I felt very much supported and as though the frustration I’d been fighting to keep under control wasn’t unreasonable – which pretty much made it evaporate. Thanks, Ian 🙂
Change is difficult
Services change in small ways and in big ways – it’s part of progression and evolution and it’s important. But sometimes it is difficult on staff and sometimes it’s painful. Be aware and be sensitive.
I saw significant operational changes occurring in the service while I was there and I found myself reflecting on their impact on staff. As a temporary employee, arguably the impact on me was minimal but many of the staff with the service have been there for a very long time (and had seen similar service changes in the past). It was a healthy reminder that change can be uncomfortable and even if we know it will all work itself out, we can be sensitive towards our colleagues facing big changes.
First, always, be humble
Sometimes there will be vomit. And sometimes, you’re going to be the person who cleans up the vomit (yes, that’s what I’m doing in the picture above and no, the vomit wasn’t mine). Humility is good for the soul – be a leader who gets their hands dirty (although tying your long hair back is strongly recommended!)
Up next: Self Care
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