CLINICAL CONCEPTS AND COMMENTARY Bruno Riou, M.D., Ph.D., Editor Developing Leaders in Anesthesiology A Practical Framework Pascal H. Scemama, M.D., M.B.A.,* Jeffrey W. Hull, Ph.D.† T HE call for more effective leadership in medicine, and specifically in anesthesiology, is not new. In 1999, Dr. Francis M. James III, in his Rovenstine lecture, outlined both the importance of leadership in medicine as well as the breadth of leadership opportunities available both inside and outside anesthesiology. 1 Eleven years later, Dr. Peter J. Pro- novost, also in his Rovenstine lecture, turned up the volume by setting out an agenda focused on accountability, perfor- mance measurement, teamwork, peer-to-peer reviews, and the need for participation from anesthesiologist-leaders in change initiatives within and outside the specialty. 2 Driven by a heightened focus on cost reduction, quality improvement, patient safety, performance measurement, and technological innovation, anesthesiology is going through a period of upheaval. Effective leadership is essential to the success of this transformation, because leadership is all about envisioning and guiding people through change. If anesthesiology is to continue to thrive as a medical specialty within a rapidly evolving healthcare system, anesthesiologists will need to envision and manifest change beyond simply providing efficient care. The specialty is confronting what has been coined an “adaptive” challenge, i.e., a challenge for which there is no preexisting solution. 3 Furthermore, there is evidence both inside and outside of medicine that organizations that focus exclusively on cost reduction and efficiency during times of rapid change ultimately do not fare well. 4–6 As a result, an- esthesiologists need to become change agents who envision, lead, and implement initiatives that ultimately result in greater patient safety, better patient outcomes, improved quality, and sustainable finances. Medicine, however, as a whole underinvests in leadership development because, according to Dr. Wiley W. Souba, a sur- geon and a prolific writer about leadership, the profession is not sure where to invest or how to “prepare people for the practice of leadership.” 3 He points out that although leadership training is available, the focus on “managerial skills” fails to get at the heart of leadership. 3 More recently, a qualitative study of emergency medicine residents at a major academic center found that the approaches to learning leadership are underdeveloped, resulting in a narrow view of leadership. 7 What is still missing is a road- map for cultivating leadership behaviors in clinicians and rele- vant tools to guide their actions. In this article, with the help of a case scenario, we propose a practical framework for turning anesthesiologists into leaders. Case Scenario The anesthesiology department of a large academic medical center has recently implemented a series of operating room and anesthesia efficiency measures designed to improve on- time starts, reduce turnover, and manage patient preopera- tive times. These measures will be used to set targets and to measure the performance of providers. A junior anesthesiologist, now in her second year as an attending, views achieving the targets as important in meet- ing her aspirations to become a leader in the department. She * Anesthesiology Resident, Department of Anesthesiology, Crit- ical Care and Pain Medicine, The Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. † President, Lead- erShift, Inc., New York, New York. Received from the Department of Anesthesiology, Critical Care and Pain Medicine, The Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. Submitted for publication January 4, 2012. Accepted for publication June 1, 2012. Support was provided solely from institutional and/or departmental sources. Dr. Scemama and Dr. Hull have no conflicts of interests related to the content of this article. Dr. Scemama and Dr. Hull had a prior business relationship that ended in 2003. Since then, they have had no financial or business relationship of any kind. In addition, nei- ther of them has any financial or intellectual property interest in the content presented in this article. Dr. Scemama is currently an anes- thesiology resident at the Massachusetts General Hospital and has no financial or intellectual property interest in any activities or business related to leadership development. Dr. Hull is currently a private-practice organizational psychologist, and independent con- sultant who has no financial or intellectual property interest related to the content or publication of this article. The figures were re- drawn by Annemarie B. Johnson, C.M.I., Medical Illustrator, Wake Forest University School of Medicine Creative Communications, Wake Forest University Medical Center, Winston-Salem, North Car- olina. Address correspondence to Dr. Scemama: Department of Anes- thesiology, Critical Care and Pain Medicine, The Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114. pscemamadegialluly@partners.org. This article may be accessed for personal use at no charge through the Journal Web site, www. anesthesiology.org. Copyright © 2012, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins. Anesthesiology 2012; 117:651– 6 Anesthesiology, V 117 • No 3 September 2012 651 Downloaded from anesthesiology.pubs.asahq.org by guest on 05/31/2020