By Dr Taj Hassan.
Dr Andrew Holdstock BSc (Hons) BMBS (Hons) MRCEM
Clinical Fellow in Simulation and Emergency Medicine, Leeds Teaching Hospitals Trust
Dr Taj Hassan is a Consultant in Emergency Medicine at the Leeds Teaching Hospitals. His main interests at present include leadership development, safer system design and the creation of sustainable working environments for emergency physicians. He is presently also seconded part time to NHS Improvement as its Assoc Medical Director for emergency care where he aims to provide strategic support and influence health regulators in these key areas. Previous appointments have included Vice President of RCEM and he was the College’s Director of eLearning for 6 years.
What’s to come:
Setting the scene – why a clear focus on leadership at every level of emergency care is vital to the individual and the development of a high performing system. Taj described the framework for the conference, the key ingredients required and how this can lead to personal satisfaction and better outcomes – the what, why and how of resilient leadership.
Taj has been a doctor for thirty years next year, sixteen of those years as a consultant in the Emergency Department; He talks at length of how he loves the challenge and stimulating environment (plus it appeals to his short attention span!) He opened by suggesting that creating a positive culture is essential for resilient and effective leadership; a good example of this being the “Leeds Way” instituted by the Leeds Teaching Hospitals Trust.
So what is resilience? There are plenty of individual leaders within the Emergency Department – Consultants, Registrars, Sisters, Nurses – and finding common values and a way forward is essential for cohesion. Everyone finds their own leadership style: with reflection and observation of other leaders Dr Hassan has come to realise that less is more – there is a time to speak loudly and a time to speak quietly. This is dynamic leadership and finding the model that works for you as an individual is important; observing and emulating other good leaders, as well as working out whom not to follow.
Different skills but a common goal:
Staff members within the ED have some incredibly different skill sets but share a common set of values, they should aim to deliver good, consistent, compassionate clinical care. There are many tough days at the office and our departments are getting busier so leadership is a key component. It can be hard therefore to maintain and manage those difficult leadership moments. As clinicians we all see thousands of patients and finding a way to consistently deliver good care, especially on a bad day, is essential. The various clinical strands of ED management are important but the patient may well remember us for our compassionate care, and what we did for them that day, for the rest of their life.
Leading on the creation of safer design…
A healthy working environment with safety embedded in the design is vital for ED in order to minimise error. Croskerry and Wears looked at this in their paper in 2002 highlighting a range of areas which they referred to as ‘Error Producing Conditions’. Whilst it can be difficult to mitigate these on a busy shift, building strategic pathways that reduce the risks will lead to safer care, a better environment and lead to delivery of good quality care.
These issues have been a key focus of the Royal College of Emergency Medicine in recent years and Taj recommends “The Drive for Quality – How to achieve safe, sustainable care in our Emergency Depts” in 2012 and “Acute and Emergency Care: Prescribing the remedy” in 2014 for strategic approaches by the College. As leaders, we need to motivate our teams to the creation of successful change igniting passion to do the right thing in a sustainable way? There is no doubt that there are big challenges – creating a resilient framework for change that is good for patients and staff whilst preventing change fatigue.
Valuing your workforce if you want to achieve excellence!
As a leader the importance of catering for the needs of staff as individuals cannot be over stated. Tailored guidance and support is vital and should be at the heart of any departmental strategy. Failure to address the issues will lead to recruitment & retention issues and ultimately ‘burnout’.
There have been many reports in recent years looking at compassion fatigue and burnout in staff; RCEM conducted a survey (‘Stretched to the Limit’) of Emergency Medicine consultants in the UK in 2012 to this effect.
This led to the development and launch of the first RCEM strategy on this subject – “Creating successful, satisfying and sustainable careers in Emergency Medicine”. The document provides detailed guidance and although mainly focused on caring for doctors at every level it has wide ranging applicability.
Dr Hassan concluded with a reflection on his personal leadership journey thus far and the lessons that he has learnt.
He rounded up his talk with eight things from his resilience ‘bucket list’ and some of the work that continues to inspire him:
- “Surround yourself with those on same mission to you.” Common shared values as a leader will lead to strong team working which lies at the very heart of being able to give decent care to our patients.
- “What gets you out of bed in the morning?” He asked referencing ‘The puzzle of motivation’ by Daniel Pink. “We are motivated by autonomy, mastery and purpose; it is not always monetary. In a range of psychology experiments monetary incentives do not give the best performance and outcomes.
- “Defining professional success?” Be clear on your goals for the near and medium term (5 year periods). An excellent review of what motivates us as men and women in HBR 2012.
- “Mindfulness and staying well” Focus on caring for yourself and learn to have clear tactics on conflict resolution.
- “Become a positive deviant” – Read Atul Gawande!
- “Inspire the next generation” Invest time and effort in your trainees. People need the right environment in which to flourish.
- “Culture and values” must be supported by composed role modelling as a leader. This will also ensure that you maintain a focus on compassionate care.
- “Connectivity” Be constantly inquisitive about your professional development and use it as a springboard for a longer life journey.
Take home messages:
A strong focus on resilience in leadership is essential within our current working environment. Burnout is a very real potential prospect if we fail to care for ourselves and our teams. We need to develop ourselves as individuals and learn techniques to prevent this. A healthy work life balance is key and will help maintain a positive view of a working environment that can be extremely challenging at times.
What would you include on your resilience bucket list?
On a personal note:
Taj has a wealth of experience in leadership and Emergency Medicine. Listening to his wisdom on resilience was both interesting and thought provoking. I am just starting my leadership journey and understanding about resilience, the importance of developing a resilient framework and healthy work-life balance is essential. Taj’s talk makes essential reading. I came away from this talk with thoughts about how to change and develop my practice in future and a mental note to try the reinvigoration strategies…