347If I can borrow a metaphor from the military, I say that medicine ought to be led at the level
of the corporal and not the general (as long as each corporal is not only qualified but is also
the best soldier). A hospital CEO ensconced in meetings in the C-suite and meetings with
VIPS is like a general who is 5 miles away: they can be out-of-touch. So, for me it would
be difficult to envision that I could run a hospital effectively without knowing what hospital
life is really like...He went on to say:
I am a thoracic surgeon and I am a CEO. As a surgeon when I perform a minimally invasive
robotic heart surgery, I must be available for that patient 24/7; as the responsible physician
working with the most qualified workforce as a team, I can make decisions that put the
patient first; in addition, I understand intimately our internal problems...As the hospital
CEO, I have morning huddles, administrative meetings and rounds, and other duties.
Playing both roles enables me and every other physician leader here at CCAD to understand
the clinical, managerial and policy world we deal with every day.To borrow a player-coach sports analogy, he is developing and executing the medi-
cal and operating strategy, holding everyone accountable for patient outcomes, and
playing and collaborating on the surgical team, calling signals, managing tactics,
and making surprise plays.
To be called a clinical leader, a surgeon needs followers (i.e., other surgeons,
residents, anesthesiologists, scrub nurses, circulating nurses, other clinical and
administrative staff, etc.). Entrepreneur Derek Sivers, in a 2010 Ted Talk,^16 said that
the first follower is “an underappreciated form of leadership.” He said, “the first fol-
lower transforms a lone nut into a leader.” So, the role of the followers is to help
keep the leader in control of the situation [ 23 ]. This means that leaders need to
embrace and value followers who become committed to innovative ideas and impor-
tant goals. Leaders do not need to push followers; followers are willing participants
who see the value of what the team is trying to accomplish.
The surgeon leaders make two primary contributions: first, they heal their
patients, and second, they take the lead for the organization. As mentioned, follow-
ership is an “underappreciated” form of leadership. My mantra for these leaders is:
Every surgeon, a leader; every leader, a collaborative follower and team player.If they are prepared to lead, surgeons should be able to engage the best people
to diagnose evolving situations—changes in the rules, the competition, and sur-
gical improvements. Through their networks they should be able to ensure a
lucid analysis of the future regulatory conditions, technical innovations, changes
in population health, reimbursement rules, and the myriad data that affect
performance.
They should be able to facilitate an assessment of the strengths and weaknesses
of the surgical team, along with future opportunities, risks, and threats in the envi-
ronment. By engaging the best people, they source new ideas and explore alterna-
tives as well as the full set of consequences.
(^16) See Derek [ 51 ]. Ted Talk. How to start a movement
20 Teaching Surgeons How to Lead