360
What this surgical leadership case involves is the essence of what leadership is
about.
Leadership is a relentless, moment by moment, strategic thinking and communication pro-
cess that guides and motivates people to want to respond to a given situation.Captain Oh, MD, as the responsible surgeon, had to diagnose the situation in the
moment, and to mobilize the people to want to deal with this challenging situation.
He called in the unexploded ordnance team to radiograph the ordnance, and they
discovered that the warhead had broken off, and only the detonator was inside—still
enough to kill the patient and wound the surgeon. What should he do?
Although I have written a case study on this, another alternative is to show the
video from YouTube.^34 Both typically elicit a great discussion.
Case 2: Developing a Minimally Invasive Esophagectomy (MIE)
Program at a Tertiary Hospital—Is the Surgical Team a Real Team?
The leader of the surgical team is Dr. Colon, a thoracic surgeon looking to develop
a minimally invasive esophagectomy (MIE) program at the Tertiary Medical Center
(TMC). He has done this procedure before at another hospital, but MIE has never
been performed at TMC. His surgical assistant will be Dr. Valley, a bariatric sur-
geon, whom Dr. Colon routinely assists in his laparoscopic bariatric cases. He has
never done an MIE before either; however, the abdominal portion is technically
similar to his bariatric cases.
The other key players are the anesthesiologists. Their leader is Dr. Kellogg, a
thoracic anesthesiologist who is also one of the senior physicians in the anesthesia
group. Dr. Kellogg has worked with Dr. Colon before and will be running anesthesia
for the MIE. Dr. Arthur is a thoracic anesthesiologist who was recently hired to the
practice to assist in the growing number of thoracic cases under Dr. Colon. Dr.
Alexis, Dr. Rohit, and Dr. Markus are other anesthesiologists on staff at TMC who
are not specialty trained in thoracic cases. Davida and Lucy are the operating room
staff that will be assisting in the procedure. Lastly, there is James, the previously
healthy 61-year-old with invasive esophageal cancer, who agrees to the first MIE at
TMC. There are a series of handoffs after Dr. Kellogg leaves. Here is how this case
unfolds.
Dr. Kellogg leaves at 3:00 pm; it is his day to leave early, and he arranges to
meet his trainer in the gym. He appears to have made adequate arrangement for
handover of the case to another anesthesiologist, Dr. Alexis, but it is not clear
whether he handed over details of the complexities—i.e., the fact that it was the
first operation of this kind in this hospital or that there had been difficulties with the
insertion of the double-lumen tube. It appears that he has made no special arrange-
ments for handover, as he states, “I am going to go check to see who’s going to take
my room at 3:00 pm.”
(^34) This is a terrific video case that you can download from YouTube (see https://www.youtube.com/
watch?v=KAKaZdFk0eA&spfreload=10).
J.A. Chilingerian