Surgeons as Educators A Guide for Academic Development and Teaching Excellence

(Ben Green) #1
363

In this case, the airline captain, Sully Sullenberger, displayed grace under pressure.
He took charge by declaring “my aircraft” and made a perfect landing in the Hudson,
and all the passengers survived. His leadership during execution had to be flawless.
Upon closer examination, we see that effective leaders like Sullenberger do two
things. First, though the entire situation unfolds in less than 5 minutes, the leader
must activate and engage the entire team to do their jobs and deal with the situation
without panic. Second, leaders must collaborate with key stakeholders by adapting
their leadership style moment by moment to respond to the situation.
Though the event was novel and uncertain under severe time constraints, there was
amazingly good coordination and “quick-teaming.” The team had to be activated
quickly, with open lines of communication and shared goals, and able to work together.
He said that there was not time to exchange words—but there was mutual observation
and listening. This decision-making unit had been strategically designed so that the
people and structures supported the critical tasks that had to be accomplished.
Captain Sullenberger said he and the copilot were on the same page—each knew
their role and the role the other would play, and so they interacted only when needed.
Both had training in crew resource management. Flight attendants sensed panic in
the back, so they calmed everyone down, and told passengers, “We lost an engine,
so we will circle back.” They made sure passengers heads were down, and that there
was no pushing and shoving.
Within minutes the first responders arrived—ferries, coast guard, helicopters,
boats and divers, hundreds of New York City fire fighters and police.^36
Alignment of roles, technology, protocols, and the emergency checklists help,
but there is also a clear role for the leader. As mentioned, Kouzes and Posner define
leadership as “the art of mobilizing people to want to struggle for shared aspira-
tions” [ 34 ]. This case demonstrates the connection between leadership and strategic
thinking. The work of leadership also requires moment-by-moment adjustments,
sourcing external knowledge, checking facts, processing information, activating
people, all of which was done quickly and efficiently by the leader in this case.


Leadership requires a relentless (moment by moment) strategic thinking and communica-
tion process that guides and motivates people to want to respond to a given situation.

Figure 20.6 illustrates how leaders adapt their style based on the demands of the situ-
ation. Shifting occurs from very task-orientated behaviors exercising the captain’s
authority by taking control of the airbus from the copilot (e.g., “my aircraft”). They
also ask open-ended questions (“any ideas”).
This airline case should be used when teaching case 2 in the OR. It enables the
instructor to raise several questions about fast versus slow thinking, quick teaming,
activating roles, and adapting styles of leading. It enables the instructor to raise
questions about leading the OR team and the various roles and relationships among
nurses, surgeons, and anesthesiologists.


(^36) Luck also plays a role in these situations. It was daytime. If this happened at night, perhaps the
outcomes would have changed.
20 Teaching Surgeons How to Lead

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