365stake and who holds the various points of view. Although strategic thinking slows
down the decision process, the pool of information is enlarged as people have more
time to think about how the decision may affect the organization in the future.
Effective decision making occurs when groups use both a rational process and a
relational process. Physicians, however, may not be trained in how to build relation-
ships via effective group communication. The work of leadership is to ensure that the
decision making process is as rational as possible. At the same time, the rational
process is used in combination with the relational process as the leader observes how
people interact with each other, making certain not to interrupt or be disrespectful.
The leader’s job is to coach the group to improve their social sensitivity, their
ability to listen, and their capacity to build on each other’s ideas. As such, the leader
can coach a group to fulfill their potential for collective intelligence. To become a
leader is to develop an enhanced understanding of human nature and interaction,
and to foster relationships that support the flow of ideas toward effective decision
making.
Leadership Lessons from Sports Coaches and Airline Captains
Research has shown that effective leaders increase the likelihood that a team can
manage complex, ambiguous, and time-critical situations. Effective leaders adjust
the strategy as the situation changes, inspire the team to perform, and enable the
team to work together in a highly coordinated way [ 28 ].
With this in mind, clinical leaders can learn lessons from sports coaches and
airline captains. First, what do good coaches do that clinical leaders can emulate?
According to Hackman [ 28 ], they build the team during practice sessions. Second,
they use pregame warm-ups to keep everyone coordinated. During a game, they
check in (at halftime) to make tactical and midcourse corrections. Finally, after the
game they review what happened and learn from the experience.
For clinical leaders, team building must happen in a practice field where mem-
bers of a team can get together with nothing at stake and tinker with ideas aimed at
creating a performance unit [ 26 ]. For example, the leader can assure that a huddle
becomes a forum for dialogue where permission is given to explore complicated
and subtle issues allowing each team member to raise conflictual issues essential to
the team’s work. Leading this type of “practice field” teaches the team to listen to
each other’s ideas and to suspend one’s own views [ 49 ].
Research on airline captains who are better leaders finds that they do more team
building activities during the first few minutes of a crew’s life. These team activities
occur in a preflight huddle and informal interactions. They also use low-workload
moments during long flights to maintain the crew as a high-performing unit [ 25 ].
As I have argued earlier, the surgeon is both coach and player. There are many
opportunities in clinic, at meetings, and in the OR when they can guide and motivate
other clinicians. In the operating room, every surgeon is leading a team of clini-
cians: anesthesiologist, scrub and circulating nurses, patient assistants, etc. They
should be taught specific skills to build stronger teams.
20 Teaching Surgeons How to Lead