5 de setembro de 2012

Artigo recomendado: Developing Leaders in Anesthesiology - A Practical Framework


Pascal H. Scemama, Jeffrey W. Hull

Anesthesiology, V 117 • No 3 651 September 2012

The call for more effective leadership in medicine, and specifically in anesthesiology, is not new. In 1999, Dr. Francis M. James III, in his Rovenstine lecture, outlined both the importance of leadership in medicine as well as the breadth of leadership opportunities available both inside and outside anesthesiology. Eleven years later, Dr. Peter J. Pronovost, also in his Rovenstine lecture, turned up the volume by setting out an agenda focused on accountability, performance measurement, teamwork, peer-to-peer reviews, and the need for participation from anesthesiologist-leaders in change initiatives within and outside the specialty.

Driven by a heightened focus on cost reduction, quality improvement, patient safety, performance measurement, and technological innovation, anesthesiology is going through a period of upheaval. Effective leadership is essential to the success of this transformation, because leadership is all about envisioning and guiding people through change. If anesthesiology is to continue to thrive as a medical specialty within a rapidly evolving healthcare system, anesthesiologists will need to envision and manifest change beyond simply providing efficient care.

The specialty is confronting what has been coined an “adaptive” challenge, i.e., a challenge for which there is no preexisting solution. Furthermore, there is evidence both inside and outside of medicine that organizations that focus exclusively on cost reduction and efficiency during times of rapid change ultimately do not fare well. As a result, anesthesiologists need to become change agents who envision, lead, and implement initiatives that ultimately result in greater patient safety, better patient outcomes, improved quality, and sustainable finances.

Medicine, however, as a whole underinvests in leadership development because, according to Dr. Wiley W. Souba, a surgeon and a prolific writer about leadership, the profession is not sure where to invest or how to “prepare people for the practice of leadership.” He points out that although leadership training is available, the focus on “managerial skills” fails to get at the heart of leadership. More recently, a qualitative study of emergency medicine residents at a major academic center found that the approaches to learning leadership are underdeveloped, resulting in a narrow view of leadership. What is still missing is a roadmap for cultivating leadership behaviors in clinicians and relevant tools to guide their actions. In this article, with the help of a case scenario, we propose a practical framework for turning anesthesiologists into leaders.

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