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• The most common way for them to go wrong are problems
with social dynamics, not with medical decision making
• To avoid the biggest pitfalls:
• Establish who is the leader, first by designation then by
action
• Signal that you want people’s input
• Direct the group like a coach, don’t rule like a queen/king
Hello, nice to meet you. Let’s code
doi:10.1001/jamainternmed.2019.2420
Many institutions don’t have physicians on the rapid response team at all
(So, consider how you will add value; PMID: 25977203)
(We’ll revisit this)
A lot needs to happen at once…
Tuckman’s
stages of
group
development
(1965)
First: are you running the code?
• Collaboration / Trust
• Lower the power distance
• Proper tone
• Are you the point person
(in practice)?
• Are you running the code/rapid
(in theory)?
You are on the code team. You’re
paged to a code on a patient on
the surgical floor. The attending
surgeon is present. You…
• defer management to the primary team
• ask if anyone is running the code
• begin running the code
• leave
You are on the code team. You’re
paged to a code on a patient on
the surgical floor. The attending
surgeon is present. You…
• defer management to the primary team
• ask if anyone is running the code
• begin running the code
• leave
Step 1: Are you running this code or not?
• "I’m ________, the resident on the the Code/RR team. Is anyone
running this code?"
• “OK, I’m running this code” or “Can I take over?"
• What do you do if the primary team comes?
• What do you do if the ICU team comes?
Step 2. Be the point person
https://doi.org/10.1016/j.resuscitation.2020.11.018
• NEVER MOVE FROM HERE
• DON’T DO IT
ACLS isn’t hard… with some help
Vs.
Step 3: Set the tone:
constructive
Calm, collected, and in control
• Modulate your voice; no yelling
• Coach, don’t reprimand.
• Give encouragement.
What about suggestions you don’t like?
• Use social capital on what’s important…
Step 4: Lower the Power Distance
• Coach, not monarch.
• The first time anyone makes any
suggestion that's not ludicrous
address them and say: "great
point/idea/catch .."
• “Thinking out loud …”
In summary:
• The most common way for them to go wrong are problems with
social dynamics, not with medical decision making
• To avoid the biggest pitfalls:
• Establish who is the leader, first by designation then by action
• Signal that you want people’s input
• Direct the group like a coach, don’t rule like a queen/king

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Leadership Style - Code and Rapid Response Workshop

  • 1. • The most common way for them to go wrong are problems with social dynamics, not with medical decision making • To avoid the biggest pitfalls: • Establish who is the leader, first by designation then by action • Signal that you want people’s input • Direct the group like a coach, don’t rule like a queen/king
  • 2. Hello, nice to meet you. Let’s code doi:10.1001/jamainternmed.2019.2420 Many institutions don’t have physicians on the rapid response team at all (So, consider how you will add value; PMID: 25977203) (We’ll revisit this)
  • 3. A lot needs to happen at once… Tuckman’s stages of group development (1965)
  • 4. First: are you running the code? • Collaboration / Trust • Lower the power distance • Proper tone • Are you the point person (in practice)? • Are you running the code/rapid (in theory)?
  • 5. You are on the code team. You’re paged to a code on a patient on the surgical floor. The attending surgeon is present. You… • defer management to the primary team • ask if anyone is running the code • begin running the code • leave
  • 6. You are on the code team. You’re paged to a code on a patient on the surgical floor. The attending surgeon is present. You… • defer management to the primary team • ask if anyone is running the code • begin running the code • leave
  • 7. Step 1: Are you running this code or not? • "I’m ________, the resident on the the Code/RR team. Is anyone running this code?" • “OK, I’m running this code” or “Can I take over?" • What do you do if the primary team comes? • What do you do if the ICU team comes?
  • 8. Step 2. Be the point person https://doi.org/10.1016/j.resuscitation.2020.11.018 • NEVER MOVE FROM HERE • DON’T DO IT
  • 9. ACLS isn’t hard… with some help Vs.
  • 10. Step 3: Set the tone: constructive Calm, collected, and in control • Modulate your voice; no yelling • Coach, don’t reprimand. • Give encouragement. What about suggestions you don’t like? • Use social capital on what’s important…
  • 11. Step 4: Lower the Power Distance • Coach, not monarch. • The first time anyone makes any suggestion that's not ludicrous address them and say: "great point/idea/catch .." • “Thinking out loud …”
  • 12. In summary: • The most common way for them to go wrong are problems with social dynamics, not with medical decision making • To avoid the biggest pitfalls: • Establish who is the leader, first by designation then by action • Signal that you want people’s input • Direct the group like a coach, don’t rule like a queen/king

Editor's Notes

  1. [ ] identify your resources [ ] don’t try to take all the roles on
  2. you're going to go in to a room with ~10+ other people who, in general, you don't know and who don't know you. They don't know if you're a genius or an idiot (though they do know you're not super experienced). You have to assemble into a team to adapt to the constraints of the situation  Everyone is stressed, it is an emergency. No MD or Resident in many places The code could run without us– our role is to *add value* This is very different from our simulations
  3. You can’t really move up the hierarchy until you hit the lower stages First impressions matter. It is very hard to re-assert yourself as a code leader if you've been there. Your goal within the first 10 seconds of walking in to that room is to establish the above things Are you running this code/rapid? (or not) Signal to everyone that you will be the point person  Signal to everyone that you want their input, and they are valued for what they might notice.  Set the proper tone (calm, collected, and in control)
  4. How do you respond? If someone IS already running it – that’s OK. They often want to hand over. If they don’t, make yourself useful. You just need to commit to saying this. Loudly, right when you enter the door.
  5. I recommend foot over groin because it’s too tempting to do things at the groin Closed Loop communication and delegation Tell specific people to do specific things Ask for closed loop communication. Park yourself at the foot of the bed (do NOT do any tasks unless there are <4 people present) feet in a power pose – power posing is bullshit and won’t change how you feel, but it will change how other people perceive you. +/-ACLS card in front of you. Direct traffic. If someone asks for a task you agree with, say "Yes, <repeat it>" - all commands are coming from you. 
  6. The card is socially better than looking at your phone. This is almost always where teams struggle ACLS algorithms: not that complex there are cards in the code carts there will be ~5+ other people there who know ACLS like the back of their hand* RRTs can be medical complex, but the key decisions are simple Sociology lens. Why? The medicine isn't that hard (not that easy, either) - but a lecture isn't the right place to review it. I will end with some medical hints because I can't resist. 
  7. You can call for quiet to lower the noise level. Have folks step out if too crowded – you control the environment. https://twitter.com/ross_prager/status/1769700101629399542?s=46&t=5eJ6uoTQrbbYTlHIOnRYRg – good thread with more detail and dope pixel art
  8. What is the point of the bottom two? Think of motivational interviewing with a patient.. You NEVER want to argue. You want to direct. Do the same thing here. You are directing a competent team of professionals who could do a pretty good job running a code on their own (they do in lots of places). Don’t break the machine – you want to productively guide it. Fine V-Fib example. RN notices, but not empowered.
  9. Last point is a Segway to the next segment.