Author's Note: Feel free to giggle at the dated technology references.  : )

​When I was first assigned a supervisory role, I was working as a technical representative
for a mobile surgical laser company. My job was to not only supervise, but to train new and
existing employees and to coach surgeons on proper technique. I was thrilled for the career
advancement and the opportunity for a new challenge. However, I quickly became aware that
leadership roles are far more challenging than I had ever imagined. I didn't have any formal
leadership training, so I started learning important lessons the hard way, through the school of
real life experience. As I have accepted other leadership positions in my various duties, I
continued to have fascinating, but tough learning experiences. My purpose in this writing is to
share some of the very important lessons that I have learned in my introduction to leadership. It
is my hope to save you, the reader, some of the heartache and frustrations that I experienced
through the turbulent journey of self-education. I would like to offer ten very frank and personal
observations for your consideration in developing yourself as a leader in a healthcare setting.

1. Seek Out Leadership Training
If you work for a large company that provides formal leadership training, consider
yourself very lucky to have such an amazing opportunity. Take full advantage of each and every
training class that you are offered. Go a step above and beyond to seek out classes to which you
may not be assigned or required, but which could be applied to your job function.
Many companies, due to our current economic situation, may have scaled back formal
training programs or may not have any at all. In these situations, it is crucial that you take
initiative to educate yourself on becoming a good leader. Very few of us are natural born leaders
and even those of us who are lucky enough to have this trait embedded in our DNA, still need to
refine our skills. The amount of literature at your local bookstore on vocational leadership will
astound you. Ask fellow leaders for recommendations on good training books, articles or guides. 

Another very easy option is to ask for appointments with leadership in any department in
your organization. Spending even a few minutes interviewing other leaders whom you admire
can be an invaluable learning opportunity. Most will be thrilled to have the chance to share their
insights and even more, your initiative will leave a lasting impression.

2. Let Your Ideas Stew & Simmer
As a new leader, you may be tempted to immediately start implementing new ideas for
improvement in your department, or your particular area of stewardship. While your enthusiasm
is very important, it is also important that you take the time to research your ideas after
brainstorming them. For example, you may have an excellent solution for a storage space issue
that is currently challenging your department. Before you dive in and start making changes, take
the time to research all possible outcomes of your proposal. Don't forget to ask the opinion of
your staff before beginning even the most basic stages of change. It may end up that you are the
only person who thinks it's a good solution. Finally, once you have done some research, and
asked for feedback on the idea, let it stew for a while and move on to another project. I can't
count how many times I have come back to ideas I had on the table ready to implement, which
after some time away from the issue, I now think are ridiculous and not feasible. It is far better to
invest the time to let ideas stew and simmer, than implementing a new change that even you may
end up not liking down the road.

3. Being a Leader Doesn't Make You An Expert
Most likely, you were put into a position of leadership based on your experience, among
many other talents you possess. However, even with many years of experience, you may be
surprised to find that you can continue to learn things from the least experienced of your peers.
Be very careful not to assume a mantle of unquestioned authority or expertise when you lead (2)
your staff. Unless you have a current AAMI or AORN guideline in front of you, don't assume
that your method or practice is correct. Many of us seasoned folks think we may know better
because a particular way of doing something may be the way we've always done it, so we assume
that it's correct. There are many times that I was absolutely sure that what I was doing was
correct. My assurance was based on the fact that a particular technique was the way I was taught
in school, or the way I was trained by another experienced professional. It's very humbling as a
leader, to be absolutely dead-sure that you are correct, and then be proven wrong by a brand new
technician. I've seen this happen, and when it does, the best thing to do is candidly admit that
you were wrong. You will gain much more respect if you can congratulate the less experienced
person for finding the right way of performing the task and admit that you were incorrect. No
matter what position we hold or what job title we are assigned, we should always remain humble
and teachable.

4. Choose Your Confrontations Wisely
A marvelous training aid that every leader should own and use, is a book called Crucial
Confrontations. The authors of this book offer exceptional insight to handling difficult
situations and discussions. There's even a special section on deciding whether or not some
issues should even be tackled and which we should let slide. The authors offer this remarkable
advice:

“Often, when you've weighed the consequences, it is a better option to remain silent about
an issue. For example, you've had difficulty working with a certain vendor and the
process could have been much cleaner, but you were working on a one-time only project
and probably won't ever see the vendor again. In this case, it may be better to avoid
rehashing an issue that will never come up again.”

“Here's the biggest stumbling block: Problem solving is never done in a vacuum. Every
company and family has an unwritten history that indicates which infractions are
appropriate to deal with and which ones a person should let slide. All expectations,
contracts, and promises aren't equally binding. Worse, in some organizations people
aren't held accountable for delivering on any promises, or at lease accountability is
unpredictable.” 

5. Be Friendly With Everyone
It's fairly obvious and basic customer service that we treat our co-workers and other
departments with courtesy and friendly attitudes. What isn't so obvious are those relationships
with which we don't have any immediate need to be friendly with. While we may indeed be
friendly with most people in our business dealings, it is important that we remember to be
friendly with every association we have at work. The reason for this is that we can never predict
when we may run into a situation where we could use an ally or someone to defend our position
in a new policy that we would like to implement. If we have already burned a bridge with an
employee or department that we rarely deal with, we are almost certain to fail to win them over if
and when we need their help. Build your allies quickly and fortify them regularly!

6. When Possible, Leave Work at Work
Modern technology is making it increasingly difficult for us to leave our work at the
office. We can become chained to the laptop or PDA. Very often our workload seems so heavy
that if we don't take something home with us, things just will not get done. This very well might
be the case, and every situation will be different. However, it can not be stressed enough how
important it is to prioritize personal and family time. Being able to separate yourself from your
work life is vital to your own mental health, and in an indirect way, the mental health of the team 
which you lead. If you aren't relaxed, happy and full of enthusiasm, your team won't be either.
As mentioned earlier, there will be some situations where bringing work home with you will be
unavoidable, but a successful leader will do his or her best to make those situations the exception
rather than the rule.

7. Swim Like a Duck
For this lesson, you will need to use a bit of mental imagery. Imagine a serene pond in
your local park. On top of this crystal clear water is a family of ducks, floating gracefully
together. In your minds eye, you may even picture a mother duck with six or seven chicks
following close behind in a perfect line. It's a very beautiful scene to behold.
Now let your imagination take you just below the surface of the water. Immediately that
feeling of peace and serenity vanishes as you see the utter chaos of dozens of webbed feet
paddling like there's no tomorrow. You may even see some streams of turbulent water as a result
of so much vigorous movement.

An O.R. nurse I work with uses this vivid example to describe what a leader in the O.R.
or Central Service may look like on the surface to his or her team: moving around quickly, but
gracefully, almost a thing of beauty. However, “underneath the water” the leader probably feels
like he or she is paddling those little feet as fast as they can go. This is an excellent analogy
because a good leader should have the ability to keep their cool, being careful not to show the
heart pounding fear and uncertainty we sometimes feel. Our body language, our tone of voice,
even our pace of work can communicate so many messages (sometimes undesired messages) to
our staff. So, swim like a duck. On the inside you may feel like you are swimming so fast you
could create a tsunami, but on the outside you should appear as graceful and in control as the
peaceful scene of a duck floating across a calm water. 

8. Record Your Successes
Whenever you achieve a goal that you have set for yourself, document it and have fun
with the documentation! Save and collect pertinent paperwork and certifications. Even photos
and videos are wonderful ideas to use for documentation of your successes. If you are so
inclined, you can even put all of your accomplishment collection online, or save it to a CD or
DVD.

Your collection of accomplishments can be useful in two ways. First, it allows you to
have a ready-made showcase of your talents and skills for future job opportunities. Second, it is
an extremely useful tool for motivation on those days when you don't feel you are at your best or
when everything seems to be going wrong. Having access to physical proof of what a great job
you are capable of, and how much people appreciate your hard work, can lift your energy and
mood very quickly.

9. Speak Up & To The Right Person
Any person or organization that desires to progress, no matter how great or small, must learn the
skills to appropriately challenge the status quo. Being silent when there are questions or issues
does nothing but to inhibit growth. Most of us have been conditioned to not question our leaders,
but for our organizations to grow and even for the safety of our patients, it is critical that we learn
to question authority. To illustrate this point, I would like to use a story which we in healthcare
will definitely understand:

“A middle-aged man checked into a medical clinic for a simple earache and walked out,
the puzzled owner of a brand-new vasectomy. How could this have happened? Hint: It
wasn't a typographical error. Later the doctor explained that the patient had been wide
awake as medical professionals prepared him for the surgery. That included shaving him
in a place that was a whole torso away from his infected ear. And yet he said nothing. 'I
can't figure out why he didn't ask what was going on,' the doctor exclaimed. The man
deferred to the doctors—he had learned not to question authority.”

Hopefully we will not need to be faced with such a frightening situation as this man had
to deal with, but we certainly need to learn how to question authority in a more effective way
than he did. It is also critical that when the need arises for us to question our leadership, that we
learn the appropriate chain of command and proper format for addressing concerns in each of our
respective organizations.

With all of this in mind, situations will arise when your authority may be questioned.
This is something you should not fear or repel. In fact, you should welcome such a situation with
open arms. Most often when people are questioning a process or most especially a patient safety
issue, they only have good intentions in mind. My experience is that it is very rare that someone
will question authority out of anger or rebellion. I have also learned that 9 times out of 10 (my
unscientific estimate, of course) people that question authority, simply want to know the “why”
behind the rule or regulation. Rules and regulations are much easier to follow if we understand
why they exist in the first place. Finally, if the reason for the rule or regulation has no good
justification for its existence, or the situation for the rule has expired, we as leaders need to
consider discarding the rule.

10. Learn To Love Your Team
Some of you may be lucky enough to already love every single member of your team.
Yes, it really does exist and it really can happen for a leader to truly love each and every one of
his or her team members. Most of us however, have at least one or two team members that we
have a rocky relationship with. One interim manager that I had, once told the entire department
that she was there to manage the team, not to be their friend. While, I completely agree with the
premise of what she was trying to convey, I disagree with her delivery. It's true that you don't
have to be best friends with every person in your department. In fact, a day without any
arguments with certain team members could be considered a “good day”. What you can do
however, is learn to love your team and learning to love your team is an ongoing process. This
means that it's your responsibility as a leader, to get to know your team on a professional, but
personal level. This can be done on a one-on-one basis, or in a group team-building situation.
There are too many getting-to-know-you games, activities and questionnaires to mention here.
The point however, is to take time to get to know your team as human beings, not just as coworkers
or subordinates. This is extremely important for morale, for unity and cohesiveness.
This is definitely not something that can be done overnight, or even within a few weeks or
months. Remember, this lesson is Learning To Love Your Team. As long as you are on that
path of learning to love your team, you are on the right path.

Conclusion
Learning to be a leader is a challenging job, however the challenge can be extremely
rewarding. These ten items I have shared with you are only some of the countless lessons I have
learned on my own, through my various leadership roles. Many of these leadership lessons
simply can't be taught in an article, workshop or book. They have to be learned simply by
working them out based on what you have learned up to your current situation. It is my hope that
you will now be a little more prepared to face those challenges when they arise.

​Endnotes
1. Kerry Paterson, Joseph Grenny, Ron McMillan, Al Switzler, Crucial Confrontations
(New York: McGraw-Hill, 2005).
2. ibid., p. 49
3. ibid., p. 8