A New Prescription for Healthcare Leadership

h INTRODUCTION T reatment regimens and decision algorithms for care of the trauma patient have changed over the years. When was the last time a diagnostic peritoneal lavage was performed in your emergency department? The mere site of a diagnostic peritoneal lavage catheter tends to draw a crowd of gawkers curious to watch an extinct but previously important practice. Our experience echoes one institution’s report of reduction of diagnostic peritoneal lavages, as computed tomography (CT) and Focused Abdominal Sonography for Trauma (FAST) is now the trend. Similarly, management of patients with spleen injury has altered. No longer is a patient whisked off to surgery for a splenectomy; the modus operandi now is to wait and watch, or visit the angiography suite in hopes of embolizing the bleeding vessel(s). Trauma care is changing. By and large, this trend is a reflection of the overall continued evolution of healthcare. The shift from operative to nonoperative management of the trauma patient requires a different clinical skill set, including understanding radiographic interpretation, intervention, and more reliance on critical care. Trauma surgeons, program managers, and trauma centers have participated, shaped, and embraced this evolution. As clinical care continues to progress, clinicians adapt by changing their clinical skill sets. Conversely, the management tools required to operate trauma programs have not kept pace. Most clinicians find themselves thrust into management or Bquasi-management^ roles to maintain programmatic survival. Few have formal management training and are often tasked with increasing administrative responsibilities. As healthcare continues to transform, managers will need to realize new skill sets in order to manage their operations and set the future strategic agenda. Currently, there is a profound lack of business and management training for nursing, medical, and other ancillary healthcare personnel in undergraduate and graduate curricula as well as residency programs. Business skills learned today are virtually all acquired on the job and, when practiced, are generally poorly understood. This method of on-the-job training is true for the bulk of health system leaders and trauma program leaders. We are asked to manage and lead but have few tools and even less time to achieve these tasks. Ironically, trauma program leadership is uniquely qualified to receive training as we are accustomed to managing multidisciplinary teams, deeply understand the Bsystems view,^ and are inherently trained in complex decision making during times of uncertainty. Some institutions now recognize the need to further prepare leaders within health systems and, as a result, have embarked on leadership training programs. Despite this, such education is often focused on the highest echelon of system leadership, thus excluding the bulk of clinicians who manage programs or service lines. The purpose of this article is to communicate the authors’ recent education activities to the clinical domain and detail real life examples of integrating business principles into the healthcare arena. In addition, we developed a comprehensive management curriculum to provide clinicians with the basic tool kit to optimally manage their programs. Last fall, we condensed this curriculum to a 1-day course hosted by the Society of Trauma Nurses entitled BThe Business Aspects of Trauma Program Leadership for Nurses. ^ Figure 1 details the course curriculum presented by MDContent and Deborah Harkins (Paul Taheri and David Butz are principals in MDContent). This course will again be offered by the Society of Trauma Nurses on October 7, 2006 in Chicago (see traumanursesoc. Deborah Harkins, RN, MBA, CCRN, is Trauma Systems Manager; Paul Taheri, MD, MBA, is Trauma Director and Associate Dean for Academic Business Development, University of Michigan Health System; and David Butz, PhD, is Adjunct Professor of Economics, Ross School of Business, University of Michigan, Ann Arbor, Mich. Corresponding author: Deborah Harkins, RN, MBA, CCRN, 1500 East Medical Center Drive, Room 1C421, Ann Arbor, MI 48109-0033 (e-mail: dharkins@umich.edu). Robynn Gough Smith, RN, BSN Section Editor