Anesthesiologists as perioperative leaders

Generations of physicians have been attracted to anesthesiology for various reasons. Whether it is the requisite physiology knowledge, the application of pharmacotherapy principles, or the unique technical skills of our subspecialties, anesthesiology continues to attract many physicians. The element that is consistent for all anesthesiologists is a broad and deep exposure to the perioperative environment, which presents opportunities for application of a broad range of skills. Anesthesiologists must practice effective communication and interpersonal skills both in the preoperative area, where they concisely describe the anesthetic plan and reassure patients and family members, and in the operating room, where management of acute changes and teamfunction require precise and efficient expression of ideas. This operating room team, composed of members of various backgrounds, works together to accomplish a shared goal, but each teammember has differing perspectives andmay focus on various priorities. Achieving this goal requires coordination, communication, and real-time adjustment for unforeseen circumstances; additional challenges include unexpected complications, miscommunication, and discoordination. An examination of leadership qualities and how they may be applied by the anesthesiologist in the perioperative setting may be instructive. One the one hand, the anesthesiologist’s work may tend to recede into the background. Nobody notices a job well done, but problems become apparent to all. This is not the archetype of a leader: one who declares the agenda, shows the way, and acts with boldness and confidence. On the other hand, leadership is more than this caricature. When anesthesiologists function as leaders in the perioperative setting, they are effective in setting the agenda, catalyzing teamwork, communicating clearly, and resolving conflict. The bare minimum conditions that are required for leadership to exist include a group of at least 2 people, a common task, and “differentiation of responsibility. ” Although the work itself may not catch the eye of a casual observer, a skilled anesthesiologist-leader will support others in a way that improves team performance, team-member satisfaction, and patient safety. The Boston Philharmonic conductor, Benjamin Zander, in a TEDTalk, observes, “The conductor of an orchestra doesn’t make a sound. The conductor depends for his power on his ability to make others powerful. My job was to awaken possibility in other people. ” In the same way, the anesthesiologist-leader empowers others and opens up new possibilities. Also, unlike with a symphony orchestra that has only one conductor, leadership in the operating is not a zero-sum game: because communication and teamwork are key to a group accomplishing something bigger than any one person can do, there can and should be more than one leader in a clinical setting. It is often said that “leaders are not born, but made. ”With this mindset, we may embark on a study of leadership, to better learn these skills and their application. This chapter will examine key leadership qualities and how to apply them in the operating room, in the critical care setting, and in the hospital at large. An education model will be proposed, which ideally could be extended back into medical school and continued onward into medical practice. Like a concert violinist whose practice habits continue throughout a lifetime, one has never completed the acquisition of leadership skills. There will always be opportunity to apply them in different ways, which will lead to the benefits described above, and individual satisfaction.