Authors: Elad I. Levy
At the Beijing Olympics in 2008, the American 400-meter relay team was a favorite to win a medal-until the unthinkable happened. Darvis Patton failed to pass the baton cleanly to his teammate Tyson Gay, and the baton fell onto the track, eliminating any chance of a medal. Eight years later in Rio, the men's 400-meter relay team lost another medal after a disqualification regarding an improper baton hand-off. The failure to complete a smooth transition during these important milliseconds culminated in negating the promise of success, despite years of training, dreaming, and sacrificing.
It has now been four years since Dr. Nick Hopkins passed the baton and entrusted his successor (this author) to competently "run the next leg" as chairman of University of Buffalo Neurosurgery. While appreciating the trust-and the responsibility-that came with this appointment, I quickly found myself acutely aware of the new, different, and changing demands within academic medicine as a result of increasing regulations on hospitals, payers, and the physicians-all while clinical, teaching, research, and the traditional multitude of other responsibilities required attention. And, to further complicate matters, the culture of neurosurgery has continued to change as the importance of finding a thoughtful "work-life balance" has become increasingly, and appropriately, recognized. The challenges I faced as a new chairman were obvious: How could I help lead strategic departmental growth while simultaneously encouraging everyone to focus not only on optimizing our patients' experiences, but their own experiences, in order to flourish professionally and personally?
While the complexities around academic neurosurgery continue to become increasingly daunting, we have deployed nine simple strategies that allowed us to reach-and exceed-our professional and personal goals developed four years ago. These strategies help us continue to improve, but require unrelenting commitment and on-boarding by the entire organization. I am pleased to share these guiding principles, all of which are based on a culmination of conscious (and subconscious) influences of our predecessors and mentors, and hope that you and your teams might find some value in them as well.
Rule 1: The needs of the organization supersede the needs of any individual.
There are times that the direction of the organization is in direct conflict of personal needs. It is at these times that the opportunity to demonstrate leadership, regardless of title or position, is most pronounced. At no time can one supplant the mission of the organization to favor an individual. Common examples include discord around physician reimbursement strategies juxtaposed with departmental investments. While leaders of departments often set the pay scales for the physicians (based on academic rank, productivity, or combinations of these and other metrics), one approach we used was to involve the ALL the faculty in the creation of a multi-faceted strategy that is equitable and agreed upon by the majority of the department.
Rule 2: Attend to the right P/E ratio.
While most in the business world focus on the financial ratio of a stock's price to its earnings (P/E), we have come to appreciate the importance of a different P/E ratio: that of "principled actions" to "expedient actions." While short term wins and gains may feel good, it is the long view that will ultimately shape organizational success. As a result, we attempt to make principle-based decisions upon clearly articulated values, vision, mission, and policies, designed to uphold the ethics and culture that is the foundation of everything we do at University of Buffalo Neurosurgery. Some of these decisions have been costly and difficult-in the short term. But these decisions have paid greater financial and emotional dividends over time. By nurturing and prioritizing our ethics, we provide our colleagues with a safe and supportive place to work.
The UB neurosurgery team sweats it out at a Sunday spin class.
The UBNS department soccer team-residents , attendings, and their families.
Rule 3: Remember that we have two ears and one mouth.
Human anatomy is such that most of us were born with two ears and one mouth. We encourage department team members to listen twice as much as they talk. Listening-not just "hearing"- is a skill that can be difficult to learn. It requires attentiveness, understanding, and analysis, as one is digesting another's words. But autocratic or hierarchical governance is counterproductive to good work-place culture, and the importance of ensuring that every colleague has a voice is critical for promoting both fulfillment as an individual and for maintaining a productive workplace culture.
Rule 4: Seek wisdom from all sources.
Several years back, a Wall Street fable was shared with me, and its wisdom still resonates. As it was told, a new hire in an investment firm, wanting to make a good impression, would have his shoes shined daily in the lobby of the building. The young hire was usually the first in, and made friendly conversation with the man shining his shoes. After several days, the "shoeshine guy," who acquired a daily wealth of information simply by listening to all the sensitive conversations of the analysts and fund managers from his customers, gave the new hire some stock advice in passing conversation. The advice turned out to be incredibly fruitful and, hence forth, the new hire's "market research" included listening to the shoeshine guy every day. We cannot understand the nuanced complexities of our world without seeking to learn from everyone, even unconventional sources. For example, to better understand delays in operating room turnover, we should seek to learn not only from the surgeons and nurses but from the custodians and transport personnel as well.
Rule 5: Seek to build consensus and promote passion.
Margaret Thatcher defined consensus building as "the process of abandoning all beliefs, principles, values, and policies in search of something in which no one believes, but to which no one objects." For neurosurgeons and departments to flourish, leadership is necessary to find common ground despite dissenting viewpoints. Consensus sometimes requires compromise for the greater good, even embracing strategic initiatives contrary to one's personal convictions. But finding effective common ground has perhaps been more important to our department's continuing success than any other factor. As I reflect upon and draw from my MBA education, I continue to more exquisitely appreciate the importance of building consensus through clear and principled communication. That, in turn, is what promotes collegiality and renewed energy.
Rule 6: Find ways to have fun.
While lecturing at another institution, I had the opportunity to join in an annual attending-resident soccer match. On the playing field, the traditional hierarchies of neurosurgery were abandoned and, for ninety minutes, we were all gladiators competing for victory. The camaraderie engendered was so palpable that upon my return, our department began a tradition of quarterly soccer matches. On the field, the residents united under the singular focus of defeating their attendings. Though our hamstrings screamed for days following each match, the faculty and trainees appreciated each other in novel ways, which are indescribable and intangible. The competition brought the department closer, and by injecting team fun into grueling pace of residency training, we became reinvigorated. Sunday team spin classes and soccer matches are now staples of the program, as these activities lead to enhanced interpersonal dynamics between the faculty and the trainees.
Rule 7: Never stop moving your feet behind the net.
For those who may be less familiar with hockey, this phrase refers to working hard behind the net to gain control of the puck, so that one can pass the puck in front of the net to create a scoring chance. No goals are scored from behind the net, yet puck possession is critical in this area. As we reflect on this sentiment, the salient message is that success requires unrelenting work, even in the unnoticeable and unglamorous spots. Additionally, recognition for those who do this work is critical for continued success. We all know that there is no shortage of people eager to take credit. But who are the unsung heroes who tirelessly perform their responsibilities and never make the proverbial "highlight reel?" How often do we praise our surgery schedulers, transporters, or coders? All of these people are central to the success of any neurosurgery department. Simple greetings of "hello" or a well-deserved "kudos", greatly enhance work-place culture.
Rule 8: Balance "balance."
Personal fulfillment can never be attained when we are in a state of total lack of balance. Dr. Joseph Maroon, former president of the CNS, has devoted his newest book, Square One, to the concept of finding balance. On a personal note, I struggle with the question of whether or not great accomplishments can be achieved if we are seeking balance. We all are aware that neurosurgery training requires great effort and sacrifice, with "free time" dedicated to continuing reading and research. Perhaps it is not balance we should be seeking during training, or early in our careers, but rather the avoidance of significant imbalance. By carving out precious moments for activities we find personally fulfilling such as exercise, friends, family, or entertainment, young neurosurgeons may mitigate the degree of imbalance that is an inherent part of our specialty. As Dr. Maroon suggests in his book and lectures, personal connection and fulfillment is critical to nourish one's soul, which in turn will provide the fuel for longevity of success.
Rule 9: Foster a positive workplace.
Sean Achor, author of The Happiness Advantage: The Seven Principles of Positive Psychology that Fuel Success and Performance at Work, describes the research confirming that happy workers are more "energetic" than unhappy workers, and so, in turn, are more productive. Such energy and productivity further enhances an organization's "bottom-line" success. Creating a culture that promotes employee happiness and satisfaction does not need to be complicated, but it does require a top-down commitment that includes such steps as insisting on politeness, discouraging gossip, giving accolades to others, and taking personal responsibility for failures. Also important is promoting face-to-face encounters (versus texts), which is not always easy given our many commitments. But doing so can help build deep personal connections and unite colleagues. Such steps can build or nurture a "culture of trust and respect," allowing colleagues to take chances without fearing retribution. While promoting a positive workplace culture may be antithetical to "traditional" neurosurgical workplace cultures, doing so is critical to our specialty's continuing development and success. Our success depends on our dedication to cultivating a positive workplace culture and our diligence in acculturating all new team members as part of their on-boarding experience.
It has been an honor and privilege to be a part of the neurosurgery community-locally and nationally. Like everyone else, I find myself learning something new every day and believe that what works today won't necessarily work as well tomorrow. Our field is complex and challenging, as is the world we operate in. Our field, however, is comprised of brilliant and talented surgeons who synergistically depend on many other professionals. My hope is that by sharing our challenges and strategies for one academic environment, some of you might benefit with your own personal and team development goals.
"HOW COULD I HELP LEAD STRATEGIC DEPARTMENTAL GROWTH WHILE SIMULTANEOUSLY ENCOURAGING EVERYONE TO FOCUS NOT ONLY ON OPTIMIZING OUR PATIENTS’ EXPERIENCES, BUT THEIR OWN EXPERIENCES, IN ORDER TO FLOURISH PROFESSIONALLY AND PERSONALLY?"