By: Mary Nash, PhD, RN, FAAN
Chief Nurse Executive, OSU Health System

Much has been written and discussed about the importance of multidisciplinary collaboration in the diagnosis and treatment of disease. Profound changes in science, technology, patient activism, the market-driven health care environment and the nature and settings have all radically transformed the health care professions.

As a nursing leader, I am all too familiar with the changes in nursing practice and the many implications for nursing education. New nurses need to be prepared to practice safely, accurately and compassionately in varied settings where knowledge and innovation increase at an astonishing rate (Benner, 2010).

The nursing profession faces its own unique challenges that threaten the achievement of communications across disciplines and the design of safe health care systems more complex, namely the abiding hierarchical nature of the health care setting. That anomaly notwithstanding, the principle remains for all health care professions – a need for clear and precise communication within an inter-professional health care team.

At cross purposes to this need is education for the various members of the team. Nursing, medicine, physical therapy and other health care professionals educate their students in academic silos, isolated from one another and, hence, largely ignorant of the expectations of those with whom they will need to work closely.

Our challenge, as healthcare leaders and educators, is to be the catalyst of this interdisciplinary collaboration. Some of the most successful efforts and best solutions are a result of individuals bringing different perspectives to a problem. Whether we’re talking about patient centered care, advances in genomic research, or applying the latest educational approaches, diversity in background and thought is crucial. Expanding beyond interdisciplinary rounding to global initiatives benefits everyone.

I would be interested in hearing what kinds of steps you are taking to foster interdisciplinary collaboration into your teaching methods and how they enhance teamwork in patient care, research or education provided by your department, organization or institution?

By: Pete Geier
CEO of OSU Health System
COO of OSU Medical Center

In my last letter to all Medical Center faculty & staff, I wrote about our Medical Center value of Leadership.  The supporting statement for the Leadership value is: We live in alignment with our values and are thoughtful about how we influence others as we develop personalized health care. Leadership is the ability to influence others.  Never before has the idea that we each have influence over another been more important to OSU Medical Center.  This is called personal leadership.  While top leaders set goals and expectations, we rely on the leader within each of you to do the right thing as you fulfill your role in your department.

How are you exercising leadership by influencing others so that we can develop personalized health care?

A couple examples of personal leadership include each of you who helped the Medical Center set a new record for the March of Dimes March for Babies in April by joining our team of 400 walkers.  Also, Dr. Quinn Capers, associate dean for admissions for the College of Medicine, was honored for his leadership last month with a prestigious 2010 Ohio State Distinguished Diversity Enhancement award. Consider taking the lead among your group of friends in making the commitment to ride in Pelotonia this year.  All faculty and staff who pay their registration fee to ride this year before August 1^st will be eligible to win an RPAC membership or a 2010 Honda Accord. Learn more by clicking on the picture of the car that will be given away.

An admirable example of personal leadership recently took place in the Labor and Delivery Unit at University Hospital when an alert patient-care team recognized an amniotic fluid embolism in a patient whose labor was well under way.  This condition is extremely rare, unpredictable, unpreventable and usually fatal.  The team quickly arranged an emergency cesarean section, which saved the baby’s life, then began stabilizing the mother, who had sustained a cardiopulmonary arrest and developed massive bleeding common to this condition.  The cardiac anesthesiologists and cardiac surgeons were quickly consulted and the patient was transported to the Ross Heart Hospital for removal of the embolism and stabilization.  Mother and baby are doing fine today because of the personal leadership and dedication of Obstetrics, the Labor and Delivery team and the Open Heart Surgery team consisting of the surgeons, cardiac anesthesiologists, Ross 4 nurses, nurse practitioners, respiratory therapists, and critical care pharmacists.

As these examples demonstrate, leadership is less about a title and more about behavior.  To be the best leader that each of us can be, we need to understand our role on the Medical Center team, deliver on our commitments and not be afraid to accept responsibility for our actions and decisions.

Do you feel you have a deep enough understanding of your role on our team to be able to exercise personal leadership?

By: Donald Hubin, PhD
Professor & Chair, OSU Department of Philosophy
Principal Investigator of the Innovation Group for the OSU Center for Ethics and Human Values

Photo by Jo McNulty

One often hears reference to ethical (or moral) leadership.  It sounds like a good thing—and certainly better than the opposite.  But it’s worth considering what is involved in ethical leadership.

Many philosophers—especially those with a great love for theoretical simplicity—seek a single moral principle or value that will serve as the ground for all moral judgment.  Regardless of the prospects for success for such endeavors, this is not how moral issues present themselves to us in ordinary life.  Instead, moral conduct is guided by a variety of considerations.  In particular, both moral goals and moral constraints seem indispensible in our ordinary view of proper moral evaluation.  We’re all familiar with the errors that result from ignoring constraints in the pursuit of worthwhile goals:  understanding the natural course of a disease like syphilis is a worthy goal;  coming to that understanding by denying people medicine that is known to cure the disease is a morally impermissible way to achieve that goal.

But errors result as surely from focusing on moral constraints to the exclusion of moral goals.  All too often, there is a tendency to treat the ethics of one’s profession or the ethics of leadership as if these things can be reduced, in good lawyerly fashion, to a set of requirements and prohibitions.  The concept of ethical leadership is diminished if it is thought of as merely leading an organization through a maze of moral constraints.  Ethical leadership requires keeping one’s eyes on a morally desirable prize, having the vision to set a course to that goal that doesn’t require treating others as mere means to its achievement, and displaying the ability to inspire others to follow that course.

What moral goals do you believe are essential for ethical leadership?

By: Larry Hurtubise
Educational Technology Consultant, Center for Education and Scholarship, College of Medicine
Member, Professionalism Education Working Group

As part of his semi-annual address to the faculty this spring, President E. Gordon Gee provided a vision for academia in his statement, “We have to assume a central role in reestablishing civil national discourse…. to create here the epicenter of the nation’s new intellectual infrastructure, one that is committed to civility and to service for the greater good.”

Based on their book, The Four-Conversations: Daily Communication that Gets Results,  Jeffrey and Laurie Ford would call Dr. Gee’s address an “Initiative Conversation”.  Initiative conversations are designed to create a future. 

 The four conversations proposed by the Fords are:

1. Initiative Conversations: Create a Future
2. Understanding Conversations: Include and Engage
3. Performance Conversations: Ask and Promise
4. Closure Conversations: Create Endings

After an Initiative conversation, people start “Understanding Conversations” to help find a positive meaning in the message.   

So let’s start. Consider that the infrastructure of civil national discourse is built on common courtesy.  Saying “Please” and “Thank you” are the basics.  When you are having a “Performance, Ask and Promise Conversation,” adding a “please” helps to (whatever you want to say about it).   “Closure Conversations” are a natural place for lots of “thank you’s”.

Making “please” and “thank you” a habit just might produce better results.  What if, from now on when you are frustrated and starting a conversation you hope will get action, you begin with a “thank you” acknowledging the contributions the other makes toward the mission.. What would happen if, from now on when asking anyone — and I mean anyone — a waiter, a co-worker, your child — for the smallest thing, you start with “please”?

Thank you.

What are the common courtesies that mean the most to you?

 By: John Mahan, MD
Director, Center for Education and Scholarship, OSU College of Medicine
Professor, Pediatrics, Nationwide Children’s Hospital

Most people believe the truest and most effective leader is one who embraces and lives the principles of a leadership style that has become known as “servant leadership.” Robert Greenleaf  first coined the phrase and described the servant leader as one who leads by moral authority, and enacts a role that is grounded in human nature and defined by conscience, sacrifice and empathy.

Unlike Formal Authority, which relies on position and is dictated, Moral Authority is earned — it exists because it has earned the trust and commitment of those who have willingly chosen to give it authority. It is this earned quality that makes it trustworthy and effective.

At the heart of Moral Authority is Conscience. Conscience inspires us to become part of a cause worthy of our commitment. Conscience teaches us that the ends and means are inseparable. Conscience underlies the world of meaningful relationships.

The Servant Leader is effective and enduring because he/she inspires, collaborates and empowers others to greatness. His/her behavior is based in caring for others, listening, understanding, acceptance, empathy, awareness and perception, foresight, and a sense for the unknowable and respecting uncertainty.

As educators, we are in a unique position to influence the growth of our students and trainees into potential leaders. Is it possible to teach them devotion to service and caring for others, to value listening and to be empathetic – the true power of leading from moral authority? If so, how can we accomplish this task? Do we merely serve as examples and as sources of inspiration, or are there intentional actions we can take to teach these principles?

 I’d be interested in hearing what you do to develop servant leaders in your role as educator.

From Chip Souba:

In the top right hand corner of our blog, under the Welcome, we have asked for your feedback on topics you would like to discuss (and have included a handy link to quickly email your ideas). The latest post from Keith Smith on Ethics and Leadership (see below) comes from such feedback on topics and we’re delighted to welcome Dr. Smith to the conversation.

 We’d love to have even more ideas, topics, comments and feedback – so please JOIN THE CONVERSATION in whatever way you feel most comfortable!

By: Keith Smith
Associate Vice President, Agricultural Administration
Associate Dean,  Food, Agriculture and Environmental Sciences
Director, Ohio State University Extension

What would you do for your company or organization?

What does your behavior say about your choices as a leader?

If we put ethics into its simplest terms, as offered by the Harvard Business School, we could say that leadership is the ability to ethically move an organization from point A to point B. While I appreciate the simplicity of that statement, and being an ethical leader is something I strive for personally, I think we all know the practice of doing so can be more complicated.

The choice between right and wrong seems obvious for most of us – but it’s not hard to get sidetracked. For example, when you look at the scandal among the financial institutions on Wall Street – the mistakes those company executives made by adjusting the records, cheating for business or personal gain, and outright lying to cover it up show how far you can fall when businesses bend the rules for the bottom line.

As Joanne Ciulla mentions in Ethics, the Heart of Leadership: “The rule of business remains ‘the law of the jungle,’ ‘the survival of the fittest;’ and the goal of survival engenders a … mentality that condones the moral imperative of getting ahead by any means necessary.”

But does this process end with business? What if a grocery store clerk gives you too much change…do you keep it? Or, you realize you can get free Internet access through your neighbor’s wireless network…do you use it? When faced with these everyday scenarios, we realize ethics is not just something we should think about at work – we have a personal code to live up to as well. So, as leaders, ethics permeates our professional and personal lives. If we start to make something “acceptable” at work, will that transcend into our personal life – and vice versa?

You can face many ethical dilemmas in making the right choices for an organization. In fact, “Certain ethical challenges or dilemmas are inherent in the leadership role. If you choose to become a leader, recognize that you accept ethical burdens along with new tasks, expectations, and rewards.” – Craig Johnson, Meeting the Ethical Challenges of Leadership.

Leaders can fail if they fall victim to greed/external gratification, if they crave success/fear failure more than they want to do right by the organization, or if they can be easily persuaded by others and rationalize their behavior “on behalf” of the organization.

What are you willing to do on behalf of your organization? If you expect people to behave ethically when dealing with you, you should do the same in return. And remember – you set the standards for your employees. If you are unethical or tolerate that type of behavior, you can bet your employees will follow suit.

What type of foundation are you building for ethical leadership – in yourself and others?

I challenge you to discuss ethical behavior with your colleagues, share practical applications to address challenges you face, and be an example of leadership practices that encourage ethical behavior.

By: Jason Barger
Author, Speaker, Consultant, and creator of the Step Back from the Baggage Claim Movement

“The height of cultivation always runs to simplicity.” – Bruce Lee

Chances are, we’ve all been told to “Keep It Simple Stupid” at some point in our lives. But, as our knowledge base increases and our leadership spheres widen, the natural tendency (and trap) is to “out think” the situation.

As we think about the cultures we are trying to cultivate within our staff, department, hospital, or most importantly, our world, we must start small – our own individual actions. What seems simple is often the most difficult for us to actualize. Yet, it is our simple, small, intentional actions that separate good leaders from good managers.

This week, try to K.I.S.S. those along your path with a new spirit.

K – Keep eye contact. It is amazing how empowered another human being can feel when they sense your eyes value them and that moment.

I – Include others. We build too many walls when bridges are needed. Include someone new at lunch, in an important decision, or a discussion that needs another point of view.

S – Slow down. In a fast-food culture and world of instantaneous communication, allow yourself a few minutes to be still and centered. When we don’t, we race recklessly past people on our path.

S – Send positive ripples. Intentionally send messages rooted in appreciation, celebration, and compassion to those around you. A genuine note, email, phone call, or purposeful stop at their office door, can deliver rejuvenating ripples that do spread.

So, who will you K.I.S.S. along your leadership journey today

By: Bryan L. Martin, DO
Associate Dean for Graduate Medical Education
Director, Allergy & Immunology Fellowship Program

“Change your thoughts and you change your world.”
Norman Vincent Peale (1898-1993)

Recent works have shed light on the influence of Emotional Intelligence on effective leadership. There are many who argue that emotional intelligence is fixed; some are born with a great deal of it, others very little. These people may say things like “that’s just how I am,” or “I always react that way.” These phrases provide an excuse for not facing one’s own insecurities and moving forward. The basic concepts of emotional intelligence and their effects on an individual’s leadership capacity are easy to understand, yet often poorly interpreted and executed.

The four prime concepts of emotional intelligence include self awareness, self management, social awareness and social or relationship management. It may seem that these ideas and behaviors are so obvious that they do not need to be taught at all, but some recent decisions at the national level show the importance of EQ training in the Medical Center.

The Joint Commission has recognized that behaviors are important, but does not believe that good behavior is always evident within American Hospitals. A Sentinel Event Alert dated July 9, 2008 describes behaviors that can undermine a culture of safety, and how disruptive behaviors can lead to preventable adverse outcomes. Inappropriate behaviors range from such obvious problems as physical threats and verbal outbursts to less definable characteristics as condescending language and impatience. The Accreditation Council for Graduate Medical Education (ACGME) has also embraced emotional intelligence skills. With the introduction of the six competencies in medical education, professionalism, communication, practice based learning and system based practice competencies have joined the traditional competencies of patient care and medical knowledge.

The bottom line: medical care giver’s EQ skills impact patient care and patient safety.

Where do you learn and how do you apply EQ skills?

 By: Jerry Friedman
Associate Vice President in the Office of Health Sciences and
Advisor for Health Policy at The Ohio State University Medical Center

The  breadth and depth of how health care reform  would impact academic medicine was revealed and explored  during a panel discussion at the Ohio State University Medical Center (OSUMC).  Congresswoman Mary Jo Kilroy (OH-15) kicked off the event with remarks about the personal and political,  health and economic imperatives that moved Congress to enact the transformational Patient Protection and Affordable Care Act.   She then joined health sciences leadership in a panel moderated by Dr. Steven G. Gabbe, OSU Medical Center CEO to discuss the impact the legislation would have on the health and wealth of our country and its citizens.

Education and research, nursing and pharmacy, diversity and disparities, medicine and insurance were all on the table for commentary. It became clear that the legislation contained opportunities for and challenges to the mission, vision and values of the Medical Center and OSU’s health science colleges.  There were clear opportunities for alignment along the strategic path towards personalized medicine: patient centered, evidence based care that that would be preventive, predictive, personalized and participatory.  There would be challenges as well.  

OSUMC has thrived based on the way that medicine has historically been delivered and paid for, notwithstanding that system’s fragmentation, inefficiency and unsustainability. The challenge is readiness to change. 

Can OSUMC adapt and lead that transformation? There is no question that our educators, researchers and patient care professionals have the ability.  

The remaining question is: Do they, as Congress did, have the will?   

By: Kathy Matney
Executive Director of Service Excellence

How can we make sure our employees are fully engaged?  To create a culture of service excellence, one of the “must haves” is engaged employees.  This is something I’ve been asked a lot, in my previous work as an executive coach and since I arrived at the medical center.   My short answer is:  it’s all about the leader.  Engaged leaders reliably mean engaged employees. 

Probably the best known work on employee engagement has been done by The Gallup Organization.  Based on very robust research spanning more than 30 years Gallup developed an employee survey called the Q12. Q12 is a 12 question inventory of key employee expectations that, when satisfied, form the foundation of strong feelings of engagement.¹   I like using the Q12 because it’s simple and provides specific actions leaders can take to increase employee engagement. Below are a few suggestions.  Consider how you might use them, such as in your rounding, or in individual or group meetings. The key is to “hardwire” them into your daily practices. 

1. Begin with something personal (before starting the “to do” list).  Ask about and remember things that are important in their family or personal lives.
2. Ask if they have the tools and equipment they need. 
3. Set clear expectations, and always connect to purpose (why it matters)
4. Recognize their good work, a lot.
5. Actively re-recruit your high performers.  Develop your good performers.  Make sure low performers improve quickly…or exit the organization?
6. Communicate frequently.   Ask specific questions, and listen carefully to the answers.   

 Many leaders are already great role models for the above.  But for us to reach our highest goals, it will take all of us.  Consistent engaged leaders = consistent engaged employees = a high performing organization. 

 Ask yourself these questions:

1. How engaged are your employees?  What does employee engagement look like in your department(s)?
2. What actions are you taking to be an engaged leader? 

^{1  Thackray, John. Feedback for Real. 15 March 2001.  Obtained April 21, 2010 from http://gmj.gallup.com/content/811/feedback-real.aspx}