The 2016 American College of Surgeons (ACS) Leadership & Advocacy Summit, April 9−12 at the JW Marriott, Washington, DC, drew 447 attendees—the highest number to date—representing all levels of ACS leadership, including Regents, Governors, Advisory Council Members, Chapter Officers, Resident Member leaders, and other stakeholders. “We have attendees at this meeting who are in the beginning of careers, the middle of their careers, and senior surgeons,” said Patricia L. Turner, MD, FACS, Director, ACS Division of Member Services, in opening comments at the fifth annual summit. “These [attendance] numbers highlight the value of this meeting,” Dr. Turner added. “We hope to leave you with specific and actionable elements that you can put to use in your day-to-day work.”
The summit—a twofold meeting with a focus on both leadership enhancement and advocacy training—featured success stories from several ACS chapters; professional development programming, including sessions on “cultural dexterity,” reputation management skills for social media, and improving emotional intelligence (EI); along with numerous networking opportunities.
Leading through team conflict
“Conflict occurs in any group that is doing meaningful work. It’s not a sign of dysfunction,” said David A. Rogers, MD, MHPE, FACS, FAAP, senior associate dean of faculty affairs and professional development, and professor of surgery, University of Alabama School of Medicine, Birmingham. An awareness of conflict structure is the first step to resolution, noted Dr. Rogers, who outlined three sources of primary conflict:
- Task: Disagreement related to the outcomes of the task being performed
- Process: Disagreement related to the logistical issues of the task
- Relationship: Disagreement related to personal issues outside the task
Responses to conflict range from “smoothing,” such as using humor to diffuse the situation, to “forcing.” An example of forcing is copying too many people unnecessarily on e-mails, “which might be a plus for [accomplishing] a task, but it is a minus for relationships because it impairs them,” according to Dr. Rogers. He cited Abraham Lincoln’s restraint in communicating with others as an example of how to avoid the forcing response to conflict. “They talk about finding all these letters in Lincoln’s papers that he never sent…. The same thing can be done when you receive a blistering e-mail,” he said, suggesting attendees step away from a potentially heated exchange and, instead, pick up the phone.
Another common response to conflict is avoidance. “It sounds like you should do that, right? But it’s actually a very aggressive response because the individuals are refusing to participate or be engaged.”
Dr. Rogers said fostering a sense of trustworthiness is key for surgeons to be effective leaders, regardless of the source of the conflict or team members’ response to that discord. “Build a sense of trust and do it around your abilities,” he said, advising attendees to avoid “behaving one way in the operating room (OR) and another way outside the OR. Be consistent—wherever you lead.”
“If a surgeon creates a sense of trust, a task conflict is less likely to develop into a relationship conflict,” he added, noting that a relationship conflict should be avoided whenever possible because it focuses on personalities and may result in project delays and permanently fractured relationships.
Chapter success stories
Officers of the West Virginia and North Texas Chapters and the Georgia Society of the ACS shared their success stories in an effort to inspire other chapter leaders to boost member engagement and to improve their effectiveness.
West Virginia Chapter
Bryan K. Richmond, MD, MBA, FACS, professor of surgery and division chief, general surgery, West Virginia University, Charleston, and ACS Governor and Immediate Past-President of the West Virginia Chapter, described the chapter’s efforts to increase medical student involvement. “Several years ago, we began inviting students from the medical school near the location of our meetings,” said Dr. Richmond. “This year, we extended [the invitation] to all three state medical schools using surgery student interest group presidents as our contacts.”
The 2015 West Virginia Chapter three-day meeting drew 95 surgeon and resident attendees and 70 medical students. “We found that our chapter members enjoy giving advice to young minds who will one day be their colleagues,” said Dr. Richmond. “These meetings establish the concept that surgeons are the most effective mentors and that networking and involvement [are] essential for career development and success.”
Additional efforts to attract medical students included a waived conference fee, accommodation funding assistance, open access to all of the meeting’s receptions and social events, and an open forum session with an opportunity for students to engage in a discussion with academic and community surgeons and ACS leaders.
The West Virginia Chapter has received $20,000 in funding to enhance medical student engagement, including three separate $5,000 grants from training programs in the state and a $5,000 grant from private industry.
Medical student involvement invigorates the chapter meeting, and in turn, shows the students that “the ACS is interested in them and that they have a role and a voice within the College,” Dr. Richmond said.
North Texas Chapter
ACS Governor Dhiresh R. Jeyarajah, MD, FACS, director, surgical oncology, and director, upper gastrointestinal fellowship, Methodist Hospital, Dallas, TX, and Immediate Past-President of the North Texas Chapter, focused on the chapter’s efforts to revitalize its annual meeting. “Historically, there has been a fixed format for the meeting, which included a series of talks and three named lectures,” Dr. Jeyarajah said. “We wanted the meeting to be more interactive and to engage everyone, especially surgeons in private practice, so we focused on the tagline ‘Engaging the practicing surgeon,’ which we thought would be a good way not to alienate anyone and include everyone, town and gown, because all attendees are practicing surgeons.”
Chapter meeting organizers decreased the number of abstracts by 25 percent and used that time to feature a tumor board meeting with faculty from multiple institutions. The annual meeting also included a town hall with ACS Governors and leaders discussing a spectrum of issues, including electronic health records.
Dr. Jeyarajah said the chapter kept meeting costs down by increasing its exhibitor fee and featured electronic posters, rather than the traditional poster format, to increase space for additional exhibitors.
“Make [the meeting] applicable, engage your audience, and don’t be afraid to be edgy,” said Dr. Jeyarajah.
Georgia Society of the ACS
“How do we engage younger people and get them to attend meetings when they can just ‘Google it’ for the information they need? How do we enhance a sense of camaraderie at these meetings?” asked Christopher K. Senkowski, MD, FACS, professor and chair, department of surgery, Mercer University School of Medicine, Savannah, GA, and ACS Governor for Georgia and President, Georgia Society of the ACS.
The leadership of the society have implemented several strategies to increase meeting attendance, including collaborating with other state specialty societies, such as the Georgia Chapter of the American Society for Metabolic and Bariatric Surgery; offering new sessions on practice management topics; involving state legislators in the meeting; and providing updates on statewide quality initiatives.
Membership growth has increased 12 percent in the last two years, according to Dr. Senkowski, and annual meeting attendance has grown 40 percent in the same time period.
Enhancing cultural dexterity
Developing cultural dexterity (sometimes called “cultural competency”) as a means of reducing health care disparities and providing patient-centered care was the focus of a presentation by Adil H. Haider, MD, MPH, FACS, the Kessler Director of the Center for Surgery and Public Health at Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, and Co-Chair of the ACS Committee on Health Care Disparities. “Equality is the cornerstone of medicine,” said Dr. Haider. “Every patient, no matter where they come from, deserves the best possible outcome.”
Unfortunately, multiple medical studies have shown that “unconscious bias” affects how some physicians treat patients, Dr. Haider noted. He cited a survey sent to 536 ACS Fellows from July 2013 to March 2014, which found 40 percent of 173 respondents believe that the “evidence for disparities is weak,” and of the 50 percent who identified disparities in their own practice, “90 percent blamed the patient [for disparities in health care].”
Dr. Haider credited the College for making disparities in health care a top priority, citing an article published in the March issue of JAMA Surgery titled “Setting a national agenda for surgical disparities research: Recommendations from the National Institutes of Health and American College of Surgeons Summit,” which established five research priorities for reducing surgical disparities:
- Improve patient-clinician communication through culturally dexterous care
- Use technology for engagement and community outreach to optimize patient education, literacy, and shared decision making
- Improve quality of care at facilities with a high proportion of minority patients
- Evaluate interventions such as rehab support on functional outcomes and quality of life
- Improve patient centeredness by having patients identify expectations for recovery and palliative care
“Be aware of unequal outcomes, participate in or create a program, and advocate for policy change,” he said. “As I look around this room, which is more diverse than it was 20 years ago, I believe that we can do better [and that our actions] will lead to the eradication of disparities in surgical care.”
Leading by example
“What is the most popular American sport? It’s not baseball. It’s not football. Some might say it’s soccer, but it’s actually boss-watching. We are all watching our bosses, so lead by example, because motions and behaviors are contagious,” said Kurt O’Brien, MHROD, senior lecturer, department of health services, University of Washington, Seattle, whose presentation focused on interpersonal skill development.
“The emotional part of our brain works much faster than the logical part of our brain. The question is—what do we do about it? We need to reframe conflict,” said Mr. O’Brien, referring to the surgeon-leader’s role in diffusing discord among colleagues and team members. “Start with the heart,” he said. “Seek to understand the unmet needs” of the individuals involved in the conflict.
He outlined a multistep approach to conflict resolution, including determining what you appreciate about the other person, discovering your mutual purpose, and disputing your own “story.” “We all have beliefs about the activating event—the story you tell yourself about how the conflict started,” said Mr. O’Brien. “Ask yourself what other possible explanations exist.”
He also advised attendees to increase self-awareness and suggested that leaders who engage in self-reflection are more successful at interpersonal skills development and conflict resolution.
Breaking boundaries in strategic thinking
“Being decisive is a quality in leaders, but when it comes to being strategic, don’t be decisive, at least not yet,” said Joshua Klayman, PhD, a faculty member with the Booth School of Business, University of Chicago, IL, and subject matter expert on managerial and organizational behavior. Dr. Klayman stressed the importance of flexibility in problem solving, particularly the ability to reframe a problem and examine it from a variety of perspectives.
To illustrate the utility of unconventional thinking in problem solving, he asked attendees to solve the nine dots puzzle, a popular brain-teaser that involves individuals linking all nine dots, three rows across and three rows down, without lifting the pen and without tracing the same line more than once. A variety of solutions exist, typically ones that require the problem solver to “think outside the box”—a phrase that was first popularized by the puzzle, according to Dr. Klayman.
He cautioned leaders to avoid giving instructions or asking questions that contain “hidden boundaries,” and he cited the history of the cold storage door as an example of a hidden boundary gone awry. A businessman was looking for a cold storage door that he would not have to open since his hands were carrying trays of heavy meat, according to Dr. Klayman. Industrial designers were initially flummoxed, but eventually solved the problem by moving away from the concept of a standard door, which was part of the wording in the original request, and using heavy plastic strips to allow ease of access while keeping the cold air trapped in the freezer.
“It’s a mistake to spend too much time on being the decider and not enough time being the strategic thinker,” Dr. Klayman said.
Authentic leadership
After a brief introduction by Daniel D. Klaristenfeld, MD, FACS, FASCRS, a member of the Governing Council of the ACS Young Fellows Association, Susan Moffatt-Bruce, BSc, MD, PhD, MBOE, FACS, FRCSC, led a session on the leadership skills necessary to transition from “volume-driven to value-driven” patient care.
“Leadership is not a static endeavor—leadership demands fluidity, which requires the willingness to recognize the need for change and the ability to lead change,” said Dr. Moffatt-Bruce, chief quality and patient safety officer; associate dean of clinical affairs, quality, and patient safety; and associate professor of surgery and associate professor, biomedical informatics, Ohio State University, Columbus.
She outlined effective leadership traits, such as possessing a compelling vision, fostering a sense of accountability, and developing effective communication skills. Dr. Moffatt-Bruce also suggested that attendees broaden their view of what it means to be a capable leader, urging surgeon leaders to engage in what she called authentic leadership. “Authentic leaders know who they are and what they believe in; they act on values openly and candidly, and their followers consider them to be ethical people and have faith [in their abilities],” said Dr. Moffatt-Bruce, who described this style of leadership as “innate to all of us.”
Authentic leadership “emerges from your life story,” she said, via one or more transformative experiences or “crucibles,” such as illness, having a family, death of a loved one, and career-related experiences that inspire a surgeon to become a leader. Dr. Moffatt-Bruce added that “discovering your authentic leadership requires a commitment to developing self-awareness,” which she called “the first component of emotional intelligence. She noted that “the most effective leaders are alike in one crucial way—they all have a high degree of emotional intelligence.”
Social media and reputation management
Surgeons who neglect social media in their practices are out of touch with patients’ growing demand for digital communication, and they run the risk of allowing negative reviews to define their reputation, said Deanna J. Attai, MD, FACS, David Geffen School of Medicine, University of California, Los Angeles, and president, American Society of Breast Surgeons.
A surgeon’s digital footprint can be described as controlled or uncontrolled, Dr. Attai said. Examples of an uncontrolled digital footprint include Healthgrades, Angie’s List, Yelp, and RateMDs.com, some of which may allow surgeons to respond to reviews. “However, the solution to pollution is dilution,” she said, encouraging attendees to amplify their controlled online presence by creating a profile on LinkedIn and Doximity. “If you do nothing else, do this,” said Dr. Attai. “Include a professional picture and set up areas of interest. LinkedIn now has a blog post feature so you don’t have to set up your own website or blog. You can just post directly from that platform.”
As for other social media platforms such as Facebook and Twitter—which can also help shape a physician’s online reputation when used properly—she encouraged attendees to establish a relatable presence. “Patients and doctors want to know you are a real person. Social media users are savvy, they can see through the spin and will notice if you are only there for self-promotion. Don’t be afraid to show a little bit of your personality. During the week I will post articles on breast cancer issues, but on the weekend, I might post pictures of my garden,” she said.
Developing a digital footprint is a balancing act of opportunities (patient education, collaboration with colleagues, access to information) and challenges related to maintaining professionalism and patient privacy. “Common sense online is so uncommon,” said Dr. Attai. “Regardless of how anonymous you think you are…you have to post and tweet as if the entire world is watching.”
“Don’t feed the trolls,” she added, highlighting another way surgeons can control their online reputation. Social media trolls are individuals who create conflict on Facebook or Twitter by posting controversial, inflammatory, or off-topic comments. “Expect some debate, and remember there are many sides to a story or issue. However, you should be able to recognize pretty quickly if you’re going to make headway with an individual. If that’s not possible, just walk away.”
While residents and medical students may have been “raised on social media,” they still benefit from mentoring relationships that underscore professionalism. “The next generation may be comfortable with these platforms, but they are professionally naïve, and we need to set the example,” Dr. Attai said.
Enhanced EI leads to better outcomes
“Being nice is not the same thing as emotional intelligence,” said Roy Phitayakorn, MD, FACS, department of surgery, Massachusetts General Hospital, Boston. “EI is how an individual manages his or her emotions and the emotions of others and requires self-regulation, perception of others, interpretation of what others are feeling, and action. EI and personality traits are two separate domains.”
“The OR environment is not conducive to communication. We all have masks on, OR drapes block views, and it seems like every team member is focused on separate tasks, but we have found that EI enhances communication. And if people feel free to talk in the OR, they are more likely to bring up issues when a crisis comes up.” He encouraged attendees to “manage the emotions in the room because everyone is looking for you to do that in the OR. If you are emotionally intelligent, it acts as a barrier to errors coming through.”
Cultivating a culture of trust
“We are living in a time of uncertainty, but, with that in mind, we should remember that the College is an enabler of quality and the trusted source of clinical solutions,” said ACS Executive Director David B. Hoyt, MD, FACS, in closing remarks at the Leadership Summit. He described the “leadership characteristics of a thriving College,” which include the organization’s ability to “cultivate a culture of trust, maintain a laser focus on the practical needs of members, and operate at the speed of health system change.”
Dr. Hoyt also updated the attendees on key College initiatives, including the Hartford Consensus and the recently released Stop the Bleed campaign; a re-tooling of Operation Giving Back, which will feature an infrastructure that allows Fellows to participate in the program more easily; and strategizing to amplify member recruitment at all levels. He also highlighted continuous quality improvement projects, such as the quality manual that is currently in development and the forthcoming rollout of the ACS quality database system, which will allow the College to migrate all of its clinical registries into a common, consolidated warehouse and reporting platform.
To underscore the College’s interest in cultivating a culture of trust, Dr. Hoyt closed with an update on plans for regular “fireside chats” enabled by software that will support the participation of up to 1,000 attendees and up to six panelists on video simultaneously.
“Our future is very bright even though these are times of uncertainty,” he said, calling on attendees to use their leadership skills and EI acumen to meet the needs of both the profession and its patients.
The sixth annual Leadership & Advocacy Summit will take place May 6−9, 2017, at the Renaissance Washington, DC, Downtown Hotel.
