Leadership, surgeon well-being, and other non-technical aspects of pediatric cardiac surgery

Abstract

The expectations of pediatric cardiac surgeons grow as the specialty evolves and yesterday’s challenges become tomorrow’s routine. The pioneering era of fast-paced major technical advances is behind us. Integration of surgery, cardiology, anesthesia, intensive care, and nursing is now the basis of incremental improvements in perioperative performance and long-term outcomes. Surgeons can be natural leaders of this process because their skills, roles, and experience are crucial in the preoperative, intra-operative, and postoperative care of the patient and their family. However, the personality traits that draw physicians to the specialty of surgery and contribute to the drive to become a successful technical surgeon may be at odds with the collaborative aspects of this microsystem, both inside and outside the operating room. The potential for disruptive behavior on the part of the surgeon to impede the functioning of a large multidisciplinary team providing care of the upmost complexity raises fundamental questions about how to design tools and checks to create reliable pediatric cardiac surgical teams. A new dynamic is needed to support members of the team, including the surgeon, in times of extreme stress, and to help members of the team avoid destructive, maladaptive responses. Focusing these efforts around the clinical microsystem requires a detailed analysis of the interactions of the team, the underlying culture and support, and the engagement of clinical staff. Building and nurturing a resilient system remains a constant challenge in a highly specialized environment where burnout, bullying, and loss of staff exist. Creating and nurturing an environment characterized by psychological safety for all team members requires development of trust to permit ’healthy conflict’ and their successful resolution. Specific tools can be practiced to develop conscious competence in advanced methods of communication that facilitate trust. Patient safety and high value care depend on the development of trust within, between, and among team members. For many, the questions are (i) how to build a sustainable model of quality improvement in a medium sized unit, (ii) how to create an enjoyable and rewarding working environment, and, (iii) how to build resilient systems that ensure excellent outcomes and protect against avoidable poor clinical outcomes.