Maryland. This morning I have the distinct privilege of moderating this session entitled the ICU Leadership Academy. We are extremely fortunate to have convened an esteemed panel of folks from amongst our own membership in SCCM. We have a panel of leaders, as you can see in your agenda, with experience from every facet of critical care and healthcare in general, from clinical leadership and beyond, society leadership, hospital leadership, and healthcare systems leadership. I have a couple of goals for this morning. I hope that you will be hearing from our speakers, their personal stories about how they came to be in the positions that they're in, and what they learned along the way about leadership. And I'm pretty certain you'll come away from this session with a few excellent nuggets and maybe a few quotes here and there. Those of you on med Twitter, I challenge you to pay attention, but if you can multitask, live tweet some interesting quotes that you hear from this morning. So without further ado, I want to introduce very briefly our speakers, and then they're going to come up and give about 10 to 15 minutes of remarks. Dr. Judith Jacoby, past president of the society. Dr. April Capu, advanced practice leader. Dr. Halpern from Sloan Kettering Clinical Center. Dr. Anthony Slonim, CEO and healthcare executive. Dr. Addison May, director of surgical critical care at Atrium Health. So without further ado, we're going to start with Dr. Judith Jacoby. Please join me in a warm welcome. All right. It's always interesting to have the opportunity to be part of a group of certainly an audience that's interested in leadership and developing yourself. One of the things that I'm going to put in a plug for will be a new program that we are submitting to the strategic planning process for SCCM to develop a more formalized career advancement program. We recognize that individuals at different phases of their career are interested in developing themselves in various leadership capabilities, or maybe you're suddenly in a new role and need to develop yourself in some new ways. And so, we're starting pretty modestly to organize existing educational content within the SCCM structure, and then being able to make it easy for you to go and find information on a particular really career, we're calling it a career advancement program, leadership, mentorship, running meetings, reading contracts, writing financial or business plans. Some of those nitty-gritty things that sometimes you need at various phases of your career, but some things may be specifically targeted to different developmental areas and phases of the career. And we're going to be extensively working with our other sections and knowledge educational groups to really enhance some of this content. So, a plug for the future that SCCM is indeed invested in this, and we're hoping that we can get them to really increase that investment as we go on. So, I've had an interesting journey on my way to being part of leadership in this organization as well as other organizations. And in fact, I was president of SCCM in 2010. For those of you who remember and were members at that time, that was the Miami meeting when it snowed. And about the same time as the major earthquake in Haiti. So it was a pretty eventful time in our organization to support our colleagues who were responding to that disaster. But then my well-meaning professional colleagues and friends said, you know what, you've got this skill set. You should put it to good use. And I love being involved in organizations and so went in as president of the American College of Clinical Pharmacy in 2014 as a follow-up. So I had a view of different cultures, different organizations. But honestly, a lot of the process to prepare yourself for that type of activity really translates between various organizations. So just a quick idea of my timeline. I was a new practitioner in the early 80s. But honestly, that isn't where my leadership started. I was raised by parents that made me feel that pretty much anything I wanted to do was possible. And perhaps fostered some of that through student leadership activities in various phases of my education, through Girl Scouts where I was an active participant through age 18. So I think an important part of leadership starts early on. And the message there is, if you're working with people, young people in particular, raising that expectation early on that they have a role to play and can develop their leadership skills. So I went through clinical pharmacy training at the University of Minnesota. And we're blessed in those days with some exceptional communication training as well as some of the leadership training. Just the little fundamentals that go a long way. And as I became a resident under Joe Dasta, he has throughout my career been one of my most important mentors and role models, as many of your training leaders would have also been for you. I participated in a lot of different work committees. And one of the things that my boss said recently was, you know, I was a bit of a challenge as an employee. And I wasn't quite sure where he was going with that. But it was because I made an effort to insert a pharmacist into discussions where no one had even considered that a pharmacist ought to be participating. And so, I don't know, maybe you call that pushy. But you know, again that's all looking for opportunities and putting yourself in kind of difficult situations starting on a small scale as you work your way up. With my critical care practice and critical care team, I was often a leader in quality initiatives to make sure that our care process from day-to-day was as it should be on the population of patients that I was touching. And that's leadership. As I was working with families or patients, making sure they knew I was a pharmacist, showing the role of pharmacists as members of that team. Anyway, things progressed in the Society of Critical Care Medicine such that we had a designated seat on the SCCM Council by about 1990. And I was privileged to serve in that role along the way for eight years as the Clinical Pharmacy and Pharmacology Designated Council member. And talk about a learning laboratory. You know, here were leaders from all the other sections and from the society. And along the way had to, you know, go beyond the absolute admiration to observation, learning, and ideally mimicking those behaviors and attitudes that I thought were important. And if you have the right stuff in SCCM, it's the existing Executive Committee leadership that selects their successors from the members of council who they feel have that leadership either demonstrated or potential. And so I joined the Executive Committee leadership and then had the ability to work even more closely with some of the very important leaders of this organization, Mitchell Levy, Phil Berry, and certainly David Martin, our CEO. I served as president for a year and past president. And as I said, my friends roped me into another organization, but a completely different experience because I went on to that president-elect position without prior experience within their board of regents or governing group. And it was, you know, fast forward because you're it now and you have to learn quickly. So different organizations will give you different types of platforms to progress and kind of hone your skills. And so it's really just a matter of at some point as you're developing to consciously start to pay attention. What is it this person does that I think makes a difference or makes them effective? You learn the process as quickly as you can, but you have to sometimes do it in a very accelerated fashion. I've left the bedside. I'm now doing pharmacy consulting. And so I get to insert myself into other places where perhaps no one anticipated a pharmacist would be playing a role. To me, you know, I'm impressed at this meeting how much more diversity we have as an organization. And I'll tell you, Maxwell in his inaugural presidential address talked about a multidisciplinary group and probably this group of white men was really thinking about anesthesia and internal medicine and surgery. But he did give a nod to various other healthcare professionals and the fundamental of this organization was built on at least a version of diversity that we have, I think, expanded beautifully. And I'm really kind of excited at the scope and depth of membership that we have developed. For us to be diverse means we need everyone. And we want everyone engaged to the level that's possible in your career so that we enhance the quality of this organization. But from the leadership side, we continually need to ask and listen. And you know, that's gotten harder as the organization has gotten so much bigger. My membership number is in the 2000s. And I haven't heard a number 17-18,000 members now. It's quite a change. But as intimidating as it might be, there are a lot of ways to insert yourself into our creative community. We call it C4 for critical care. And extensively within your specialty sections, those are smaller groups, just looking for somebody to step forward and add a little bit of time and energy and enthusiasm. Our local chapters, same thing. And I think we have the real opportunity there to draw beyond our SCCM membership and start to touch the people in your community who are involved in critical care, again, who may just need a voice or the opportunity to lend an ear. But I always like to put in a plug. We've got a formal process for you to join our larger committees. And it's an online volunteer form. Usually it's about a May 1st deadline. There's a lot of competition out there. So you need to be a little braggadocious. Sell yourself. Say why you have something to contribute to that committee so that, again, hopefully you kind of rise above your competitors and get some recognition. We really work hard though in those appointments to make sure that we have various disciplines represented to the best we can figure out, male and female, because some names are obvious and some names aren't. And so our database kind of limits us a little bit there. So we're really working to try and enhance that diversity. And then, gosh, the Fundamentals Program is something that reaches around the world. And locally you may have the opportunity to participate in a course and become an instructor and share your expertise locally. Or start a Fundamentals Training Program locally. There are a lot of ways that you can enhance your leadership skills. So as you get into kind of leadership stuff, it gives you a whole new realm of reading materials to consider. And as I was trying to prepare myself for more detailed and expansive leadership opportunities, I really took the opportunity to read a lot of these resources. And I'll tell you, Kuzes and Posner has written as a group several really good books. But their feeling is that everybody's got the potential skill to be a leader. Sometimes you just sort of have to be willing to take that plunge. And so we have to liberate ourselves that way. But as mentors, perhaps look for that in others. And assume that anybody can be a leader in as big a field of play as is appropriate. Takes a little belief in yourself, a little bit of work to develop some of those skills so that if the opportunity comes, you can be prepared. But there are failures. And I don't know about you. In patient care, I always remember the things that I probably could have done differently or better. Kind of the same thing in leadership. The odd meeting where it's like, oh, that did not go well. Hopefully I learned from it so that I did better the next time. Now when I was coming up, I am a little bit stubborn. Not a lot stubborn. One of the things as a clinical pharmacist, kind of forging new practice realms is I had to learn to be maybe oblivious but just not take things personally. So rejection wasn't usually about me or what I was suggesting. And certainly discussion led to opportunities for me to learn and perhaps educate others and come to a consensus that hopefully was correct for a patient care scenario. And the term imposter syndrome really wasn't around at that time. But particularly as a pharmacist moving into leadership in a highly physician-centric organization, I had to realize that it wasn't uncommon for me to say, oh, my gosh, how did I get here? What am I doing here? How is someone going to treat a pharmacist? Maybe I don't really belong here. I certainly felt welcome. Oh, my gosh, the leadership of this organization really just embraces people and helps pull them along. But gosh, I worked hard to make sure I was prepared because I was a bit insecure. I knew I'd make mistakes. And hopefully I learned from them. I was, you have to be open to new things. And no matter what level of leadership you're in, probably one of the biggest things that you can demonstrate is ability to finish the job. If you volunteer for something, follow through to the best of your ability. And in real life when we go home, it invades and makes that difficult. Certainly for those of you who are in some leadership position or training positions, parents, look for and recognize people who have the leadership skills, those characteristics that leaders portray. They often are happy to serve others. They often either have or are developing very describable values. They have a passion about what they're doing at whatever level they're contributing and maybe a vision for the future. They often are very effective teachers, but hopefully aren't braggadocious about it and demonstrate humility in going about their activities. And probably the most important thing in our world is to not let urgency crowd out what is important. Because patient care, family life, all the things that keep us very busy have a tendency to crowd out what sometimes that we think ought to be important. So I encourage you to hopefully as we get this career advancement program rolling ahead in SCCM to look for opportunities and resources and readings and presentations, references that you can use. But certainly hope you, if you haven't, embrace our creative community and become part of our team. Thank you. Next I'd like to invite Dr. Kapu from Vanderbilt. That was wonderful. Now I know I have a fellow Girl Scout on the panel. So that's right. So it says a lot about the Girl Scouts and you've said a lot of wonderful things about the Society of Critical Care Medicine. And definitely it has offered many, many leadership opportunities for me personally. So my name is April Kapu. I'm the Associate Chief Nursing Officer for Advanced Practice for Vanderbilt University Medical Center. And it has not been easy to get to where I am today. And so I wanted to share a little bit about my journey and hopefully some lessons learned because I certainly am learning lessons each and every day. I was one of those kids that always went around with skinned knees and kept trying and just kept trying until eventually I would get there. So that's kind of my mantra in life and what I try to teach not only my kids and my family, but all of the folks that I work with every day. So I was a critical care nurse. My background was in cardiovascular critical care. I went on to be a nurse practitioner there and absolutely loved it. Loved being part of the team. Loved learning each and every day. Really enjoyed working with my physician mentors, leaders, nursing leaders, my fellow PAs and NPs and all of the nurses. So it was a wonderful team environment, really focused on the patient. And I really, really enjoyed just the opportunity to learn and learn every detail of what was happening with my patient and really learn from others and have had the very fortunate opportunity to work with people that are absolutely brilliant and just to have a moment to really explore what they're thinking and putting all those pieces together to be able to provide the very best inpatient care. After there became an opportunity where at Vanderbilt we built a critical care tower back in 2009. And at that particular time I applied to be the director of critical care. We had had a very successful critical care team of NPs and PAs in our cardiovascular ICU. And so that said a lot. A very big statement in terms of building out our critical care tower where we doubled our numbers of beds. And it said a lot in terms of the organization to be able to say, hey, we want to have someone come and help put NPs and PAs in all of these units 24-7. So it was a really wonderful opportunity. I got to work with fantastic medical directors. One is here on the stage today, Dr. May, as we worked really hard to create 24-7 NPPA teams in those six adult ICUs. And we also have two amazing pediatric ICUs with our children's hospital next door. So now I'm the Associate Chief Nursing Officer over all of advanced practice for the health system. We have about 1300 advanced practice professionals. The majority of those right now are nurse practitioners, but also a growing population of PAs, a good number of midwives and CRNAs in that number. So it's a big organization. I feel that my background in critical care and being able to really see the potential in NPs and PAs has really helped in my current role today. And it's been fun to see all of the different practices, work streams across the system, both ambulatory, inpatient, and critical care, and how there are some things that we do that are very similar and some things we do that are very different. But at the end of the day, it's just amazing to be able to work with health care providers and health care team members that are just really focused on what is best. And I think at the very end of the day, that's the type of people that I'm very fortunate to work with each and every day. I'm also a professor for nursing at our Vanderbilt University School of Nursing and teach in their doctoral program. And then I'm an associate professor for critical care in the Division of Critical Care in the Department of Anesthesiology. I'm very, very proud to be part of that group as well. I have directed our doctoral-led fellowship programs. I am a fellow for the Society of Critical Care Medicine, also a fellow for the American Association of Nurse Practitioners, where I also serve as the region director for our region there. And then I am also most recently a fellow with the American Academy of Nursing. I hold a lot of roles on a day-to-day basis just within our organization, so chair many task force, work groups, committees. And I'm a member of many committees and task force. And I think it's been very powerful to learn how important it is to be a follower as well as a leader in the many things, the many initiatives that we do on a day-to-day basis. I'm also very involved here at SCCM. I'm the outgoing chair for our APP Resource Committee, which is all about education and resources from the perspective of critical care. And then a member of our nursing section and different committees that we've had available to us here. And I am super excited about the evolution and how diverse our SCCM membership has become, not only with women in critical care, but also in accepting all of the different members of the healthcare team. So our nurses, our NPs, our PAs, our CNSs, our pharmacists, we're all working so closely together with one common mission really. So a lot of those things, and I just wanted to stop here and say that work and my leadership journey has not come all from within. I certainly believe in myself and believe in what I can potentially achieve. And I've had great parents to show me that, but really it has been the mentors that I've worked with each day that have seen a spark of potential in me, that have seen curiosity and seen that I am very passionate, very hardworking, and have given of their time, and in many cases it's been a lot of time, to really help me to learn and grow as a leader. So as a system leader, I've worked very closely with our chief nursing officer, our executive chief nursing officer, our chief medical officers, our chiefs of staff, and each one of them has just really been so generous in taking me under their wing to teach me much of their leadership, background, their journey, their lessons learned, and really how to navigate in what sometimes can be very challenging environments, certainly the healthcare environment as a whole. But with us in an academic medical center and many healthcare systems, there are a lot of political things occurring, a lot of sensitive issues, a lot of the need for use of your social, emotional, political intelligence, and if it weren't for those mentors, I don't think that I could have progressed as I have today. Certainly in the fellowships and being part of SCCM and the different organizations and associations I'm part of, it's really been mentors like Dr. Ruth Kleinpell and some of the different advanced practice leaders that are in the audience today that we're so close with one another and we talk about the different challenges that we have on a regular basis and I learn from them almost every moment just how to do things differently, how to see things differently, how to see things more from a higher vantage point than just exactly what I'm seeing at that particular moment in time. So mentors have been powerful in addition to the formal educational processes, the mentorships, the informal day-to-day coaching has been really key to my growth and development. And then from an academic standpoint, when I moved from my role from a CVICU nurse practitioner more into the academic realm, I really had some amazing academic mentors that really said, you know, this is going to be a very important part of your career. So going after those grant funded projects, leading research projects, publishing often, getting our work out there and a lot of my background in publications has been around advanced practice and building out NP and PA teams in critical care. And so having that out in the public domain is so important. And so a couple of my mentors there have certainly been, if you went to the opening ceremony with Dr. Bernard, he mentioned Dr. Art Wheeler. And so I had the very, very fortunate opportunity to have an office just a couple steps down the hallway from him for many years. And he really took me under my wing and taught me how to write, how to research, how to put my projects together so that they were very strong in terms of evidence. And I will never forget that opportunity and how deeply I value the opportunity to have worked with him as well as a mentor. We now have 18 directors across our organization. Specifically we have a director of critical care for our adult hospital and our pediatric hospital. So really focused on that patient population. But our directors work very closely with their physician leader partners, their nursing leader partners each and every day to really provide their perspective and focus on their cohort. How does their cohort complement and blend with the entire healthcare team? Each of those directors have managers and team leads that work with them. And so it's a very good opportunity for our clinical experts as NPs and PAs to grow into a leadership opportunity or a leadership role. And we want to make sure we provide the pathway to do that within our organization. But also we provide opportunities for all of our advanced practice professionals to be able to go out and be part of research, part of education, part of our leadership growth and development program. We value greatly the opportunity to partner. And I think that's key that we bring our perspective to the table and that we certainly are seen as partners and we have a common vision. So every one of us has had an opportunity to be able to work with remarkable medical directors, attendings, physician leaders. And I have had the great opportunity to have the respect of those many very accomplished leaders and to be able to contribute my voice in terms of building different programs, plans, as well as day-to-day patient care plans. Our APN leaders are invested. They take ownership in the team and they work on those things that are unique to our group. So we're very good at recruiting the right people with the right education, the right background, the right amount of experience. We're very good at putting together orientation and onboarding programs so that our NPs and PAs feel very invested and very competent in what they do and a valuable member of the team. Our leaders put together schedules and things like that, but they also put together standards of care, procedures, protocols that they work collaboratively with our medical leaders and our nursing leaders to develop. So very important role, that advanced practice leader. And above all, they elevate the APP as a very valuable member of a very highly reliable team. So challenges. We were asked to talk a little bit about our challenges. So I'm just going to throw five big challenges that we've had throughout the years. And that has been staffing. How do you pull together the right combination of people within an ICU? How many NPs and PAs do you need? How does that complement your teaching team if you're an academic medical center, the number of interns, residents, fellows? How do we put the right combination together at the bedside so the patient gets the very best in care? When we put forward staffing proposals, we always put forward, if your organization, our organization, our APPs are billing, we put forth a Common Performa, a business plan. But we also make sure that we incorporate the total compilation of the team. And then what are our quality metrics that we are going to achieve? And what's the downstream ROI to those quality components? So that's huge, making that case, making sure we're including the entire care team, what everyone's going to do, and then making the case for our staffing. Certainly understanding within each patient population what is ideal in terms of a number of patients to care for. As an APP, that goes into the mix as well. So staffing has been something that has grown throughout the years and something that I try to teach to our up-and-coming teachers. How do you put a plan together and how do you present that plan effectively? Pay is always an issue and comes up all the time. And if I was, you know, if somebody said, you know, if you could give any piece of advice and if I could give this advice to my own organization, I would say just benchmark and stay with the benchmarks. It seems hard year over year to do that, but the loss that you incur from losing a very experienced member of that team is incredible. And for APPs, it can be one and a half times an APP's annual salary, an immediate loss to the turnover of that APP. So the financial loss that comes along with not staying with market is great. And so if I could just wave a magic wand, that would be it. Benchmark and stay with the market. Even if it's with the 50th percentile, stay there and don't get behind because that can really bring a lot of pains along the way. Schedule. So always when we're in 24-7 environments, certainly where we are here, scheduling has always been a challenge. Nobody wants to work every night, night over night, year over year, and every weekend. There's an occasional person that does, and they're a diamond in the rough. But, you know, if you're going to ask people to work tough schedules, nights, weekends, call, pay for that. Pay for that. And I know that can be, you know, that's some people take that as a challenge, but I'm just saying pay more for taking on the worst hours. And then you'll have people that will readily jump in and say, hey, you know what? I'll sign up for that for a couple of years. I'll work dedicated nights and be there. My other big challenge is communication. In a big, complex organization, communicating, even though you felt like you've communicated to your blue in the face and you've involved everyone, you can never communicate enough. There's always that one person that says, wow, they didn't tell me. I didn't know anything about that. So constantly communicating, often as much as possible. If you feel like you've communicated, over-communicated, you still haven't communicated enough. So that's my mantra. I take that from a clinical bedside perspective as an NP. Sometimes I felt like I've told the story of the patient to 10 different people in two hours' time, and I learned that's important. Everybody has to be on the same page. It's the same in executive leadership with healthcare, communicating often. And then for us as an academic medical center, teaching is core to our mission. And as APPs, sometimes we just want to go, get the job done, go home. But what we have to realize is that we're part of that teaching team. And so there are residents and fellows that know more than we do that we really need to learn from. And there are residents and fellows that would love to learn from us if we would impart of our knowledge. So constantly learning from one another. One of my greatest teaching mentors was a PA, 30 years of experience in the OR and in the ICU. And I cannot tell you today how grateful I was for his teaching me how to very carefully do so many procedures to where I took great pride in the different procedures that I performed in critical care. Those things are very important, being constantly part of that teaching team and contributing and learning. Lastly, just some pearls from along the way. And these are just pearls from my own skin knees. So not great quotes, but they are just some things that I've learned along the way. And one of those is if you're going to lead people, you really need to walk in those shoes. If you're really going to lead in critical care, you need to have worked in critical care. And some people don't have that opportunity. So I have a team that works for me, an admin team, a finance director, operations manager, different folks in my office that work for me to help support our Advanced Practice Program. And so one of the things I ask for them to do when they're new is go out and round with our APPs. Go to the unit, round, see what they do. We have a new biller come on, a coder, a biller, we say go round and see what those folks are doing each and every day. You need to see it. You have to experience it. And then you value it, you respect it, and you're committed. And so walking in those shoes is incredibly important to be respected as a leader, but also making sure that people that may not be medical in nature, that they have that insight to what you all are doing each and every day. The second thing is focus on the moment. So we get so busy with so many things we're doing, and we know this from being at the bedside in the ICUs, is when we're talking to that patient and that family, it's all about them. And the house could be on fire burning down so many other things happening, but we really need to focus on that patient and that family at that particular time. And it's the same in executive leadership. If you've got 30-minute meetings throughout the day, which I often find, you might be talking about a research project, you might be talking about the budget, you might be talking about staffing, every single thing, every 30 minutes of the day, but you really have to give your focus to those folks in that room and that project at that particular time. So shutting everything out and laser focus on the moment and the people that are there and really listening and to all of the contributions that they're making. Timing is everything. Gosh, I've learned this so many times over and over. If your proposal today doesn't go through, wait it out. Come back again. Time might not be right at that particular moment, but it will be in a week. It will be in a month. It will be in a year. It will be in five years. There are so many projects that I've had to really dig in for the long game and know that timing is everything and things will align within the organization that open the opportunity for that perfect idea, that perfect solution, that perfect project to come into play. And I've more recently seen that with our deployment of a dedicated rapid response team that, gosh, we did everything and it just seemed like the best idea, but to everyone in the organization and the decision makers, it just didn't align for so long until just recently. And we just had everything, all the stars aligned. We were able to take our complete proposal, our pilot, our data, and be able to say, this is the solution. This is what we've been saying, but this is the solution. And it was able to come to pass. So timing is everything. If it doesn't happen now, it will eventually. And then the next thing, and this is really hard for me in critical care, I am just really all about you've got to get the facts together and you've got to make a decision with the facts that you have at the moment. That's what we do. We get our facts. We got to make a decision. We're in a lot of very urgent situations. And so that's a lot of that clinical background, but that's not the same with healthcare administration. Sometimes we have to say, okay, we're not going to check off our whole list today. We're not going to make sure that that right's controlled or the ejection factions. We're not going to be able to do all of that today because now we're in administration and we're going to have to wait and we're going to have to vet the proposals more, talk to more people. We're going to have to put our facts back together. We're going to have to reformat our presentations and we're going to have to go back to bat over and over again. So everything's not going to happen by the end of the shift or the end of the day or the end of the 24 hours. And that's something that's been hard to learn, but something that's important and important to teach as well. No one's going to die if you don't make that staffing decision today. No one is going to die if we don't make that budget decision today. We may need to think it over for a couple of days before we come back to the table. And then just these other few comments just to share is that healthcare is very complex, and there's so many different perspectives. There's financial perspectives, there's the CEO's perspective, the nursing perspective, the physician perspective, all of the different perspectives, and we really may not have all the facts at the same time, or all be on the same page. So really what we need to do is just say, you know what, we're all going after the same thing, let me continue to make the case for my team, or my idea, and if all else fails, pilot. Pilots just work all the time, and for some reason, people in healthcare administration today, they understand a pilot. It's a short-term investment to see if you're gonna have long-term gains, and if it goes well, then hopefully you can put all that into place on a regular basis. And then the very last thing I wanted to share is that seize the challenge. It is a gift to have a challenge. It is a gift to be in a complex environment. It is a gift to have a very complicated situation in front of us. We can pick through that, we can work it out. There are so many opportunities that can come of that challenge. So I love the term seize the day, seize the moment, take on the challenge, see it as an amazing opportunity, and find out what can come of this challenge that can make everything that much better. So thank you. Thank you very much. Next, I'd like to invite Dr. Halpern to the stage. Thank you very much. Dr. Jacoby's number was in the 2000s. I think I may be one of the few in the three digits. I am number 621. That puts us back to 1984. So I feel a little ancient with that. Anyway, I'm going to talk about the lessons I've picked up along the way from the perspective of a critical care physician leader. Currently, I'm the director of the Critical Care Center at Memorial Sloan Kettering. Some disclosures. In terms of leadership, I've sat on two, forget the consult advisor stuff. I've sat on two, I do sit on two boards of directors, which has been very helpful for me in learning about leadership. One is the FGI, the Facility Guideline Institute, and they are the group that develops the guidelines for hospitals, nursing homes, and any kind of facility related to healthcare. And that's been a wonderful experience in seeing how a group creates the guidelines that are used by, I think, 45 states in the country. The Healthcare Chaplaincy is a totally different organization. This was one of the largest organizations in the country. And at one point, we had approximately 100 chaplains. And we provided the chaplains for Hurricane Sandy and when the World Trade Center collapsed. So it's been a very good experience being with those groups. My background and leadership really starts with my father. My father was a rabbi of a very large, diverse, and dynamic synagogue for 64 years. One person in a job, 64 years. And that teaches a lot. First of all, survivorship. Second, to lead people where the congregation changes over time. Imagine if by each speaker, a new group of audience members came in. So you have to learn to adjust. In fact, my father at some point learned Russian because he had 100 members that came out of the USSR. So I was mentored by him. And I would think over the years, he's been the finest leader I saw. I had leadership positions in high school and college. I think I took a vacation of leadership during medical school residency and the wonderful fellowship I had in critical care at University of Pittsburgh under one of the giants that, the founders of critical care, Dr. Aki Grenvick. So interestingly, we rounded every night at 2 a.m. One on one. And people ask me about it again at this meeting, is this possible? He lived on a different time. He ate breakfast at 11.30 p.m., came into the office at 11, found the fellow and did rounds. And there was nothing as comparable as rounding with this master of critical care and life at 2 a.m. It was a great experience. My first job out of the fellowship in Pittsburgh was in leadership. So I will talk about that in a moment. I've never been in the professional world, not in some type of leadership position. And I've had no advanced formal education and training in leadership, although there are multiple approaches to obtaining that. I've really learned on the ground. So my first job out of fellowship was at the James J. Peters Department of Veterans Affairs Medical Center in the Bronx. It isn't just Bronx, the Bronx in New York. I was recruited as the chief of surgical critical care. I was an internist going into a department of surgery. And that already started all kinds of challenges. It was fortunate that at Mount Sinai, the mothership, Tom Liberty, my close friend who passed away years ago and a leader in our society, was the first internist in that group. So we were internists in the department of surgery running surgical critical care units. And that was a challenge. So I was recruited to be this SICU director. I want to know who my staff was. Well, I was a leader of myself. There was no staff. So it took a while to sort this stuff out, deal with the challenge of the surgeons and begin to create a staff. One day, the chairman of surgery walks in and he goes, you know those labs that are next to the ICU? I go, yeah, I've been wondering, it's been a year. Who owns those? I may have neglected to tell you, you are now the director of surgical stat labs on point-of-care testing. So this comes to leaders need to be able to learn. I knew nothing about these machines. I knew nothing about point-of-care testing. And it took several years and tremendous amount of learning experiences. And I became very comfortable in that world. And that's helped me going forward 30 years. And the next year he said to me, by the way, there's this group called the AABB, American Association of Blood Banks. I go, wow, never heard of that. And they're coming to inspect the intraoperative autologous transfusion program in the OR. So, wow, what does that have to do with me? That's well, I may have neglected to tell you, you are the director of this program. I go, wow, do I have to be a pathologist? You are the director, it's the VA. The government could create its own rules. So one of the messages is opportunities came, were handed to me really on a platter. And the question was, can I or anyone faced with this grow into things they know nothing about? And I would hope the answer is yes, but it's a lot of work. I had a great interest in products, devices bought in the hospital. So we put together a Commodity Standards Committee, Capital Equipment Committee, and I chaired those for many years. I then moved into the medical attending staff, thinking that the president of the medical attending staff is in a strong political position. I learned actually the opposite. It's really a joint commission mandated position, but it was an interesting year. Then our internal medicine program fell apart. What does that have to do with me? I'm a surgical ICU director. Well, we needed house staff. And the Residency Review Committee, the ACGME had withdrawn our program. Multiple years, people had tried to get it back online. And I said to the director of the hospital, give me a chance. What do you know about this? I go, not much. Anyway, we were able to get the program back online and put house staff in the unit. I was the VA rep on the Mount Sinai Faculty Council, and you learn a lot. You're with the dean and the president of the school and university, and you see what's happening. And then the opportunity came as we expanded our fellowship to Englewood Hospital in New Jersey. So I coordinated that. Then in the 90s, the patient care centers were the big craze. So we created a patient care center for critical care, and I oversaw different areas of the hospital. In 99, as the godfather says, you sometimes get an opportunity you can't refuse. So Memorial Sloan Kettering came online, and I was able to take the leadership experiences and lessons learned from a small stage to a much larger and far more politically animated stage. And I was happy to say they had more money than the federal government. So that was good. And essentially, in some way, I was able to take the leadership roles I had learned at the VA over 13 and a half years and take them with me and try and further development at Memorial. So I came in as service chief for critical care, medical director of respiratory therapy, which was a new role for me. And then I met with the hospital director, and we put together a clinical device and product development committee. So again, things that I've done in the past, gone on to a bigger stage. I didn't mention when I was at the VA, I had the opportunity to renovate a surgical ICU and design and build from scratch a 20 bed mixed med surge ICU. And as that next opportunity came up at the VA, I chaired the ICU design committee. And through that, fortunately, we won an ICU design award in 09, that allowed me to get onto the ICU design award committee at SCCM. So through things in the hospital, there was the opportunity to navigate into totally different environments. And I am still on that committee. I've chaired it. It's a lot of fun. As the national patient safety goals of the joint commission came online in 2014, 2015, I was asked to co-chair the alarm committee. ICUs and devices generate a lot of noise, and how can we put that together? And that's been also an unbelievable learning experience. As Memorial matured, and I helped evolve them, we developed a critical care center in 2017. That was a tremendous challenge to take a neuro unit, a pediatric unit, a surgical step down unit, and try and get everybody to sit together in a room. And it's taken several years. And part of the leadership learning experience is not necessarily to force people where they have to go, but to work with them collaboratively to help them get there. And many of the ideas come from them, not just from the leader of the group. And finally, we've developed an enterprise-wide clinical device committee as Memorial has built buildings all over. There was nobody actually looking at the bread and butter that we're looking to support. So what have I learned about leadership? I'm gonna concentrate on four things. There are three kinds of people, and we'll talk about that. Leadership skillset, and we've heard this eloquently from the prior speakers, is a combination of personality attributes. I'm gonna highlight four special capabilities of great leaders. One of them we just heard, timing is everything. And what a critical care leader needs to do specifically to maintain their critical care leadership. So I have found the three kinds of people. They're the people that are always leaders. They were born to lead, it's in their DNA. The second group is the ready to lead. They're not yet a leader, but they have strong potential. They may or may not have thought about advancing to leadership, but they're ready to lead when called upon, or they don't wait to be called upon. They step up on their own when they see an opportunity, and as the prior speaker said, they seize it. And then the third group is the people that, in my opinion, will never be a leader. No matter what opportunities exist or are offered. So there are a combination of personality attributes that when put together, create the leader, or the leader learns them along the way and improves themselves as a leader. This is different than being just an excellent clinician, educator, researcher. So the leader projects a vision, confidently and comfortable leads others to the vision, doesn't get distracted or dragged down by the noise and the naysayers. You have to be able to focus, and we've heard that already. You have to engender trust among the leadees. I'm not sure that word exists. The leader has to have imagination, intuition, resiliency, and long-term faith in what their leadership is on their program. However, they have to be receptive to contrary opinions, and they have to adjust to new realities and easily revisit past decisions. You have to grow on the job willingly, and we've heard this from the prior two speakers. Take on new tasks. Be okay with mistakes and failures. Be patient. Be both mentorable and a mentor to others. Fine-tune the leadership skills. And there are always gonna be challenges within the leadership world, and many of them are political, and many of them are sensitive. So you have to be able to find people in the organization with discretion. They could talk to them when you're addressing personal leadership challenges, and they can help you. There are four, what I see, special capabilities of great leaders. The prior two slides are just the things you need to be a good leader. Great leaders are at a whole other level. They could do two things. They could visualize and actualize. Usually, they're people that have the vision, and they're people that operationalize the vision. Great leaders can do both. We've heard timing is everything, but it may really be hard to figure out the right time. And we've similarly experienced. We thought the program was all set out, but it wasn't the right time. The stars didn't align. So the great leader can help sort out the timing. The next thing, if you know your book of Daniel from the Old Testament, the king in Babylon couldn't read the handwriting on the wall. So reading the handwriting on the wall, the messages that are spoken but silently, that's very hard. And a great leader can read the handwriting on the wall. And finally, a great leader can create leadership opportunities. The leader creates them. In sports, they call that creating space. If you watch Steph Curry over the years, he has this unbelievable move. The defender is all over him, and this guy, in a millisecond, steps back. They're three feet in between him and the defender. Defender's shocked. And you shoot a three-pointer. So that's the idea of creating space when it seems there's no space to be found. Critical care leadership needs some tweaking. You have to assure the critical care system that you oversee is positively viewed by clinical services and departments. That means the ICUs are clinically excellent, user-friendly, provide quality care, education, and research, and that all the customers of critical care, that includes your staff, the departments, your admitting doctors, your patients, their families, everybody is happy and feels their needs are being addressed. And the critical care leader supports his or her own program but is not defensive and is open to suggestions. But more than this, you have to realize ICUs are more than clinical care areas from the perspective of the hospital. They're stressful, diverse political environments, and they cost a lot of money to run. So critical care leadership then has to figure out how to be viewed as intrinsic and valuable to the hospital. This requires strong participation in both the clinical community and the hospital administrative community. I know many ICU directors, service chiefs, division chiefs, they say, why are you wasting your time on these hospital committees? They have it backwards. By wasting my time, so to speak, on these hospital committees, you become known, you become liked, you become seen as a valuable member of the hospital community, and that will only support the ICU going forward. So in conclusion, there are multiple pathways to becoming a leader. The leadership skill set is unique as a combination of many personality attributes. And a good leader should correct for typos. Excellent leaders have great situational awareness. CCM leadership itself is complicated and requires the CCM leader to understand his or her place in the organization, and successful leaders keep working at it. Thank you very much. All right, next I'd like to invite Dr. Slonim to the podium. And thank you for allowing me to speak with you for a few moments. My name is Tony Slonim. I'm the president and CEO of Round Health in Reno, Nevada, which is a five-hospital health system. I'm a recovering intensivist by background. Who aspires to be a health system CEO in Reno, Nevada? Put your hand up. Nobody. One, good. I got a job for you. It's interesting, you know, when I sat in audiences like this at the Society and in other venues, I never dreamed that I would be a health system CEO. What makes it more complicated is I've never been a hospital CEO. And the jobs are very different. The job of a hospital CEO is very operational, very deliberate on management, very execution-oriented. The job of a health system CEO is about vision and strategy, making decisions about the unknown, thinking about where you might wanna be three to five years from now. And it's always been interesting to me as I reflected on my own leadership journey about just what were the key areas where I could have benefited a little bit more by paying more attention, or perhaps was benefited because I was listening and was paying attention. And as I think about those opportunities and those instances, it certainly goes back, like many of the other speakers, I have examples of things from my childhood and from my family that really drove me, I believe, into leadership as something I aspired to. It didn't happen for me, though, initially, in medicine. I was a nurse before I went to medical school. And after being in nursing for a while as an emergency department nurse, I had broad-based experiences and really wanted to advance my work in the clinical practice of medicine. I'll share with you my entry in critical care was interesting in that I was a Med-Peds guy. Back in the 90s, I did a Med-Peds residency, so I'm an internist and a pediatrician. And then, by all accounts, as far as I can tell, I was the first one in the country to do Med-Peds critical care. So I'm an adult intensivist and a pediatric intensivist, and I still maintain all four of my boards. And it was interesting because when I applied for fellowship, I was at a place that was very non-academic, a place called St. Joseph's Medical Center, where I really learned the bread and butter of medicine. It was at a time when, whether you lived or died as a patient, I don't recommend this, but whether you lived or died as a patient depended who the third year was that night, because that's all you had available to you. And I was sitting in the doctor's lounge as the chief resident, contemplating my future, wanting to care for people in my community, and I was reading critical care medicine, because out of a 48-month residency, I spent 18 months in the intensive care units. Again, could never do that now, right, because of all the rules and regulations. And so I'm sitting there in the doctor's lounge, and there was a big ad in the back of the journal. It said, hey, if you want to do critical care cardiology or critical care infectious disease or critical care pulmonary, call us at the NIH for fellowship experiences. I got off the couch, and I walked to the phone, and I picked up the phone and called and said, hey, I want to do Med-Page critical care. And they said, what, what are you talking about? And it's interesting, because I called a couple of other programs and spoke to the program directors, and they said to me, when you figure out what you want to be when you grow up, call us back. But the NIH said, wow, that's pretty interesting. Nobody's done that. Come on down for an interview. And three days later, I went down. I had an opportunity to meet there and with the folks at Children's National. And before I got home, I had an opportunity to go down there, and three months later, I found myself in Washington, D.C. as an NIH fellow doing critical care Med-Peds. What was interesting was they said, wow, we were surprised. Henry Mazur, a great mentor of mine and active in the society, said to me, you were a real internist. We expected you to be one of those guys walking around with a teddy bear on your stethoscope, but you actually knew how to take care of patients, which was really, I guess, comforting in some ways. Along the way, and this is another Henryism, I guess, because what people say to you matter as you go through your life. After a year or two of clinical activities, you were supposed to spend two years doing research. My interest in research was in healthcare outcomes and economics of healthcare. Henry said to me, I remember that kind of mentorship, leadership meeting where he said to me, so Tony, what are you gonna do for the next two years of fellowship? I said, well, Dr. Mazur, I'm really interested in healthcare outcomes and economics. Economics of healthcare. He said, son, this is the NIH. We don't care about that stuff. Fortunately for me, another really great mentor, another wonderful father in the field of critical care medicine, Murray Pollack, came into my life and decided that having a free fellow for a couple of years was worthwhile and spent the time and energy mentoring me, and we have a relationship now that has moved into friendship, and it's just amazing. Murray said to me as a new fellow, if you wanna do this stuff, if you really wanna focus on that outcomes work, you're gonna need a master's in public health. You're gonna need to make sure you're advancing your education beyond the discipline of medicine, and really think, and I went on and got both a master's and a doctorate in healthcare administration and policy at the Center for Policy Studies at GW, but that ultimately made the difference for me because as we were standing around the intensive care unit at Children's looking at the 40 ICU beds that were filled, Murray came to me one day with a research project and said, I bet 1 3rd of the beds here potentially would be empty if we just did a better job around prevention. That's where your public health education comes in, and I have to admit, my doctorate in public health is probably worth more to me than my M.D. today in the work that I do as a health system leader because when I look out my office window, I look at 500, 600,000 people who are suffering, suffering from poor health status because they have behaviors that need to be modified, they may have illnesses or are victims of trauma that need to be addressed, and in a public health framework, it's about populations, community, and using data to improve your work. Academically, I rose through the ranks as a scientist, outcomes researcher, using large databases, ultimately became a professor with tenure, and had a variety of administrative roles like many of the folks on the stage. Started out as a medical director, medical staff leadership roles, ultimately as medical staff president, and then I changed, I transitioned, and this was very important learning for me. I transitioned from Children's National where I was an employee and a medical staff leader to vice president of medical affairs at a health system in Virginia, Carilion Clinic, and why that made the difference for me. I ultimately became the vice president of pharmacy there as well. Why that made the difference for me was I had heard people say to me, if you want to be a leader, the problem is you don't manage any people and you don't manage any budget, and those are the two key success factors for figuring out how you're going to transition up the leadership ladder. It's just unfortunately a matter of course, time, experience, managing people, and managing budgets, and for physician leaders, it's about managing other physicians. It's about how you get involved and learn how to influence and persuade people when they may not be willing to listen to you. Ultimately, one of the most important learnings what came as a vice president of medical affairs at the Carilion Clinic, one of my great mentors there is a woman named Nancy Agee. Nancy is the president and CEO of Carilion Clinic right now, an eight-hospital system in Roanoke, Virginia. She's the former chairman of the American Hospital Association, chairman of the board. And about 12, 15 years ago, Nancy was my boss. She was the chief operating officer at the time, and she said to me, Tony, you've had a great young leadership career. What do you want to do 10 years from now? I said, Nancy, I think I want to do what you do. I want to be a health system CEO. And she said, boy, we have our work cut out for us. She said, you know, you don't manage people. You don't manage budgets. You're a VP of medical affairs. You go to committee meetings, but we've got to get you in a position where you've got authority and execution and the opportunity to learn that managing people is the most important part of the work. And Nancy took me under her wing and she taught me and is still a dear and wonderful colleague and mentor to me in so many ways. But she taught me the importance of people. She said, you came from an environment where it was about bigger, better, faster, quicker, better outcomes day after day. And what you really need to know is that if you pause long enough and get to know people and work on your relationships in the middle of a meeting, even though nothing came out of the meeting, three months, six months later, those outcomes will be there because people trust you. Amazing learning, amazing learning that I had not had from any medical leader yet in my career. And so I left there and took a position as the chief medical officer for the health system at Barnabas Health. And this is a question I get asked all the time, particularly by physicians, but also from other clinicians, which is when I went to Barnabas Health, I was the health system's chief medical officer over eight hospitals. And it was in that role that I stopped practicing medicine. And that was difficult for me. I'm a clinician at heart. That's all I've ever wanted to do is be a physician. And wow, when you think about not being at the bedside anymore, and what does that mean? You really feel like a piece of your identity is being given up. And so I talked to my boss about that. And he said, you have a choice because this is about choice. Think of how wonderful this is. But we're paying you for a full-time administrative role. You can choose to go practice medicine. We'll pay you less. Maybe you don't want this job. Maybe you're not ready to commit. And it was really an important turning point in my career because I had to make a decision. Up to then, I had kept my research career going. I had still taught. I was teaching fellows, and I was teaching people. I was mentoring people on research. And I was doing my administrative work and still working clinically. But I realized that, you know what? It was harder at that time when you're practicing 10, 15% clinically to get to the head of the bed and feel confident when you got to put another tracheal tube in somebody. And you're pushing that neuromuscular block, and you're saying, wow, I better be able to get this tube in when before it was, there's no doubt I'm going to get this tube in. And so I share that with you because at some point in the leadership journey, not that you ever leave behind the clinical experiences you have, but you have to roll it forward in a way that makes you think about what you want to do and how you want to contribute. I left Barnabas Health about six years ago and I'm currently the assistant president and chief executive officer at Renown Health in Reno in honor of every day. And being assistant CEO is very interesting. It's very different. Every day is different. One meeting, you're talking about the clinical care and you're starvating. And the next meeting, you're talking about a patient grievance and how despite the fact that we hold ourselves out there, we didn't do a good job in caring for someone in the trauma unit. And I take those calls personally. I respond. There's still a part of me that believes in the bedside approach. And so even though it happens to be not next to a bed, but in my office, I meet with those families and talk to them about the ways we might've done things better and the way in which I'm sorry for the way that their loved one might've been treated. Those are very important issues. And I've been successful. I think that the ICU is an amazing training ground for being a CEO or being in leadership because we work on teams. We talk to one another. We have to communicate. Sometimes at very difficult, intense times. And so understanding how you work in that context is really important. I currently serve as the editor-in-chief of the Physician Leadership Journal, the American Association of Physician Leaders where I've been a board member for a while and chair their finance and investment committee. Now I am the editor-in-chief of the journal. Send us your writing. Give us your opportunities to publish your work. You know, I think you mentioned this so well before. For me, I've been able to run my leadership journey in parallel with my academic journey and it's made all the difference. If we were improving medication safety in the hospital, I was publishing it in a journal. If I was writing a paper on neonates and their contribution to ICU length of stay in the PICU, I was going to make sure our NICU babies were graduating from the NICU with the best care and transition back to the community. So running my academic career and my administrative career in parallel were so important. And one of the things that I think is not well shared is again, put your hand up. I'll go into, I'll conclude on my 10 pearls for you, but put your hand up. If there's an opportunity that comes your way, you don't have to be the expert. You don't have to be, you can learn so much about what the opportunities in leadership are. So when I shared that story with Nancy about wanting to be a health system CEO and she said to me, you never manage any people and you never manage any budget. Six months later, she made me the vice president of pharmacy for the health system. Eight hospitals. Everything from contracting through drug delivery and medication safety, all of IT. And I said, Nancy, I think you forgot a little bit about my background. I'm not a pharmacist. She said, no, but you're a leader. And we need a leader in this space. And so I went and led for the first time, a hundred pharmacists and 180 pharmacy technicians and six vice presidents and four directors and had a budget of about $250 million. And she said, go lead it. I'm like, I'm not gonna let you fail. I got your back. And that's what we need to do. It's just like mentoring our fellows. It's about helping them. It's about mentoring someone else, a junior faculty member in the society. It's about thinking differently about what skills you don't have and where the puck is going and what you need to do to get them. And I can reflect on my critical care journey a little bit in that space and a couple of things along the way where I was able to really tap into mentors and leaders. I was graduating from fellowship in 1999 and there was no review course actually at the time for pediatric critical care fellows. And so I talked in the fellows lounge to a couple of my colleagues and said to them, hey, how are you gonna study for the boards? And they said, gotta read the book. I said, well, that's dumb. You know, there's an adult critical care course run by Dr. Mazur. We should have a pediatric critical care course. You keep going on your pipe dream. So I called Henry, said, hey, Henry, what about a pediatric critical care course? He goes, who's gonna run it, you? I'm like, as a matter of fact, it sounds like a good idea. He said, well, you haven't even graduated from fellowship yet. Don't worry about it. I know a bunch of smart people. We'll put them in a room. They can give lectures and we did. And then 10 years later, 12 years later, it became the society's multi-professional critical care course. While we were at a society critical care medicine conference, there had been no textbook in pediatric critical care medicine from the time the Rogers textbook was last published in 1996, 2000, 2001. Went up to the Lippincott booth just down the exhibit center and said to the lady who was there, hey, by the way, there's no textbook. When's the next one coming out? She said, well, we're talking to people. We're not really sure. I said, I can write a textbook. She said, have you ever done one before? I said, no, but that doesn't matter. You can do one. I know a bunch of smart people. And I went and grabbed Murray and said, come with me. And introduced him, because he had gray hair and I didn't. I introduced him to the lady. I said, we're gonna write a textbook. He's really famous. And she, he just nodded his head. Six weeks later, we're in Philadelphia writing a textbook with a contract. Don't let people stand in your way. There are things that you can do that really will make a difference and advance your leadership career. Some pearls, you know, life is short. Know what matters to you. I'm a new grandfather. Wow, I know what life matters to me. Figure out how you want to make a difference and go for it. Stand for something. You have to stand for something in your career. Follow your passion. Know what drives you and live your values. Leadership is all about values. Care, being caring, being compassionate, working towards levels of excellence. Even if you're not any longer providing leadership in the ICU, never, never forget that healthcare is all about the patient and family and you have to treat them like your own. People in leadership matter and make all the difference. I get the great luxury of leading 7,500 great employees every day who come to work to make a difference in people's lives. And without them, I would be nothing. When someone asks you for a volunteer, put your hand up high. You don't need to know what they're asking you for. Put your hand up. Find a mentor or maybe two or three. Some of my best mentors have not been physicians. My last mentor was, my boss was an attorney by background. I've had nursing colleagues who have been amazing mentors to me, physician colleagues who have been amazing mentors to me, find a mentor. And then make sure you pay it forward to some other person who wants to come up in the ranks. You get paid on outcomes. Our world is all about outcomes, but you need to enjoy the process as well. If you don't enjoy being in groups of people and making a difference every day, don't go into leadership, not for you. You know, I was an outcomes researcher. Murray created a great outcomes researcher. I love the work I did because it was highly variable in the course of the day. And then at 38 years old, I got cancer. When you're an outcomes researcher in the ICU, you worry about live or die. Mortality is the ultimate ICU outcome. And when I got cancer at 38, I knew I wasn't gonna live or die. That wasn't the problem. I knew I was gonna live. The issue was, wow, I don't have enough energy to get off the couch and go have dinner with my family. And I had an oral cancer, and I couldn't eat for six months. And I spent my life on a stage teaching and talking, and I couldn't do that either. There are other outcomes that we need to worry about from the ICU and the way that we care for people that go well beyond the walls of the intensive care unit, back out into the community. Long-term outcomes that we know now are having an impact on people's lives from things we did or did not do while they were patients for us in the ICU. Make sure you pay attention to that. Know how and when to follow. I think somebody mentioned that before. And be appreciative and always say thank you. We are privileged to do what we do, not only in the intensive care unit, but in healthcare more broadly. Don't ever forget that. People don't get the opportunities that we have to serve others like we do. Thank you so much. Who wants to be a health system CEO in Reno, Nevada? Put your hand up. Yeah, I got a couple more hands out there. Thank you, guys. Not least, I'd like to invite Dr. May to the podium. Thank you. Thank you so much. Get my timer out here so I don't run on too long. I'll probably wax a little philosophical during this, as some of our previous speakers have done a bit. It's quite an honor to be included in this panel. I'm currently the Chief of Acute Care Surgery for Carolina's Medical Center in Atrium Health. For those of you who don't know, Carolina's Medical Center is the flagship hospital for atrium health in Charlotte, North Carolina. It's got its own residency and fellowship programs. It's the largest teaching facility for UNC Chapel Hill's medical school. Atrium Health now is somewhere just shy of about 50 hospitals, I think, at loose count. They're emerging so fast in North Carolina, South Carolina, and Georgia. So my position is really responsible for elevating and integrating the care for critically ill and injured surgical patients across the system, which is predominantly, really, in the greater metro Charlotte area at this point. So that's 10 hospitals, about 50,000 patients with EGS, traumatic injuries, or surgical critical care annually. And it's been a fun challenge to step into this role. I've only been doing it for about a year and a half. Look forward to continuing to do it. Along the way, let me see if I can figure out how to advance this. There we go, whoop, now it's going, yeah. I've, like everyone on the stage, and many in the audience, held a number of administrative positions. I wanna point out that 100% of all these administrative positions or titles are really a byproduct, not an end, of the goals that I've wanted to achieve. So the positions, really, that you hold may enable you to achieve what you want to achieve, but to me, they are not the end point of what you're trying to do. My first academic position was at UAB Birmingham, where I became the Medical Director at Surgical ICU, a fabulous experience at a young age. I served as an Interim Burn Center Director for a period there, and then got recruited to Vanderbilt, where I was a faculty member for 17 years, ran the Surgical Critical Care Service, as well as a Program Director the entire time for our Surgical Critical Care and Acute Care Surgery Fellowship. And I've held a number of other positions, including past Chair of the Surgical Section at SCCM and President of the Surgical Infection Society. So I want to define a little bit of what I want to talk about leadership. And years ago, I attended American College of Surgeons Leadership Curriculum, in which I heard Chip Shoba, who is now Emeritus Dean at Dartmouth, define leadership as the art of instilling in people the desire to strive together to create a better future. Or maybe to put it another way, your job is to facilitate and motivate groups of individuals and groups to achieve their best to attain a common desired goal. So for me, that definition, there's really two types of leadership that people define as sort of vertical, maybe the more common picture of leadership, but horizontal leadership. And what David Marquette in his book, Turn the Ship Around, calls leader-leader versus a leader-follower model of leadership. And so for me, leadership squarely fits into this, that your job is to get others and facilitate others' productivity in performing at their highest level. So along the way, I put together, this actually was a struggle for me to come up with my top 10 aphorisms, because I have a long list of them. Most of these I have pirated from books that I've read or people that I've interfaced with. A couple of them, if they're not in italics are mine. But, and there's not necessarily an order to them, but I sort of put them as sort of the base and then everything that comes down in my mind. And the first one is from a silly TV movie, I guess, I don't know if it was made for TV or not, but Secondhand Lion, in which Robert Duvall in the soliloquy tells the protagonist, the things that may or may not be true are the things that you need to believe in the most. And for me, that's doing the right thing, behaving with integrity and honesty, in the long run will trump taking shortcuts every time. So you really have to believe that and stay true to your core. Another aphorism that actually my sister-in-law sends, she forwards religious sort of texts to our family through email. And there's a website, Small Straws and Soft Wind, and Marsha Burns had this quote, it is of the utmost importance that you understand that your authority in any given situation is the direct result of carrying out your responsibilities. So to me, there's two components to that. One is, your boss can't give you authority if you don't complete responsibilities. You have to take on and accept responsibilities, which is really what all of the previous leaders have demonstrated, that they accept and complete responsibilities. There's another subtle interpretation of that though, it took me a long time to learn that you generate your own authority if you accept and complete responsibilities. There are a lot of vacuums out there in which individuals need to lead and create authority. And you can do that by accepting the role in completing responsibilities. So it is a little frustrating as a leader to have someone walk in your office and say, oh, I want to be X, and you go, well, yeah, but you've never done anything in X. It's not a successful strategy to ask for authority before you've completed responsibilities. Adversity doesn't create character, it reveals it. You really need to, again, similar to comments made by previous speakers, adversity is your friend, really. You want to accept those challenges, and it wouldn't be fun if you didn't have any adversity to deal with during your tenure. It took me a long time to recognize that it's not about being right. And I really recognize, no, actually, I was frustrated as a resident. Back in the day, we had mailboxes, stuff actually came in mail. So you'd go by the mailbox, and every day, I had this illusion that, okay, I'm gonna open my mailbox, and I'm gonna get a letter that says, hey, congratulations, you're the best resident ever. Well, that never came. But what did come was a copy of a letter from my chairman apologizing for my behavior with central supply when a patient was coding with no access, and they wouldn't give me a central line because I didn't have the charge card. Hey, please, let me have, can I speak to your super? And I thought I really handled myself well, and I was very frustrated that I got a copy of this letter. But it wasn't really until I was a medical director of a unit, and you have to call the residents in and sit them down, and you've gotten a complaint. And almost invariably, the resident's right. They're gonna say, well, but I was right in that issue. But that's not the important thing. The important thing is that two individuals have to be able to communicate and get to a common point of understanding without adversity. Because as soon as you start arguing points, you're no longer talking about the third party. You're just protecting your turf. And so it's really not about being right. It's about how you communicate and create bonds to move people together rather than proving yourself right. And then, you probably learned this best as a parent, it's better to let them be wrong. Right, if you're gonna change behavior, we don't learn by being right, we learn by being wrong. You learn very little by being right. And so, you know, that's why critical care is a great leadership training setting. You know, you can argue with somebody. If you're a good intensivist, you're probably gonna be right about whatever it is you feel passionate about. And you can argue and you can win your argument. The problem is, you know, you're gonna be right and so you will have prevented a complication, but no one ever accepts that a complication was gonna happen if it didn't. So all they're gonna remember is that you're a pain in the backside and they don't wanna deal with you anymore because you just argued with them and won the argument. And they're not gonna change their behavior. So really communicating, putting out your point, and then letting others be wrong is a much more successful strategy to changing long-term behavior. And I like to read a lot of books ever since I got an iPad mini and downloaded Kindle so I can read while I'm walking. And so in one of the recent books, Ryan Holiday, Ego is the Enemy, you need to choose. Are you gonna choose to be or choose to do? So positions and titles are being. And you can choose to be, but it's more important to choose to do. Getting things done, making a difference, regardless of titles, regardless of credit, in the long run, at least in my view, is what provides the return on investment for you. Another sort of quote or equation they use in the book as an aligning narrative in One Mission, which is the follow-up book to Team of Teams, Chris Fussell's credibility equals proven competence plus integrity plus relationships. And that sort of highlights and summarizes a lot of what the previous speakers have said. To be viewed as credible, you obviously have to have demonstrated competence, but you have to act with integrity, which could be defined as meeting your commitments, doing so with honesty and clarity. But the relationships you have are critically important. This is a complex environment. Thinking that you can do and achieve anything on your own as a silo is not an effective strategy. So you have to build strong relationships of trust so that people can work towards common goals. EDB, it comes from a close friend of mine who said, their father always said EDB, that expectations drive behavior. And Robert Caldini's book on influence really speaks to that. There's a lot of strong scientific data that talks about how expectations will change performance. So you have to maintain high expectations. You have to communicate those expectations and hold people accountable to those expectations. Another really good book that changed the way I look at a lot of things, Wisdom of Crowds. Diversity and independence are important because the best collective decisions are a product of disagreement and contest, not consensus and compromise. The more information that you can get into a decision and aggregate it appropriately, and there are ways to do that, the better the decision's going to be. And it's been proven scientifically over and over. This audience will have a better main answer to guessing the number of jelly beans in a jar than any one of you will on a single time. And finally, the true leader is not the seeker of consensus, but the motor of consensus. If you're gonna believe in the diversity and the strength with what that brings to the table, you have to be able to mold consensus. That's difficult. It requires that you allow people to speak and be heard, but at some point in the end, there can only be one decision, and you're gonna have to be able to accept that and move it forward. And so my final slide is just a reminder of the reading list that I'll leave up. I've read a lot of books. It was hard to put it to a top 10 suggested list, but this is a top 10 suggested list, and I'd be happy to forward anybody a list of books if you would like. Thank you very much. All right, well, if you're like me, a lifelong learner, you probably got a lot out of this session from all the comments. Lots of pearls there to dissect. So at this point, I'd like to take the next 20 minutes or so that we have left to ask some questions. Please, I have a few questions that I have prepared. I actually queried MedTwitter in this conference and got a number of questions that flooded in, and I was able to get a few of them. That flooded in, and I was able to dissect it down to just a few important ones that I think I'd like to ask the panel. But as we go through this, please, if you have any questions, keep them in mind, and then I'm gonna be opening it up to the audience. So my first question is, I think a lot of you have a lot on your plate and have done a tremendous amount during the course of your careers. Have you personally ever dealt with burnout? And on the flip side, how do you deal with burnout in your organization? And I'll just open it up to any of the panel. We have a new physician-in-chief, Lisa DeAngelis, who was the chairman of neurology for many years, and we had some upheaval at the top echelons of Memorial Sloan Kettering. She became the interim physician-in-chief, equal CMO, and she is now the physician-in-chief, and she has made it her goal to start addressing burnout, whereas the organization is forever in overdrive, and many of the clinicians feel they're like hamsters in the cage, just running on the treadmill. That is true, and it's really very difficult to stop that at the organizational leadership. You wanna grow. And she has really started to deal with the burnout. She's tried to do it from a practical way. In terms of my own service, I've seen clinicians over the years go up and down in their engagement in the ICU, in projects, in research, and I don't call people into my office mostly. I walk around and try and visit people in their environment. It's less than feeling you're called into the principal, and try to address that element with them, what's going on in their professional life, is there personal issues they would like to address? But I think that burnout is a very real thing. We've just done some survey of the hospital, and burnout came out as one of the top two things that the clinical staff is very concerned with, and I believe with a physician-in-chief that says we have to focus on this, there's a chance it will get focused on. But with that said, in very busy healthcare organizations, as I'm sure all the members of the podium are involved with, it is very challenging. And the answer isn't always add more staff, add, add, add. It's manage. I can tell you I'm fortunate that I became a grandfather seven years ago, and have three grandchildren. It's become probably the most important thing in my life. In fact, if I'm doing rounds, and seven-year-old little girls FaceTiming me, the teams know Dr. Halpern is gonna walk out of rounds for a minute and talk to her. And I wanna show that as an example that people can do these things. And I think it helps assuage the burnout when new things are coming in your life, if you're fortunate, or you create them, to help navigate work and life experiences. And you hope the organization's going along with it. Sure. I'd love to just follow up on that, because when you mentioned this was exactly what came to mind. I don't feel that I've struggled much with burnout, but for a long time in my career, I was very sort of myopic, and only put energy into just your career. The danger to that is, no matter how good of a job you do, there will be reasons why people will throw grenades under your cot, right? And in reading one of the little Harvard Business Review things that they send out called, Throw Your Life a Curve, so individuals are happy when they're on the steep part of a learning curve. And the article's about, oh, make sure you give yourself multiple curves, because it builds resilience. And so, if the only thing that you feel like you're making a purpose is your work, you are not very resilient. Because if somebody starts throwing grenades under your cot for no reason related to you, it's going to be miserable. So for me, that was a very big lesson. I still struggle with maintaining multiple curves. I've become very myopic, but for me, that was important. Go ahead, Michael. My experience in this has been interesting. I got some really great advice, I remember, on the second day of fellowship from an amazing grandfather, I guess we would call him now in the field, Alan Fields, who really had some early conversations with the society about burnout back in the early 80s when he first addressed this issue. And he said to me on the second day of fellowship, nice to meet you. He said, what are you going to do when you're done with this? I said, done with what? He said, done with this ICU stuff, because you're going to last about seven years. He said, I don't care if you're going to be the best dad, the best CEO, the best researcher, or the best teacher, whatever that is, go figure out how to get the skills now so that when that time comes, you're ready. And I think it was the best advice I've ever received in my career. I was just going to add a couple of things. I think as a very busy clinician, self-care is incredibly important, that you think of how you are going to care for yourself. And that is the hardest thing for clinicians to do, just like it's the hardest things for us to go and get annual checkups and things like that. But that is what is going to keep ourself, our body, our instrument strong over the long haul is that we really invest in self-care and part of that is, I agree, being a grandparent, too, has opened up a whole new world of being able to step out and really enjoy life. But I wanted to share, recently, we did a study of burnout among our APRN population and it was in parallel to the physicians also doing the same. But what we heard from, and we had about a 50% response rate, so about 500 or so people identified as either being burned out currently, formally burned out, or never have experiencing burned out. And we learned quite a bit from those people who identified with being formally burned out. So what, in their experience, helped them to become resilient and now identify with being formally burned out? And the key thing that we saw over and over again from the free text and whatnot was to make a change. And the type of change was all over the map. Some said, I took a different job. I began a different project. I got out of this or that. The type of change was all over the map. Social, they got involved in a social group. They spent more time with family. But it came down to make a change versus the people who were experiencing current burnout identify with not being able to get out or make a change. So it was really interesting what we learned from that. And in my experience when other, I was at the bedside for 38 years, so I made it past seven. But for other pharmacists, sometimes you feel a little bit powerless within your own department or within your team, various constraints to really potentially impact your practice and ability to really kind of have some control. And so the folks that tended to just kind of draw into themselves had more of those challenges, and I don't know that we knew to call it burnout, but more frustration, more than oh, I'm gonna change jobs or I'm gonna leave the bedside and go into management or just something to try and gain some control of my situation. And as you said, if you lose those experienced people, that's a huge loss at the bedside. And so I know for me, my outlet was professional organizations and the ability to network and find that other people have the same frustrations. And so it's kind of reaching externally to something I think is a really important component of that self-care. Thank you very much for those comments. Any questions from the audience about this topic in particular? Thank you, Jason Kane. I'm currently the interim division chief at Comer Children's Hospital in the University of Chicago in Chicago. An interim is challenging, mostly because I don't wanna be a division chief. So many of you have mentioned the issue of conflict and professionalism in your careers. And now talking about burnout, it seems like one of the key drivers to burnout is also interdisciplinary conflict and communication. And it seems that many who have advanced up the ladder towards administration have benefited from outside consultants or coaches. And I hear from our CMO that the vast majority of his work is talking about professionalism with clinicians who seem to not know where that line is drawn. And I reflect back on my own training and understand that there was never a day or a lecture or a session on communication and professionalism in the context of what I think you all do on a daily basis. And I'm just wondering from your perspective, is this a gap in training in our current environment? And do we as a society, meaning SCCM, need to target professionalism and targeted communications training or as fellowships and accreditation agencies, do we need to somehow make adequate and professional communication and training a metric or a milestone? Because it seems like advancing up this ladder requires a skill set that many of us who went into ICU care have avoided because it actually sometimes hurts the direction of our clinical care. So I'm curious about your opinions on that. I suspect if you look at any training program, you're going to see different versions of that or ideally components of that. And clearly, everybody can have a bad day and maybe snap about something or at someone they aren't really the problem to begin with, but certainly are the recipient of that. And so part of my resilience training was to never take that personally. But when it becomes a pattern, you're right, I think it illustrates that there's an opportunity for someone to be coached or to work in that setting. And I can't say whether it should or shouldn't be part of formal training. Ideally, there would be some attention to that professionalism development in any training program for any professional. I have made note of that, and I don't know if you were here for the beginning, the career advancement program that we're developing for SCCM is looking for ideas just like that. And I think that's a really important contribution that we haven't heard yet from some of our needs assessments. So I appreciate that and look forward to others' comments. Periodically, there are complaints about our fellows or attendings in their communications with families, other clinicians of any sort in the building. So I think as the leader in the group, I end up having to meet with the people and try and make sure we get rid of any defensiveness and go through what happened. So commonly the complaints come, but it's just one side of the complaint. So we then need to hear what happened from the other perspective and then try and sort it out. Can the conversation have gone a bit differently? But what we see in the ICU, sometimes I enjoyed the story of that you couldn't get the central line because sometimes in the ICU, things are very emergent. And the bureaucracy of the organization just manages to get in the way and trips the clinicians over their own legs. So a note gets sent, this is what happened, but the leader also has to go back to the hospital supply chain in that case or administration or patient rep. We spent a lot of time with the patient rep and try and re-navigate what happened. And help the person that may have been an offender re-look at how he or she navigated the situation. And we usually wait a few days to do this because people's emotions are still a bit elevated. I'm not sure that I can give a concise answer to your question because I believe it. Yes, we do a woeful job of developing professionalism during training. As a previous fellowship director, I tried to give our fellows a lot of responsibility for developing and growing things within the program and their own education. And it was amazing to me how inadequate they were coming in to that request. Throughout their training, it's amazing to me, we must just put a box around them and everything is done for them because they can't start a process. They would say, well, what do you mean I'm responsible for the educational program and people showing up when I'm not in the unit, I'm on another rotation? It's like, well, what do you think you're gonna do if you're an ICU medical director? By design, if you're faculty, you're in there, you're not. And so I don't think we do a very good job of training it. The problem is it's very much skills that are more through apprenticeships sort of models than you can just easily teach. So Quint Studer, when it came to Vanderbilt, made a quote about professionalism. A lot of it is better caught than taught. So it's important to find good mentors to support you throughout your career. A little bit of a pet peeve, you create a mentoring program, that probably the biggest skill we need to teach is how to get somebody to be able to identify and make their own mentors. Because that's what you have to do throughout your career. They're not gonna step up, you're gonna have to go find them. And so for that skill, it's a lifelong process. Yes, we could do a better job, but it's a long road to teach all those skills. I'd like to move on to the next question, probably our last one since we only have five minutes left. Have you ever perceived a diversity problem in your organization? And if so, what did you do about it? Yes, so definitely. I think my experience with diversity is it is important. And the evidence shows that diverse perspectives bring forth the best ideas and best solutions. And so that's something I think we've been taught over the years. What more recently I've learned is that, and try to practice is that diversity needs to be there. And I think that's something that we've been taught over the years is that diversity needs to be intentional. And so if you don't have a diverse pool of candidates, you can't say I truly chose the best candidate for the position. So it needs to be intentional. Intentionally, you bring diversity to the team, intentionally. And that was the part of the equation that it took me a little bit longer to really put together. Diversity is incredibly important, but it needs to be intentional. You have to often go out and recruit from the source of the population that you're missing. And so pharmacy tends to across the country, be a very white level of profession. And gladly that's finally changing. But if I have a training program and I want to bring in someone with a different cultural or ethnic background, I'm gonna have to intentionally go and seek those people out. And so it's that intention. Go to the school that has a greater percentage of graduates and say, here's how I can help you. Here's how you can help me. And so sometimes that's a strategy. Yeah, I agree. I think one thing that we have not talked a lot about here, which I spend about, I guess, 25% of my week on is board relationships. And so relationships with members of the community who serve as our governing body, we need them to be diverse too, because they help us to make decisions that are a reflection of the community that we're there to serve. And that's often challenging. I like the intentionality of it. I've also found in particular, you can learn yourself about the challenges in diversity by embedding yourself in the other person's shoes. So for example, there's a fair amount written about women and how women lead differently than men, better communicators, more personable and more trusted. It's a wonder we don't have more women CEOs and more deans and more other things. And so, wow, what are the things that help you to want to create that diversity from women? And how do you integrate that learning so that you can be a better leader? If it's important to leadership, why isn't it a part of all of us and how do we go about learning those skills? Thank you for those comments. Any final questions from the audience? Like to know where the panel places in terms of importance, emotional intelligence in a leader. Well, I think it was one of Addison's comments about reading the writing on the wall. Being in tune with what's going on with the people around you. And again, certainly I learned something directed in my direction to not take that personally. I had to identify that there was probably something else far more vexing than whatever question I had just asked. And so part of that is the timing is everything. Being aware that whatever it is you're gonna propose or a situation you're gonna challenge, you have to be aware of that mood in the room. And so I think that you're right, Russ, that's a really important capability. I would end that comment on, it's interesting for me as intensive care folks how we get paid for pattern recognition. What we do is to identify the patient who's deteriorating before they die. That's important. So using those pattern recognition skill sets and feeling about when the tension in the room is going kind of wonky before it ends up being exploding. Don't wait for the cardiac arrest. Intervene in a way that drives a more robust conversation before the end point is. For the sake of time, we're out of time, unfortunately. So we'll have to conclude. I wanna thank the panel members for some great leadership pearls that they shared with us today. I personally learned a ton and I hope you did too. Thank you very much for attending. Thank you.

panel discussion

critical care medicine

leadership

mentorship

new opportunities

building teams

adaptability

effective communication

hospital committees

pathways to leadership

good leader characteristics

self-care

work-life balance

communication training

diversity in leadership