Balancing Leadership and Operations in Emergency Medicine

How do you build a team in the critical first moments of a crisis? The balance between rapid response and thoughtful planning is delicate, especially when understanding what defines a crisis and acknowledging when you're in the midst of one. This conversation delves into the complexity of emergency team dynamics, emphasizing that the composition and organization of these teams are deeply influenced by their members' specific skills and contexts, with lasting implications long after the crisis has passed.

We introduce 'Name, Claim, Aim'—a straightforward, three-step framework designed to streamline team organization under pressure. It's about rapid situational assessment, clear role delegation, and setting concise objectives. The discussion extends to effective leadership in high-stakes situations, including establishing command, ensuring effective communication from the start, and striking the right balance to encourage team input without compromising decisiveness.

Exploring the subtleties of crisis leadership, we'll discuss the strategic balance needed for effective oversight and the practicality of 'Name, Claim, Aim' as a distilled version of more complex crisis management theories tailored for the immediacy of emergency care. The conversation will also cover the practical implementation of this framework, from team huddles to understanding the profound impact of the first few seconds on the trajectory of team success.

This episode builds on episode 115 - Zero Warning | Frameworks for no notice critical patients

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Guest Bio:

Lon Setnik, MD, is an emergency physician practicing in New Hampshire and the associate director of clinical programs at the Center for Medical Simulation. Lon is a Stimulus fan favorite. Here are some of his most popular episodes:

• Listening to Understand versus Listening to Win
• Feedback can be hard to give and harder to receive. Here are techniques to do both better
• Take the Suck out of Documentation | Making the most of scribes, documenting in the room (and in front of the patient), efficient workflows

We discuss:

• The tension between planning and action
• What defines a crisis?
• How do you know when you're in a crisis?
• Teams are contextual in their skill sets
• How you organize a team in a crisis has ripples after the event has ended
• The three steps to organizing teams in a crisis: Name, Claim, Aim
• How to declare yourself as a team leader
• Modeling closed-loop communication from the first moments of team formation
• The balance between being a tyrant vs an effective leader and how to avoid suppressing speaking-up behaviors
• The two pillars of Aiming what we want to achieve and who is going to do what to get us there
• Name, Claim, Aim needs to be fast and efficient; otherwise, people will just start getting to work without organizing
• Balancing the balcony and the dance floor | The impulse in crisis is to do. The leader does not have to be the primary operator, but it's hard to hold back!
• As a team leader, it's ideal to keep your hands off the patient during the beginning of a resuscitation
• Distributing decision-making across time and space, explicitly transferring authority when you need to put your cognitive load elsewhere
• Resetting Name, Claim, Aim at the first lull in action
• Crisis resource management transformed how teams function, but it has a lot of steps and can be hard to deploy in a flash. Name, Claim, Aim is a simple distillation of CRM that can be used in the point of care
• A graded introduction of Naming, Claiming, and Aiming
• Practicing Name, Claim, Aim in team huddles
• Taking 10 seconds for the next 10 minutes | Time is not linear and every second is not worth the same amount
• The consequences of not getting the first 10 seconds right
• Team success is an emergent property

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