The importance of leadership in the cath lab.

Abstract

High-quality leadership in medical settings improves the success and safety of patient care 1, 2. This has been well-documented in operating rooms 3, 4 and resuscitation teams 5. The catheterization laboratory team is no different. The patient relies on this team and recognizes the physician as the individual who coordinates care before, during and after the procedure. Within the catheterization laboratory, the physician takes the lead, commensurate with training, knowledge and status. Technologists, nurses and trainees complete the team. While the chief goal of the cath lab team is to safely and effectively complete the invasive procedure, a secondary goal is to optimize the experience for the patient and the cath lab team. Physician leaders must balance procedural safety and efficiency with the sometimes contradictory needs of the patient and team. For example, procedures go slower when the operator answers all of the questions of a highly inquisitive patient or allows a trainee to make multiple attempts to selectively engage a coronary artery. Formal leadership training is not provided in most cardiology fellowships 6, even though the Accreditation Council for Graduate Medical Education competencies include leadership. Until this changes, physicians who want to become competent leaders must learn these skills while on the job. An extensive literature on leadership has appeared in recent years and has been well summarized 7. A critically important point in theory of leadership is the difference between transactional and transformational leadership. Transactional leadership is the style most commonly practiced in cath lab. It is a quid pro quo relationship in which the physician leader provides the team with direction during the procedure and a “thank you” at the end, and the team provides the physician leader with their skilled services to accomplish the procedure. In contrast, transformational leadership enriches the team as it works together 8. The transformational leader teaches during the procedure, empowers the team to speak up when problems occur, supports suggestions for improvements, encourages collaboration among team members and provides psychological safety. Transactional and transformational styles are not mutually exclusive; leaders can transition between them as appropriate for a particular situation. However, the transformational style will lead to better long-term team dynamics and team member satisfaction, and physician leaders should strive to use it 9, 10. As SCAI welcomes new members who are non-physician cath lab professionals, it is particularly appropriate that we view the cath lab as a team enterprise. Physicians, as leaders of the cath lab team, are responsible for helping all members of the cath lab team to thrive, individually and together. This promotes high-quality patient care and creates a positive working environment for all. Thanks to Charles Chambers MD, MSCAI, Kathy Boyd David, BA, Peter L. Duffy, MD, MMM, FSCAI, Kirk N. Garratt, MD, MSc, FSCAI, Rashelle Koser, RCIS, Ken Rosenfield, MD, MHCDS, MSCAI, Sara Singer, PhD, Tom Scott, DO, FSCAI, Elizabeth Truxall RCIS for critical review and editing.