Non Traditional Leadership Roles

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Respiratory Therapists
in Non-Traditional
Leadership Roles Dan Belford RRT. MEd, MBA (c)

2. 22
Leadership
• There are almost as many definitions of
leadership as there are persons who have
attempted to define the concept.
• Google search for leadership = about
496,000,000 results.
• No one leadership definition is correct.

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Adaptive Leadership
• Our personal leadership definition can be
very different from other’s leadership
definition.
• “Leadership is the ability to step outside
the culture... to start evolutionary change
processes that are more adaptive”
(Schein, 1992, p. 3).

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Leading Change
• There are some theorists that argue that
leading change is the fundamental role of
a leader everything else is secondary.
• “Management is efficiency in climbing the
ladder of success; leadership determines
whether the ladder is leaning against the
right wall."
— Stephen R. Covey

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Leadership’s Traits
• Psychologists have not sorted out which
traits define leaders or whether leadership
exists outside of specific situations.
• Culture.
• Context.
• Process.
• Outcome.

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What we know….
• We know with absolute certainty that a
handful of people have changed
millions of lives and reshaped the
world.

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What does it take to become a
Respiratory Therapist?
• Strong back ground in math and science.
• Good physical and Mental Health.
• Ability to work under intense pressure.
• Stamina.
• High degree of integrity.
• Tact and discretion.
• Critical Thinking Skills.
• Teamwork and leadership skills.

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What does it take to become a
Leader?
• If knowledge is possessing facts, and
thinking is the application of knowledge
“critical thinking” in the simplest of terms is
the application of knowledge in more
complex ways.

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What does that mean…
• Critical thinkers strive to be clear,
accurate, precise, logical, complete,
significant and fair when they listen,
speak, read and write.
• Critical thinkers think deeply and broadly.
• Their thinking is adequate for their
intended purpose (Paul, Scriven, Norris &
Ennis).

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Critical Thinking Skills
• The six core critical thinking skills are:
• Analysis.
• Inference.
• Interpretation.
• Explanation.
• Self-regulation.
• Evaluation.

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Decisions
• Leaders deal with complex problems that
require complex solutions.
• Leaders who can think critically will be
more effective.
• Evidence suggests that formal classroom
instruction rarely leads to critical thinking
(Lizzio & Wilson, 2207)

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Self-Reflection
• Without self-reflection it is difficult for
students to develop critical thinking skills.
• Utilizing context based knowledge with
real world inputs demonstrate increased
critical thinking compared to those who
experience traditional classroom lectures
(Tiwari, 2006).

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What Organizations want…
• Organizations are
seeking well trained
individuals that have
technical skills and
have critical thinking
skills to be effective in a
constantly changing
environment.

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Patient Care
• Critical thinking is required during clinical
simulations and during clinical placements.
• Nowhere is critical thinking more
impetrative than in the life and death world
of critical care.
• Without critical thinking patients can be
mismanaged, leading to adverse
outcomes.

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Failure to Critically Think
• In the business setting, failure to think
critically can result in missed opportunities,
faulty decisions, inefficiencies, and
ineffectiveness.
• “The downfall of many organizations can
be tied to faulty leadership” (Carroll & Mul,
2008, Spreier 2006).

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Research in Motion
• RIM’s leadership did not respond more
quickly to a fast-changing market.
• RIM’s technology had transformed it into a
global technology leader over the past
decade.
• Assumed the BlackBerry technology would
be enough to keep it at the top indefinitely.

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Decision Making
• How leaders make decisions impacts the
quality of their decisions.
• For some of us the most challenging
leadership development opportunities
arise when moving from being subject
matter experts to assuming leadership
positions.

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From Clinical Profession to Leader
• It can be challenging because in the previous
role a strong emphasis is placed on data and
logical reasoning.
• We need to learn soft skills leaders require to
manage people and teamwork.
• Such as showing empathy (emotional
intelligence) and listening.
• Typically not part of our education or training
• And these skills do not necessarily reflect our
natural preferences.

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The Transition
• There are several factors for success:
• Be willing to take risks.
• Having mentors.
• Being part of a support network.
• Commitment to life long learning.
• Using failure as a learning experience.

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Career Path Progression
• ACLS Instructor
• Critical Care Instructor.
• Regional Charge RRT.
• OPSEU President.
• Interprofessional Practice Leader.
• Clinical Manager: Emergency Department
and a Urgent Care Center.
• Clinical Manger: Level 3 ICU, Respiratory
Therapy Department and a Telemetry
Unit.

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Organizational Challenges
• Organizations face key challenges as they
try to transform and evolve.
• The ability to lead change has become a
skill as organizations, are required to
transform in order to meet higher
expectations of success.

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Organizational Culture
• In healthcare effective leaders create
fertile, supportive environments for
creative thought and can challenge
assumptions about how particular
branches of healthcare are delivered.

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Managing Change
• Organizational culture is an important
factor affecting strategy execution.
• A recent Wharton School of Business
Study assesses that managing change is
the single most important requisite for
execution for success.

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Leading Organizational Cultural
Change
• To many leaders, the ability to change is
synonymous with the ability to manage
organizational cultural change.
• Because culture is enduring and difficult to
change, strategy formulation must
consider culture.

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Cultural Leadership
• Leadership is an important component in
building and maintaining organizational culture
• Cultural leadership performs 3 important tasks:
• It sustains the mission, creates a distinctive role,
and establishes the basic commitments of the
organization.
• It embodies its purpose by actually implementing
its mission and in the process gives shape to its
culture.
• It maintains organizational values and identity.

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A Case Study in Organizational
Cultural Change
• Implementation of Interprofessional Care
(IPC) within a multi-site community based
hospital in Ontario.
• A collaborative, team-based approach that
enables improved patient care.
• IPC leverages individual and team
capacity to optimize health outcomes.

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Why IPC
• A non- controlled study of the impact of a
medical emergency team in a 300 bed
hospital found that the incidence of
unexpected cardiac arrest declined by
50%>( Buist,M.D., et al. Effects of a medical emergency team on
the reduction of incidence of mortality from unexpected cardiac
arrests in hospital: preliminary study. BMJ 2002;324(7334):387-390.

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Deliverable:
• Development of a formal strategic plan for
interprofessional care that will encompass
interprofessional models of care to support
collaborative practice among care
providers.

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Timeline 2008-2009
• All levels of administration, union leadership,
and various disciplines representing frontline
health care professionals were engaged.
• Focus groups were conducted with respect to
Interprofessional care with over 140 participants.
• Organizational “snap shot” of Interprofessional
care

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Predominant Themes:
Barriers
• Resistance to change/fear factor.
– Hierarchies
• medical model dominance.
– Physician & Nurse driven organization.
– Turf wars & silos/territorialism.
• Individual groups vs. collective good.

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Predominant Themes:
Enablers
• Provincial and federal support and funding are now
available
– Time and resources available.
• MOH, Professional Colleges, Government all
working together.
• Strong Senior leadership endorsement.
– Commitment from organization and individuals –
Dedicated Project Lead
– Right people are at the table in Steering
Committee, Focus Groups, Education, working
groups.

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All Health Professionals Share Similar
Standards of Practice
• Client Centered Care.
• Interdisciplinary Collaboration.
• Accountability.
• Practice knowledge - assess, plan, implement,
and evaluate.
• Applied Knowledge.
• Code of Ethics.
• Communication.
• Continuing Competence.
Belford & Matthews

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Sustainability
• The core strategy for sustainability is your
desire to create and commitment to an
organization or a business unit, or a
product or service or even a process that
will endure long after you are gone
(Werbach, 2009, p.82)

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Sustainability Reporting
• The Global Reporting Initiative de facto global standard
for sustainability reporting.
• Key organizational values, policies, strategies,
operational management systems, goals, and targets
(e.g. employees, shareholders, and suppliers)
• The interests and the expectations of stakeholders
specifically invested in the success of the organization.
• Significant risks to the organization.
• Critical success factors for organizational success.
• The core competencies of the organization and how
they can or could contribute to sustainable development
(Werbach, 2009, p.114).

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Interprofessional Core
Competencies
I. Interpersonal and Communication Skills
II. Patient/Client & Family Centred Care
III. Collaborative Practice:
A. Collaborative Decision-Making
B. Roles and Responsibilities
C. Team Functioning
D. Continuous Quality Improvement

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Clinical Simulation

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Education
• Focus on Interprofessional Core
Competencies, not technical performance.
• 180 Participants – RN, RPN, RRT, HCA,
Pastoral Care, Social Work, Administrators
• Realism of scenarios.
• Debriefing led by Clinical Educators.

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Evaluation
• Informal evaluation amongst participants
as the program progressed good word-of-
mouth.
• Formal evaluation (qualitative and
quantitative) resulting in a formal study.

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Application of Interprofessional
Practice Model
• Application of an interprofessional practice
model in the ED and ICU during clinical
manager roles.

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Emergency Manager Role
• Introduced Interprofessional practice model
within the Emergency Department.
• Within a “See and Treat” area.
• Team composed of MD, Nurse Practioner,
Register Nurse, Registered Practical Nurse.
• Ministry funded “Pay for Results” Program
• Goal was to decrease CTAS 3 waiting time by
improving provider to be seen times.

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Scope of Practice
• 2 MDs coverage 24/7.
• Introduced Nurse Practioner Role to treat
patients within ED: CTAS , 3, 4, and 5.
• Registered Nurse: introduced 27 medical
directives to implement care at Triage.
• Registered Practical Nurse: ACLS Course,
IV insertion, Pediatric clinical up grading.

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Emergency Manager Role
• Created an Interprofessional team that
applied LEAN methodology that results in
process improvement.
• Physical redesigned the “See and Treat”
area to improve patient flow.
• Provider to be seen times for CTAS 3
patients decreased from 8 hours to 1.8
hours (Ministry Bench Mark 2 hours).

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CANADIAN TRIAGE AND ACUITY
SCALE (CTAS) NATIONAL
GUIDELINES
• CTAS Level 1 - Patients need to be seen by a
physician immediately 98% of the time.
• CTAS Level 2 - Patients need to be seen by a
physician within 15 minutes 95% of the time.
• CTAS Level 3 - Patients need to be seen by a
physician within 30 minutes 90% of the time.
• CTAS Level 4 - Patients need to be seen by a
physician within 60 minutes 85% of the time.
• CTAS Level 5 - Patients need to be seen by a
physician within 120 minutes 80 % of the time.

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CTAS 3
• Level 3 - Urgent
• Could potentially progress to a serious problem.
• Can be associated with significant discomfort
• Can affect activities of daily living.
• Conditions: moderate trauma, asthma, GI bleed,
vaginal,bleeding and pregnancy, acute
psychosis and/or suicidal thoughts and acute
pain.

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Urgent Care Center
• Conversion of a 30,000 visit per year Emergency
Department into an Urgent Care Center.
• Redirection of CTAS 1,2, and 3 to a Full Service
Emergency.
• First Urgent Care Center in Ontario to accept
Ambulances (CTAS 4 and 5).
• Introduction a RN/RPN collaborative practice
model.
• Increased UCC visits and improved patient/client
satisfaction results.

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Results
• All healthcare providers working to full
scope of practice.
• Decrease CTAS 3 “provider to be seen
times” from 8 hours to 1.8 hours ( below
Ministry bench mark of 2 hours)..
• Improved retention and recruitment of
staff.

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ICU Manager Role
• Introduced Unit Council/Shared governance
model.
• Unit Council promotes staff empowerment to
participate in excellent patient client centered
care and advancing professional practice.
• Able to retain and recruit staff long standing
Full time vacancies .
• Improved Infection Control practices utilizing a
standard work tool developed during a Nursing
Clinical Practice Fellowship.

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Organizational Restructuring…

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Giving back to the Profession!
• Manager Cardio Respiratory, Neurodiagnostics,
and Sleep Lab
• 115 staff composed of RRTs, RNs, Echo
Technologists, Cardio Technologists, ECG
Technicians.
• Reorganization of reporting structure within
areas.
• Moving towards full scope of practice for all
healthcare providers.
• Process of establishing RACE Team, Anesthetic
Assistant role.

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Being Recognized…

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References
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and Thistlewaite, J. (2004). Learning for real life: Patient-focused interprofessional
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References
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Thank You to the Canadian Society
of Respiratory Therapist !
Questions?