The Rio Paralympic Games experience can be seen as a condensed leadership lab that allows for reflection and learning that can be applied to physician leadership. Starting with good governance is essential, including clarity of message and proper stakeholder engagement. Preparation is key and involves scenario-based planning for expected as well as less-expected but risk-laden situations. Leadership presence and leveraging team skills are paramount.
My involvement in the Paralympic Games makes me a better health care leader. The paralympic experience, it turns out, is a condensed leadership lab conducted in a fishbowl. With a set beginning and end, the event allows for rapid reflection and learning that will be applied to the next games. Top
The basic premise for success in a large sporting event can be equally applied to many other endeavours, including the running of a large health care organization. With everything magnified — the successes and failures are indeed very public — and so compressed in time, the lessons that emerge cannot be easily ignored.
Here are a few key points I learned from my participation at the last nine Paralympic and Winter Paralympic Games, most recently in Rio de Janiero. I’ve grouped them around three themes: good governance, practice, and leadership presence.
Start with good governance
Success comes to the well prepared, and preparation starts with good governance. Private businesses are keenly aware of the importance of a high-functioning board of directors, and these people are selected carefully to ensure a wide variety of skills around the table.
The Canadian Paralympic Committee’s Board of Directors is chosen through an open election, a common occurrence in the world of sport. For the chair, this represents a challenge, as he or she is given a team of people chosen by the member sports organizations rather than people specifically picked for their balance of skills.
Although this is a departure from best practices for most business people, it will feel familiar to the health care leader. Who among us was able to choose the physician leaders on the Medical Advisory Committee? We are generally given a mandate and a group of smart people to work with, but must find all the skills we need in that group, occasionally with a bit of outside help.
The successful leader will spend time learning something about the members of the team, what they really care about, and what skills they have that may help further the goals of the group as a whole. It takes time, and there can be no shortcuts. Email is not a particularly good tool for this; instead, the effective leader will “cross the floor,” meet colleagues on their own turf, create time for listening, and invite comment from those who care about the organization. Top
Seek a variety of opinions
Looking at an issue from all angles minimizes the risk of preventable failure. Some of the most useful advice I was given was, ask “what else?” and count to seven before moving on. This practice gives team or group members permission to think and raise an issue rather than simply react. Too often, I’ve heard the ubiquitous, “anything else?” with the unspoken message “please don’t.” If some lower items on the agenda have to be deferred, so be it. A well-constructed agenda places the important items up front for this very reason.
Be mindful that, in complex environments, discussions are often as political as they are business-related. People around the table may have different motives, often directed by their peer groups. An effective board eventually rises above these constraints, but it takes time, and trust must be built among the group.
Don’t get into the weeds
Pay attention, but don’t try to run someone else’s business. “Noses in, fingers out” is the golden rule of governance. For instance, at the Canadian Paralympic Committee, we have talented staff, who are experts in their field. We also have board members who have similar responsibilities in other organizations and great operational skills. They may want to focus on minutiae to the detriment of the big picture. Blind spots can easily emerge when one gets too close to the ground.
In fact, one of the most difficult tasks of the chair may be developing an effective way to say, “We have more important things to discuss right now,” but this is crucial to board functioning. As it’s likely that the person focusing on details has an emotional attachment to the issue, redirecting without disengaging is an important skill for the leader to develop. Top
Engage all partners
Is the paralympics all about the athletes? Is health care all about patients? Yes, to a certain extent, but in reality both involve many other stakeholders, all of whom have a significant interest in a positive outcome. Coaches, national sports organizations, sponsors, and government all have a real stake in the success of the games. However, how they measure success may vary significantly. As a leader you may not necessarily agree, but failure to engage is akin to operating with one’s head in the sand.
Know your key messages
Blaise Pascal once said, “I would have written a shorter letter, but I did not have the time.” Make sure you are clear and concise about what your group is trying to say. Those who disagree with you, or have other personal motives, will undoubtedly try to take you in a different direction. Spending time agreeing on the important messages — and communicating them clearly to all stakeholders — is a crucial component of success.
Knowing your key messages can also make decision-making easier. Shortly before the Rio Paralympics, the International Paralympic Committee announced a total ban on Russia’s participation. Despite numerous requests, I refused to go on live television to discuss the issue, as it was clear from the pre-interviews that journalists’ preferred story was criticism of the Olympic movement rather than highlighting the work of the paralympics. Criticizing our partners was definitely not a top message for us; thus, we passed up the opportunity for media coverage that was not congruent with our aspirations. Top
Practice makes perfect
Practising in the operating room is not a good idea, and neither is trying to run a complex games operation without proper practice. Our challenge is compounded by the fact that a large proportion of the mission team on site is composed of volunteers and staff of other organizations, such as national sports bodies. Yet they have to operate as one unit during the games in support of the athletes.
Groups within the mission team each have clear leadership (e.g., media, medical, security), but, even at that sub-team level, new relationships have to be forged very rapidly. This is best done before the stress of the games begins and the inevitable tensions occur when the needs of one team clash with those of another.
A few months before the games, the entire mission team meets for several days to rehearse and, more important, to work and solve problems together in a controlled environment. In fact, the inability to attend this orientation session is a disqualifying factor for participation at the games.
Communication is the key
If safety huddles are new to Canadian hospitals, they are not to running games operations and are deemed essential to team success. They last a bit longer, and a “look back, look ahead” format is used to ensure that mistakes are not repeated or compounded and that one team’s plans will not compromise the success of another. Despite the high stress and time constraints, these regular meetings take place twice a day and take precedence over other activities, even sleep, which unfortunately comes in short supply to our volunteers. Top
Plan for the expected
It’s fairly easy to be motivated to prepare for an event that has a high probability of occurring. That at least one athlete will be significantly injured or become sick during the games is almost a certainty. It’s also not difficult to dedicate time to incidents that often occur and can have significant negative outcomes, particularly if a non-event would be welcome news; a Norwalk virus outbreak would be one such instance.
In Rio, the main issues highlighted by the press were possible violent crime, demonstrations related to political instability, and, most of all, the Zika virus.
As well-informed professionals, our concerns were 180 degrees from those conveyed by the Canadian press. Spontaneous demonstration and political turmoil were the least predictable and controllable, crime was worrisome but manageable, and Zika was really a non-issue based on the scientific evidence we had received. Most of us never saw a mosquito during our entire stay, although several ankles were feasted on by “no-see-ems.” Top
The lesson for health care leaders here is that emotion trumps knowledge. As tempting as it may have been to be dismissive about Zika, this would have been seen as not caring about the team, and who would follow a leader who doesn’t care? We prepared for Zika, even though the chances of having to implement any on-site plan was remote.
Plan for the unexpected
It is more difficult to find motivation to spend time on events that have little chance of occurring. However, building scenarios for practice around the same issues can be counterproductive; practice becomes repetitive, less engaging, and the response less creative. The answer can be to create credible scenarios around events with some level of probability rather than the truly rare and unexpected. Top
For the Vancouver Winter Olympics and Paralympic Games, a course was developed to train, not only the Canadian team, but also the host Vancouver-based medical volunteers who would provide assistance to athletes from all nations at the various sport venues.
The course leader, Dr. Julia Alleyne, who later became the chief medical officer for the Toronto Pan-Am and Parapan-Am Games, used this approach in developing a two-day course, and she was eerily accurate in her predictions. The two anchor cases were a crash on the bobsled track and a medal contender seriously shaken by the death of a close relative.
Anchoring the course kept the participants engaged and their minds open to “what ifs.” This type of approach can be very useful in a difficult project implementation, or even introducing a new patient population or procedure to your health care organization. Top
Leaders must be visible and easy to follow. I have already alluded to clarity of message as a prerequisite to good leadership; equally critical is being present at important moments.
Visibility has always been difficult for me, and jumping on a podium is not within my comfort zone. In reality, how you are received has more to do with the receptors and filters of your audience than how you think you are communicating. Symbols are important and we all use them, whether we are aware of it or not. Knowing your own biases, and factoring them in, is a must for an effective leader.
This was demonstrated near the end of the games, when our wheelchair basketball teams held an event to thank their families and friends for their support. Our men’s team, the defending paralympic gold medalists, although in a renewal phase, had not expected to lose so many games. Our women’s team, the defending world champions, had just lost a tough quarter final and would not even make the medal rounds.Top
I was asked to say a few words and declined. Who wants to hear from a guy in a suit when in pain? However, the basketball team manager, whom I had gotten to know well during our training seminar, ignored my wishes and called me to the stage. I don’t really recall what I said. I just recall athletes and parents coming by through the evening to thank me for coming and making a few comments. The women’s team captain even sent me an email the next morning. Having a relationship with a colleague who understood the power of being visible proved invaluable to me.
One cannot rush success. Medical professionals are often frustrated by what they perceive as suboptimal results from their teams. My experience is that this is almost always a result of deficits in governance, preparation, or leadership presence. Having the paralympic fishbowl as a laboratory has proven extremely helpful in making these lessons clear to me.
Gaétan Tardif, MD, FRCPC, ICD.D, is president of the Canadian Paralympic Committee. He is also physiatrist in chief at the Toronto Rehabilitation Institute, University Health Network, and a professor of medicine at the University of Toronto.