Challenge Them Into the Future.
Dr Fiona Wood, AM is one of the world's leading plastic surgeons who specialises in burns patients. Earlier this year she was interviewed about what she had learned from her surgical research and practice about Good Decision Making and Leadership.
She started where all Leadership and Good Decision Making begins - the Widget - or 'purpose' as Dr Wood described it:
'I think decision making is something that you have to really take on - I was almost going to say a level of aggression - but a level of purpose might be a better term. Because you have to make a decision. There is someone in front of you that needs your help - you have to make a decision.
Dr Wood acknowledged that decision making is cumulative - that each decision informs the next:
'That decision may not be right – you have to take that. You have to understand that the decision you've made, the action you've taken, has led to then making the next decision. Sometimes it will be right, sometimes wrong. You've just got do deal with it with a level of purpose. And so you bring to the table all your experience - the knowledge that brought you to that point. And it's a question really of visualising the outcome.'
Her Widget focus is paramount in her thinking, and relies on the systems that have been developed to support it:
'I see this individual....If you meet me as a professional you're having a bad day. So they are damaged, and now I want to use everything in my power, in our systems that we work in, in our systems and the knowledge that is out there to make their path to the outcome the very best it can be.'
Even though in each operation she is focussed on the person before her on that day, she maintains her disciplined focus on a more strategic Widget. Each patient illuminates the path to her Widget, yet in such a way that nether the immediate needs of her patient, or the longer term Widget journey is compromised:
'And the outcome that I've visualised for many, many years is scarless healing. We've changed the goalpost. We've inched doggedly there...are we there all the time? Absolutely not. But we're making progress. So it's visualising that outcome and making every play such that you can move it closer to that outcome day by day. And it's learning. It's always taking the blinkers off and learning so that whatever the decisions you've made today, you make sure that you make better ones tomorrow. And that has been actually an entrenched coping strategy to make sure that you critically analyse the work of today to make sure that tomorrow is better.'
Dr Wood's focus does not mean that she is blind to other new information that can serve her Widget:
'I see people out there that do nanotechnology, or genetics or all sorts of different things - psychology, neuroscience and they've got parts of my jigsaw. I need to get parts of that jigsaw and bring it in to play here. And therefore you have to make decisions on lots of different levels. But when you pare that all away you look at the person in front of you, you've got to get the removal of the dead tissue without them bleeding out such that you can repair them the best you can with today's technology such that you set them up for the best outcome.'
Her Widget focus allows her to quickly engage a surgical team with the needs of each patient:
'I teach my guys: As you walk in you make sure you connect with everybody in the room and if there's people you've never seen before you write everything on the board that you're going to do. You should not be making the decisions while you're doing it. You should have visualised it - you go in knowing what you're going to do and knowing your escape routes. So all of that has to be in your mind. And you have to see the landscape. What is it that you've got to work with in terms of your human resources - and engage them. Make sure they understand what you're trying to do and feel the passion - feel that for that period of time the only focus is for that individual. And that's a really important part of the whole. Engaging everyone.'
Dr Wood explained how the path towards the Widget is a meandering one, and that we should not measure our progress on the result of one decision alone:
'The outcomes have got to get better every day. And it's not linear. I don't live in an environment where every day that passes your chance of survival increases. It's not linear - it's a roller coaster. The waves of infection come relentlessly over, unless we've completely sealed - the person weakens and weakens and weakens. A third of the patients who don't survive will survive somewhere around three months. And they're hard days.'
Dr Wood affirmed Step 1: Step Back as being important in good decision making:
'We have this concept that 'Oh, it's macho to keep going'. But it isn't macho to keep going if your performance falls away. And so for a long, long time I've been very aware of people around me and trying to work out who needs to be rotated out...and so it's having that awareness and as I've got older, I don't stay in and so part of it is rotating yourself out, so that it becomes acceptable....
Dr Wood's ideas on leadership are consistent with Creating the Space and Defining the Purpose and inviting people into that space and using the focus on the Purpose as vehicles to reach their potential:
'I think leadership…Vision...is really interesting. Because I believe that everybody can dream. I think leadership is giving people permission to dream. Because I think if you take the time to listen to people you'd be amazed at what they dream. And then you encompass that dream into a vision.'
Yet always the laser Widget focus:
'I saw a child in 1985 and it changed my life. I thought 'That child is so badly injured from a cup of coffee?' We've got to be able to do better. I've carried that photograph around with me for a long time.'
Dr Wood addressed the potential for conflict between Widget focus and learning where we are in relation to our Widget, and the need to get the day-to-day work done. She described the importance of being disciplined in routine and preparation in order to be creative:
'What we want to be is innovative problem solvers but we want to generate outcomes on a regular basis. In every field of endeavour that is a conflict - on the surface of it. But when you start to dig a little bit deeper… I indicated that it is not appropriate to be making decisions about where you cut when it's right there in front of you. You've made those decisions previously. You've visualised. you've gone to the table - whatever table it is - with your outcome in mind and understanding the opportunities you've got to get there. So there’s an element of planning almost on the run all the time. It's getting into the habit.'
She affirmed the idea that good decision making is being confident enough about what you know, to be attentively curious about what you don't:
'What is it that I bring to the table? What's my experience? What's my knowledge? The lawyers do it all the time with precedent, looking back at old cases. Get into the habit that it's always ticking over. Questioning the landscape. And I think underpinning that is a fundamental belief that today is not as good as it gets. Not in that you criticise today. It's not bad. It's the best it can be - today.'
Dr Wood's approach to learning is to seek out feedback. She goes beyond a healthy belief in relying on the power of complaints to provide it. In fact, why wait for a complaint to inform you, and assume that if there is none that you are doing okay? She advocates declaring your understanding of your Widget to the world and inviting it to comment:
'As you've finished, as you've closed up and you walk away, you don't strut. You actually think 'Okay - given that same situation happens tomorrow, how could I have analysed it better, and then you go through the whole exercise again…the debrief. That's not specifically surgery, It's not specifically sport. It's part of exercising your mind. And the next step is doing that in public. Because that's when it starts getting exciting because there's absolutely no doubt we're in an environment where you need multiple minds to solve problems. And so you have to have that level of inquiry and sort of ticking over and then you connect. And you start to develop a language of innovation and visualisation. So you can push forward.'
Dr Wood shared her belief in the value of 'trauma' as a stimulus to growth, extending the literal trauma to her patients' longer term recovery and resilience, to a metaphor about character:
'I can track periods of my life where I went through post traumatic growth. And it wasn't painless. The hardest thing for me post Bali was that people wanted to know my name. Yet I recognised that as part of that I became stronger. And I became able to engage in this positive energy, in this positive good news stories. And I had my blinkers taken off such that i engaged with the community in a broader sense....How we can use energy that is so profoundly negative and turn that around - I think that's fascinating. It's tiring sometimes. And it's hard. But part of that post traumatic growth is having the infrastructure around you, having the people and connectivity around you that give you the ability to lead.'
She had some powerful advice to give on how to deal with criticism and how innovation challenges conventional thought about 'the way things are done':
'There's an element of inertia in practice. Whether that be clinical practice or business practice...This level of inertia is really quite an interesting animal. Because it's useful, but it's also a hindrance. We need to have a level of capacity to maintain things moving forward at a pace that can be managed. And equally, we have to have people testing out the front. And so I have engaged with surgical inertia up front and centre and I've had to make the decision not to engage in that negative energy but to continue to be driven by the positive outcome, collect the data, present the data. And as the things roll forward, the data will speak for itself. And so that inertia starts to be overcome. And I think that the challenge when you're in a situation with that level of inertia is to understand you've got a choice. You turn around and you fight it…and it's bigger than you. Or you stay out the front and you wait for them to catch up. And they get there.'
Yet always returning to the supremacy of the Widget - and the need for a leader to be clear about defining it to the team, regardless of how clear it is to her or how passionate she is about it:
'I had a really interesting lesson in leadership inadvertently in the early 90s. 1991 I hit the ground running. I was very focussed on time to healing. Every day in a burns unit is a day too long. I aggressively engaged in a skin culture programme....the social worker at the time who was a bit older than the rest of us came and said 'Stop!' I thought 'What do you mean, Stop? ‘Sit down. I need to talk to you. I've been asked to come and speak with you. Well you're too intimidating.’ (Give me a break! )‘We understand that what you're doing has got to be right. It's got to have some real benefit. But we don't know what it is. We can feel your passion. We have no idea how we can explain it to the parents, to the patients, to their relatives, to the new nurses when they come on. We're all at sea…’
Dr Wood learned the definition that a leader is someone who makes good decisions that others choose to follow:
'Leadership 101. No team - no leader. Done. The elastic was at breaking point and almost snapping behind me. And had I not had that energy that they all got caught up in, it would have snapped well and truly. So that's the point when I said 'Right. Everybody who's at this table is here for a reason. You've got to be able to be leaders in your own right....Passion on its own doesn't cut it. The communication bit has to be strong.'
A Leader retreats:
There is absolutely no point in me being so entrenched that as I get through my final kick, everything fades away. Succession is so important. It's not because I want to be remembered. It's because the people need treating! And they need to be treated better and better and better. So for me, it's delegation. But delegation with meaning. Empowerment in a real sense. I need to let them deliver. Such that I can get out of my head, get it on paper and challenge them into the future. But in a way that is not intrusive. Not imposing my surgical inertia on them. But allowing them to grow.
Dr Wood leads a team in Good Decision Making in life and death situations. It's not just theory to her. She is still able to use the language of 'dreams', 'visualisation', 'mistakes', 'passion', 'innovation' and 'personal growth' while literally operating at the leading edge of science.
If Dr Wood can save lives while still creating the space for these ideals that allow others to become who they are, then most workplaces have no excuse.