Annals of Burns and Fire Disasters - vol. IX - n. 4 - December 1996

WHICH PERSONALITY SHOULD LEAD THE BURN TEAM?

Bucek S, Hruba J, Svobodova K, Blaha J, Singerova H.

Prague Burn Centre, 3rd Medical School, Charles University Hospital, Czech Republic


SUMMARY. This paper seeks the answer to a question often discussed in medical literature: "Which personality should lead a burn care team?" Attention is drawn to the fact that the personal, professional and social qualities of the applicants for the post of Head of a bum care team should not only be subjected to very detailed examination during the oral competition tests (which may be influenced by pressure groups) but also be objectively evaluated by computerized scoring of the applicants' personality. The target is to find the optimum Head of the burn care team (i.e. a medical personality in the best sense of the word, compatible in his discipline at world level). The Head of the burn care team must be able to accept and also creatively develop all aspects of modern medical science, university teaching and scientific activity at the end of the 20th and the beginning of the 21st century.

Introduction to the problem

In the Czech Republic, where the transformation of the health care system is being carried out with great difficulty, economic interests are often placed before other considerations. The economic prosperity of a bum care centre (however important it may be) results from the work of the burn care team (i.e. the physicians and nurses) and is only one part and one result of their work. It has never been the work of a single person and thus it cannot be a decisive factor in considerations as to who should be the Head of the bum care team. It has been generally accepted that the care of patients with severe burns requires a multidisciplinary medical approach. A multidisciplinary team is difficult to create (usually it takes several years) but it can easily be destroyed by inappropriate interventions.
Has anybody among the hospital and university authorities ever asked the question whether the person selected during a competitive test - possibly taking just a few minutes - for the position of Head of the bum care team would stand a chance of obtaining the same position (with all that goes with it) in another country?
We are trying to integrate into a Europe without frontiers, but is not the language barrier, above all, the basic obstacle to such integration? In the conditions prevailing in our country the question "Which personality should lead a bum care team?" takes on a different dimension from the question "Who should lead the bum care team?

Leaders or managers?

If we ask the question 1eaders or managers?" we also have to ask another question: 'Is it admissible that a unique university department with a rich teaching and research tradition should be transformed into an ordinary hospital? The answer is clearly no. But we have to find the strength to develop a vision of the future. "We need leaders with vision; we do not need managers and our leaders must have a vision of where we must go," as Birnbaum wrote in his paper "Where have all our leaders gone?"' He went on to say: "For too long, we have continued to follow medical managers. They come into positions demanding leadership by means of ascension, not because of their leadership ability. They attempt to assume the roles of leaders without the talents and skills required." It is interesting how Birnbaum's ideas are topical also for us. They do not require extensive comment.

The leader's qualities

What do we expect of a person who is to be identified as Head of a burn care team? Regarding character, we mainly expect honesty, straightforwardness, judiciousness, generosity, the ability to acquire and maintain the respect of subordinates (i.e. a capacity for natural authority), the ability to inspire trust in the patient, a capacity for decision making, managerial expertise, skill in establishing a hierarchy of values, a capacity for a conceptual system of thinking with a long-term horizon, a recog~ nition of the priority of positive and constructive thinking, and the drive to seek and exploit sources of influence.
We believe that from the professional point of view the Head of the burn care team should have specializations in both general and plastic surgery. He or she should have profound theoretical knowledge evidenced by publishing and lecturing activities, and practical skill in the full scope of the required operational procedures. The leader should be able to implement new diagnostic and therapeutic methods, supervise the care of the more serious and more complicated cases, and take responsible decisions in controversial and complex cases. He or she should have experience of university teaching activity (i.e. teaching undergraduate and post-graduate students). The leader should be able to represent the burn centre at international congresses by lecturing and chairing a variety of sessions. He or she should be able to establish and maintain contacts with other departments of the university hospital and also with corresponding burn centres in other countries. It is necessary for the leader to possess the ability to become a member of the committees and boards of international professional societies, as well as the capacity for independent scientific and research activity and for the orientation of younger colleagues in this aspect of their work. The Head of the burn care team should have oral and written mastery of at least two world languages. He or she should be capable of organizing multidisciplinary team work and of distributing individual roles in the team. The leader should know about health insurance systems and the multisource financing of health care, take decisions in economic matters, preside over committees responsible for the purchase of medical equipment and material, decide on salaries, bonuses, incentives and professional missions, and be able to implement the experience acquired during extensive stays abroad. The leader must also be able to train morally and professionally valid successors and not fear competition of ideas.
From the social point of view it is necessary for the leader to possess wide general knowledge and culture as well as the ability to define the specific philosophy and culture of the bum centre, foresee critical periods, implement communication at times of crisis, and liquidate the aftermath of crisis.

Historical models

A whole series of examples might be drawn from the history of medicine. We should like to cite two of these: the founder of Czech and European plastic surgery, Prof. Frantisek Burian, an outstanding personality, and the South African surgeon Prof. Christian Barnard. These two men lived their medical lives in different periods of time and in different countries but they had much in common - in particular the courage to start something new. Both were aware of the fact that since they came from small countries they had to be more persistent and hardworking in their studies and work than their colleagues from "large" countries, who did not have the same financial problems and prejudices to face. Both were strongly motivated to make advances in medical science for the good of their patients.

An experienced plastic surgeon as the Head of the burn care team

In our country it is generally accepted that the Head of a burn care team should be a physician with a specialization in plastic surgery. But this is not an absolute rule everywhere and thus among Heads of burn care teams there are general surgeons, internists and paediatricians. On the basis of many years of experience, we are convinced that the best head and coordinator is a plastic surgeon with extensive experience in general surgery and orthopaedics, anaesthesiology and intensive care, internal medicine, paediatrics, biochemistry, microbiology, neurology and physiotherapy. We are well aware of the need for narrow specialization in modern medical science but we also consider it important to be able to continue the complex care of the severely burned patient, including post-burn reconstructive surgery. We believe that it is not always necessary to invite an anaesthesiologist to perform an endotrachial intubation, or to send for an orthopaedist to remove periarticular ossifications or perform an arthrodesis. We may and indeed must do these things ourselves (the same applies to a whole series of other interventions) simply because we know best the specificity of severe burn injury.

Selection of the appropriate person

How is the appropriate person for the leadership of a bum centre to be selected? A short competitive procedure, which often lasts only a few minutes and may be influenced by a hospital lobby, is certainly insufficient. For this reason the only way to objectivize applicants' ability or lack of ability is a computerized scoring system.
It is of great importance to know whether the applicant is the real author of medical publications or just a formal "added" co-author; which journals the publications appeared in; whether and how often the applicant has given lectures at international congresses (or if the participation was only that of a "congress tourist"); and which surgical operations the applicant has performed, and how often. The hospital and university authorities should be interested in finding out if the applicant speaks only his or her mother tongue or also two world languages - there are foreign students at university, paying their fees, who rightly require lessons in English (moreover, the majority of medical literature is today in English).
Foreign experience in both work and study should be reflected to a great extent in the scoring system, and references from at least two foreign institutions should be required.
We reiterate that the economic prosperity of a burn centre is not the work of one person only and thus cannot be a decisive factor in the selection of the Head of the burn team.

Conclusion

Mediocrity, whether medical or human, is not a tradition in the medical schools at Charles University or in our medical discipline. This is true for the acquiring of higher academic degrees in the discipline of burn medicine and also for the position of Head of the burn care team.

Acknowledgement. The authors wish to thank Prof. Radana Kiinigov~ for her work of several decades in our Department and for the food for thought that she contributed in mid-November 1995 regarding the qualities required by the Head of the Prague Burn Centre.

RESUME. Les Auteurs, pour trouver la réponse à la demande: "Quelle personnalité doit guider l'équipe de la thérapie des brûlures", soulignent l'importance des qualités personelles, professionnelles et sociales du candidat, qualités qui doivent non seulement être soumises à un examen très détaillé pendant la phase des épreuves orales (qui peuvent être influencées par des groupes de pression) mais aussi être évaluées à travers un système informatisé pour comprendre la personnalité du candidat. Le but est celui d'identifier le chef optimal de l'équipe pour la thérapie des brûlures, c'est-à-dire une personnalité médicale dans le sens meilleur de la parole, compatible dans sa discipline à niveau mondial. Le chef de l'équipe de la thérapie des brûlures doit savoir accepter et aussi développer avec créativité tous les aspects de la science médicale moderne, de l'enseignement universitaire et de l'activité scientifique à la fin du vingtième et au seuil du vingt et unième siècle.


BIBLIOGRAPHY

  1. Shakespeare P.G.: Who should lead the bum care team? Burns, 19: 490-4, 1993.
  2. Birnbaum M.L.: Where have all our leaders gone? Prehospital and disaster medicine, 11: 1, 1996.
  3. Kotter J.P.: "A force for change: How leadership differs from management", The Free Press, New York, 1990.
  4. MacGregor F.: "Identity and transformation", New York, Triangle, 1974.
  5. Wallace A.B.: Training in the case of bum injuries: the importance of folklore, history, libraries, teaching museums and a philosophy. Bums, 1: 281-4, 1975.
  6. Wallace A.B: The International Society for Burn Injuries. Burns, 1: 2-4,1975.
This paper was received on 23 March 1996.

Address correspondence to: Dr S. Bueek, Prague Bum Centre, Srobdrova 50, 10034 Prague 10, Czech Republic.




 

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