Surgical leadership – a plea for action in rapidly changing times

Abstract

Currently, we face multiple, sometimes even dramatic changes worldwide. Not only in the Western hemisphere, but also in emerging countries there are increasing trends towards nationalism, isolation and delimitation. Social media demonstrate self-optimization and it can be hardly denied, that apparently the “Me” is above all. These political and social changes are in sharp contrast to the reality of working conditions in medicine in general and in surgery in particular. Treating patients with the aspiration of the best available therapy has been part of teamwork since ancient history but has emerged even more in the last years. Multimodal treatment in mutliprofessional and interdisciplinary teams is the current standard. Realizing these facts, we also face a shortage of young medical students applying for a surgical career, increased demands for an intact work-life balance as well as altered family structures with more women being fulltime employed. This professional environment requires changed organizational structures and improved abilities and skills to manage a surgical department and to act as a leader in team structures. Simply said – it is not enough to be an excellent surgeon. Economic knowledge and non-technical skills matter as well [1]. And what else is required to be a good surgical leader? The current issue of Innovative Surgical Sciences (ISS) aims to highlight the essentials of modern surgical leadership in different countries and cultures. One important issue in surgical leadership is pointed out by Ohki in his paper: you need to guide surgeons by getting them excited about the work, by creating friendships within the team and by instilling a feeling of secureness. The experiences from Japan clearly demonstrate that non-technical skills are much more important for an inspiring working environment than, for example, financial incentives. It also shows that social activities outside the hospital add substantial value to the team spirit. Wallner and Solecki from Poland, in their paper, argue for a structured learning course within a system of harmonized, methodologically correct system of surgical training and education. This is most likely a good concept, because it is well accepted that a brilliant surgeon is not necessarily an excellent surgical leader as well. Therefore, a structured learning system of non-technical skills may be helpful to increase leadership abilities. As regards the situation in Germany, SchmitzRixen and Grundmann show that economic knowledge is crucial in leading a surgical department. In many German hospitals, leadership by objectives is very common. These objectives, however, refer to case numbers and case severity, but they do not reflect the soft skills of leadership. Additionally, it is very important to offer structured surgical training programs to fulfil the needs of the younger generation as well as women. The paper from Germany addresses one other increasingly important issue: we face more and more colleagues with signs of distress, depression and burnout. This could be a topic for a separate special issue of ISS, and it clearly demonstrates that surgical leaders need to have a close and critical look to their staff in order to recognize these symptoms of burnout in surgeons to offer help and relief. In contrast to the situation in Japan and Europe, the paper from Ghana points out, that surgical leadership necessitates becoming politically involved to improve the surgical care of the people. Africa faces substantial infrastructural challenges, low manufacturing capacity and a significant lack of political will to change the situation of surgical patients. It is noteworthy, that surgical disease has a higher mortality than the politically more highly-ranked fight against HIV/AIDS and tuberculosis. Frimpong-Boateng and his co-author Frank Edwin impressively describe that surgical leaders in Africa need to engage with political authorities and to advocate for surgical care in order to obtain political priority. These views on surgical leadership are in complete contrast to the challenges in first-world countries, but there is one issue which unifies the various aspects – the development of information and communication technology. The paper from Ghana illustrates the possible benefits of digitalization in surgery and clearly this will most likely improve the possibilities of surgery in the future for the benefit of our patients worldwide.