According to legend, on December 29, 1913, an ad was placed in the London Times. It read, “Men wanted for hazardous journey…[s]mall wages, bitter cold, long months of complete darkness, constant danger. Safe return doubtful. Honor and recognition in case of success.” After an overwhelming response to the ad, 28 men were chosen to begin preparing the ship Endurance for the Imperial Trans-Antarctic Expedition.
Over the next two years, what followed was a journey led by Sir Earnest Shackleton that many consider to be one of the most harrowing in human history. More than 100 years later, Shackleton’s actions during that journey are considered the ultimate example of peoplecentered leadership. Following his death, Shackleton’s remarkable capacity as a leader was described by his well-regarded British contemporary, Sir Raymond Priestley, who stated, “…when disaster strikes and all hope is gone, get down on your knees and pray for Shackleton.”
This edition of the Congress Quarterly is dedicated to leadership. This theme was not chosen at random. The most common response on more than 5,000 blinded surveys of our members, focus groups, and in-depth telephone interviews about CNS member needs over the last few years centered on developing business and leadership skills.
Initially, this came as a bit of a surprise. After all, the daily practice of most neurosurgeons revolves around the diagnosis and surgical treatment of disease, not the challenges and difficult decisions of running a business or leading a team. However, upon reflection, I suspect many of us are struck by the rather stark reality that medicine has become something that feels unfamiliar and requires a different set of skills in order to succeed.
Once upon a time, medicine was the province of individuals. In the era of Shackleton and his predecessors, physicians were single, independent professionals trying to diagnose a handful of mostly infectious maladies and provide treatment primarily with supportive care. As time passed and our knowledge improved, the mystery of disease began to unravel while the treatments we could provide, both medical and surgical, multiplied. More treatment options created a need for more resources—specialists, hospitals, drugs, and devices. The infusion of public tax dollars into medicine to cover rising costs accelerated research, innovation, and the provision of care to millions in ways few could have anticipated.
What ensued was what many refer to as the golden age of medicine. Individual achievement was celebrated throughout the formal education and subsequent medical career via high standards for grades, test scores, numbers of patients and cases, salary, job titles, scientific publications, and single patient outcomes. But then, like in all things, the eternal force of change continued to exert itself. Celebrations of what was being made possible by contemporary medicine began to be replaced by concerns about costs that exceeded what was affordable. New realities shifted the focus away from individual achievement onto team-oriented measures such as population outcomes, cost per patient, all cause readmission, health care acquired infections, case mix index and net operating income. These measures leave many scratching their heads, wondering how we are to succeed in this era when individual measures of performance have been replaced by team measures of value, systems of care,panels of patients, and management of risk.
I suspect this explains the results of our member surveys and the need for business and leadership skills. Thankfully, as neurosurgeons, we tend to be a group that is self-reflective, insightful, adaptive to change, and ready to lead, especially when still waters become rough. This is our nature—to assess difficult situations, take responsibility for creating plans to solve those problems, remain resilient during the inevitable setbacks, and hold ourselves accountable for the consequences. From the times of Shackleton, Cushing, and Dandy, neurosurgery has drawn to it those who wanted to be relied on for such things. It is where we fit. Yet just as there are similarities to that bygone era and now, there are also recognizable differences.
While Cushing and Dandy created legacies based on personal effort and achievement, leaders in a contemporary system of care emerge because they are able to get things done through the people they inspire and the teams they create. More than what they do, today’s leaders are being defined by who they are, those that are inspired to follow them to meet a common, meaningful challenge, and their ability to get their teams to believe in something bigger than themselves.
I would argue that is the great message of hope in our profession today. Just as Shackleton put out the call in 1913 for a very special group of people who were capable of facing unimaginable risk in the service of a cause greater than themselves, so today we also put out an annual call to young men and women to join our ranks to do something with us that is physically and emotionally very difficult. The care of patients with life-threatening illnesses affecting God’s most guarded real estate is demanding even under the best of circumstances. While arctic historians may not put such demands on the same level as Shackleton’s push to the south pole, our calling is nonetheless noble and worthy of our very best.
I encourage you read through this edition of the cnsq and consider your role as a neurosurgical leader, whether that be in your practice group, department, hospital or health system. Collaborate with like-minded individuals, improve your leadership skills, and create a better system of care for your patients and your community. As you do so, please know the CNS is here to help you build those skills through our courses, publications, and online resources.
Please enjoy and thank you for a wonderful year!