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© Springer Nature Switzerland AG 2019
M. L. D. Broekman (ed.), Ethics of Innovation in Neurosurgery, https://doi.org/10.1007/978-3-030-05502-8_17
M. van Dam (*)
Intensive Care Center, University Medical Center Utrecht, Utrecht, The Netherlands Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
e-mail: [email protected] M. L. D. Broekman
Department of Neurosurgery, Computational Neurosciences Outcomes Center (CNOC), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands e-mail: [email protected]; [email protected]
17
Culture and Attitudes Supporting Ethical
LHS places a moral emphasis on learning, which requires a specific culture and attitudes. This chapter will discuss how a “learning” culture, which is characterized by trust, respect, collaboration, and transparency among others, can be created as well as the attitudes are needed for such a culture.
Creating a Culture Supporting Ethically Sound Innovation
Even though individual surgeons are often initiators of innovative treatments and inventors of novel devices that could benefit their practice, innovation is in general a joint venture [3]. In various settings, including business and medicine, it is evident that innovation can be enhanced through collaboration and teamwork.
Even though effective team collaboration depends on many factors, team leaders play a crucial role in creating and fostering an environment of innovation and initia- tive. Unfortunately, there is no clear road map that helps create such an environ- ment. However, guidelines for team leaders in business management that aim to create an optimal environment for innovation might be useful for medical leaders as well. In 2014, Llopis formulated five suggestions for leaders to enable innovation (Table 17.1) [4], which will be discussed here.
The first piece of advice for team leaders is to trust yourself enough to trust oth- ers. Innovation requires willingness to leave behind old rules of thought and adopt new ones. This requires that each of the members of the team must become more transparent than before. Trust in oneself is essential to achieve this [4].
Besides trust in oneself, it is essential to trust the other members of the team. All team members should be confident that the other team members are available and accessible and that they pursue the same goals. This trust in oneself and in each other is essential for a culture in which innovation can thrive.
The second piece of advice is to collaborate and discover. Confidence in the team is essential, but without true collaboration within the team and with others, it will be impossible to develop something novel that can be implemented in the clinic.
Collaboration not only means working together but also includes the identification of clear roles of all involved and pursuing the same goals. A true joint venture will make the odds for innovations higher.
Third, team leaders should stimulate communication. This is essential to build trust and to collaborate to innovate. By communicating and challenging each other’s ideas in a respectful manner, innovations can be improved, and seeds can be planted for future innovations. The nature of the communication among team members is
Table 17.1 Six advices for team leaders to foster an environment of innovation and initiative (Adapted from [4])
1. Trust yourself enough to trust others 2. Collaborate and discover
3. Communicate to learn 4. Be a courageous change agent 5. Course correct to perfect 6. Create a culture of respect
critically important and should be constant, bidirectional, clear, and unambiguous.
Only then can potential problems or misunderstandings be addressed immediately and innovation be supported.
Fourth, leaders that want to create an environment that promotes innovation have to be courageous agents of change. This means that leaders must constantly chal- lenge everyone to think about how an innovation (be it novel procedures or devices for surgery) could be improved even further. Indeed, to develop effective strategies, teams should be built to learn from and incorporate both positive and negative expe- riences [5].
Last, to perfect the team and its innovative abilities, a leader needs to be able to course correct. This will steer a team more toward a culture that you aim to create and will keep the team members active, alert, and able to adjust to new circum- stances, new people, and personalities. This makes building or developing a team, also known as “teaming,” a dynamic process [6].
In our view, the creation of optimal circumstances to innovate requires one more crucial aspect: leaders need to foster a culture of respect [7]. A team whose members do not have mutual respect for each other will fail to move an idea forward effectively. A recent study showed that rudeness not only had an adverse effect on diagnostic and intervention parameters but also weakened collabora- tive processes such as information and workload sharing, helping, and commu- nication – all of which are essential for patient care and safety but also for innovation [8].
At the same time, research in aviation has shown that positive attitudes about teamwork and respect for the work in the team are associated with error-reducing behavior [9]. Indeed, a culture of teamwork, transparency, respect, and communica- tion can facilitate innovation and continuous improvement of patient outcomes.
Attitudes for Ethical Innovation
A culture that supports ethical innovation requires specific attitudes of the team members. Collaboration, interpersonal communication, leadership, and decision- making are indispensable skills for innovation and are increasingly recognized as important skills in surgery [10]. In order to incorporate these nonsurgical skills, certain attitudes and behaviors are essential and include non-macho behavior, trans- parency, and verifiable and sensitive behavior.
The Federal Aviation Administration and the Canadian Air Transport Administration identified “hazardous attitudes” (macho, impulsive, antiauthority, resignation, invulnerable, and confident) contributing to road traffic incidents among college-aged drivers and felt to be useful for the prevention of aviation acci- dents. A team of orthopedic surgeons has investigated whether these “hazardous attitudes” were prevalent among their colleagues [11]. Indeed, among the respond- ing orthopedic surgeons, “hazardous attitudes” were common. In addition, almost one fifth of the responders implied absence of a safe climate. These attitudes do not contribute to an environment promoting ethical innovation.
In neurosurgery, an adapted version of the orthopedic surgeons’ survey showed that high levels of “hazardous attitudes” are not as prevalent among neurosurgeons [12].
However, 12.2% of the responders had a potentially hazardous score for at least one of the evaluated attitudes. Potentially hazardous levels of resignation and anxi- ety were most prevalent. One could argue that certain attitudes are hazardous in an aviation or traffic setting but might very well be necessary for a neurosurgeon to function in a high-intensity environment. For instance, possessing a certain degree of machismo, antiauthority, and self-confidence may be required from a leader in times of emergency. These attitudes might offer stability and direction to a team in a stressful situation. However, these same attitudes might result in a situation in which members of the team don’t dare to speak up or admit errors and are not eager to learn from them. Therefore, even in times of stress, attitudes should be guided by the rules of professional conduct or professionalism—the skill, good judgment, and polite behavior—that is expected from a person who is trained to do a job well.
Even though it has been argued that too strict “rules of professionalism” might stifle innovation, professionalism does not have to interfere with innovative ideas or treat- ments. On the contrary, professionalism can give directions on how to support (ideas for) new treatments or techniques. In addition, it has been shown to help team per- formance: controlled supervision in a training situation resulted in significantly bet- ter performing teams than rude supervision [8].
Ultimately, professional attitudes will contribute to effective team collaboration, which is essential for innovation.
Conclusion
Innovation takes place without strict oversight and regulation, and ethical innova- tion requires a specific culture that focuses on team collaboration. Effective team- work can be aided by medical leadership and requires specific attitudes guided by the rules of professionalism.
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© Springer Nature Switzerland AG 2019
M. L. D. Broekman (ed.), Ethics of Innovation in Neurosurgery, https://doi.org/10.1007/978-3-030-05502-8_18
M. L. D. Broekman (*)
Department of Neurosurgery, Computational Neurosciences Outcomes Center (CNOC), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands e-mail: [email protected]; [email protected]