I spoke with my father, a board certified neonatologist who has been caring for critically sick babies for more than three decades, about leading during stressful moments. I’ve always been impressed by his ability to keep a cool head during stressful situations, and I’ve always tried to emulate that ability.
Content warning: contains discussion of neonatal and pediatric mortality
For those who don’t know you, what’s your experience working in crises?
I run intensive care units (ICUs). ICUs are decentralized in that nobody has everybody else’s skillset. Your job is that you’re trying to get people with different specializations to work at peak efficiency.
The Neonatal Intensive Care Unit (NICU) used to be a really self-selecting group of people, and I was initially attracted to it because it attracted the toughest, grittiest, most independent people. Now there are all kinds of personalities, people drawn to helping babies, and they’re not always emotionally prepared [for the difficult situations we face]. As a leader, how do you get them through that kind of trial by fire?
I think my job is 20% being a doctor and 80% being a team leader.
[note: he doesn’t mention it here, but he regularly deals with both high adrenaline in-the-moment emergencies and comparably long running crises]
What’s the number one thing that leaders need to do in a crisis situation?
Your job is to prevent your staff from locking up, from being so terrified or so uncertain that they cease to function. That’s the number one goal: keep people operational and not let the moment paralyze them.
Can you talk a little bit more about people?
They’re indispensable and they’re not interchangeable. You have to work with what you have.
You can do it without knowing your people, but it’s best if you know who your people are, what their strengths and weaknesses are and how to work with them. Most people have skills that they can bring to the crisis. My experience is that everyone has something to add, even the raw rookie nurse who’s never been in that situation before. And it’s hard to place them in a situation where they can be useful and feel good about themselves if you don’t know about them beforehand.
I think that’s the biggest difference between small group leadership in a hospital setting versus in a military setting. I read a lot of military history and have tried to take a lot of lessons from that. The difference there is that those people have all been through the exact same training and you can make assumptions about what they know and don’t know.
That feels really relevant to our current situation. How do you approach leading a team where everybody is coming in with a totally different experience?
I’ve told you that the mark of a good leader is that when you come into the room in the middle of a crisis, everybody relaxes because they’re glad to see you there. You need to take responsibility for the situation. You want to say “I’m in charge. That means that if something goes south, I’m going to take the blame and protect my people.” Simultaneously, you want everybody to talk to you and give you their best ideas.
I have standing orders in every unit I work in not to call me Doctor. I don’t want my rank getting in the way. If somebody has an idea, I want to hear it. I won’t belittle you for having a crazy idea or for the letters you have after your name. I need all the input I can get from any source.
I also crack a lot of jokes. I want people to relax a little. I don’t want people to suffer from task fixation; everyone needs to keep situational awareness. Most of the time people don’t need to be hyperfixated in order to do their job. You want them to stay loose.
If you let them, your people will save your ass.
How do you keep people loose when they’re thinking about the magnitude of the problem in front of them, the potential fallout, and the impact to human life?
[note: this story is pretty upsetting— the faint of heart should skip over the next paragraph]
The best story I have of this: I was working in this one hospital, in intensive care. And I got a call from the ER asking if I could come help them out. What happened was that this 3 or 4 year old was under his dad’s SUV for whatever reason, and the father ended up accidentally backing over him. The child was obviously dead, but all the staff in the ER were fumbling around, doing everything they’re trained to do because they were so distraught about what had happened.
What I did in that situation was I became the teacher. For example, I talked to the person who was doing chest compressions, I said “look at the monitor over there, look at the pulse oximeter, it’s not moving and that means you need to be doing deeper chest compressions.” Because we couldn’t change this situation, but we could practice for the future. Defocus it off of the unsavable situation at hand and look at the bigger picture. This won’t be the last time this will happen, and we’ll need these skills the next time it happens.
It helped. Assuming a student teacher role helped depersonalize the situation. It’s an alternative role and alternative thought process that will allow you perform even though everything’s going to hell in a handbasket. It’s a sort of a misdirection, giving people another role to play in the crisis, one that is less likely to result in situational paralysis.
Sometimes you just can’t win. In those settings, your job as a leader is to get people to feel good about the job that they were able to do.
That’s pretty heavy. I think one of the things that happens in software is because it’s not immediately life or death it’s almost easier for people to fall into analysis paralysis. You’re not looking at the first order effects of your actions, you’re looking at the second and third order effects.
Yeah. It’s harder to predict those second and third order effects. You can only control what you can control, and you have to remind people of that.
You’re not gonna win all the battles. You’re defined as much by the battles you lose as the battles you win. And that’s part of the “everybody relaxes when you get in the room” thing — people count on you to do the right thing. It’s often hard to define, but everybody in the room seems to understand what the right thing is anyway. Sometimes doing the right thing means taking the fall for the team. Sometimes it means pushing them a little harder to do the thing you know they’re capable of even when they don’t feel that way. Sometimes it means saying “We’re not going to win but we’re going to go down like heroes.”
Your job as a leader is to take that 20,000 foot view that your people can’t afford to have because they’re focused on the task in front of them.
It also means being scrupulously honest with them and saying “I could be wrong, I don’t know, but here’s what I’m thinking and why.” I’ve never pulled rank on somebody. If someone disagrees I explain where I’m coming from and try to convince them. I owe it to them.
I agree that transparency and communication are critical. One of the things that I’m seeing is that people in leadership roles are not communicating because they don’t know what’s happening…
But you can say that, you can tell them that.
Why is that important?
(laughing)
Because they probably already know you don’t know, and at least if you admit it you get points for honesty.
It’s also important because if you say you don’t know when you don’t know, they’ll believe you when you say that you do know. It takes more self confidence to say “I don’t know” when you’re not sure; the people with the least self confidence are the ones who are going to stand their ground and pull rank.
Let’s talk about delegation and empowerment. Those are good leadership practices all the time, but how do you delegate to people when you’re not sure what’s happening or what needs to get done?
That doesn’t happen a lot at my level — I delegate tasks, but not generally decisions. I give people decisions like the IV rate or the ventilator or whatnot, I’ll generally ask people “What do you think?” and then tell them I trust them.
When you delegate your job is to know everything about what they’re going to do, but not tell them that. When I was a senior resident teaching interns, we got told “Go through the labs for all your patients and know all of them. Then let your interns come to you and tell you about the lab results like you don’t already know.” Because you don’t know your people yet, so you’re giving them space to show you.
Generally I have found that people who are getting promoted into these roles are making decisions that I trust. If I see someone I don’t trust moving into a role, I try to divert them, and you have to have very specific reasons for that, not just “it’s a personality thing.”
The most recent time this happened to me, I was training a new nurse and walking her through a situation and helping her learn and do it herself. And someone else who was gunning for a promotion jumped in between me and this nurse and just started to telling her what to do. When I talked to her afterwards, about how I was doing what I was doing for a reason, she said “Well, that’s just how I roll.” And I can’t have someone who’s going to steamroll people.
You’re describing investing in people — why is that important?
Well, we stay with our teams for a long time. I have people I work with who I’ve worked alongside for 20 years, who I knew when they were new grads. The most selfish reason is that they will be your team, they’ll be your senior people.
It’s also good for the morale of the unit for people to feel like they can grow, like there’s a path for them, like they matter and people know what their potential is. It makes them more likely to learn new things, attempt new procedures, and grow outside their current boundaries, if they see that it’s appreciated and important for them to do so.
The other piece of leadership there is that you have to appreciate everybody. If everyone does just a little bit more than they have to, a little more than their share, then everything gets done and everyone feels good about it. If everyone does exactly what they’re supposed to, something inevitably falls through and what you get is backbiting and finger pointing.
Going in a different direction, how do you keep your head together when everything is going sideways?
Sometimes things just don’t work, sometimes you just can’t save the baby. In my particular job, if you fight to the last second what that means is that this baby will have lived and died without ever getting held by their parents. In my mind there is a definite penalty for going too far, and I think it’s an unspeakably horrible penalty.
I have to balance the decreasing probability that we will succeed and pull this out with the increasing probability that the baby will die without being held by their parents. I find that helps me stay grounded and focus on what’s important. Because in my world the situations that you are keeping your head about is when a baby is declining really quickly and the decision you’re making is about whether to keep going or whether to stop.
It’s easy to get task-fixated on trying to save the baby, because that’s your job. But the bigger truth is that there’s something else to lose, and you could be creating this much bigger harm. There’s the big picture importance, and sometimes you just have to call the mother in and put her baby in her arms.
I don’t know how you’re going to make that relevant to software in the age of coronavirus…
Well I think we also have that risk of becoming task-fixated and saying “I have to get that website out, we have to make this product work…”
It’s the path of least resistance. Nobody is going to blame you for doing that, for doing what you were assigned.
Yeah. The other that I see is a lot of reactivity. People identify the first possible opportunity to help, and they think “I have to jump on this” and scramble all of their people.
Yes, absolutely. One my mentors, David Woodrum, used to do this thing. People would come to him and say we need to do this thing for this kid right now, we need to get this therapy going, or whatever. And he would stroke his chin and say “I think I need a day to think about that.” And he would always come back with a decision, but he would put a finite time on it so that he could think about it.
That’s a really good leadership habit, as long as you never ever forget that you promised that. Don’t use it to get out of making a decision, but don’t be reactive.
Right, don’t make your decisions based on adrenaline.
Yeah. That’s not where wisdom lies.
And where we are right now, especially in software, we have very few decisions that need to be made in the next 20 or 30 minutes. So maybe all of us, while emotions are running so hot, should be practicing saying “I will get back to you in half an hour.”
Yes. I think that’s something we don’t do enough of. Making snap decisions can be a form of false leadership, it’s bravado. There’s a lot of humility in saying “I don’t know this situation well enough, let me think about it.”
So, we haven’t talked about jokes yet… Why are jokes important?
They loosen people up. They imply that you’re not going to blame them for anything that goes wrong, and it tells your team that you don’t blame them for the current situation. It tells them that you feel comfortable enough to joke about the current situation, and that means you’re that much less likely to freeze up.
Sometimes the greatest thing you can do for your team is to make them laugh in the middle of their tears. It implies that you appreciate them and appreciate that they’re doing their job.
We’ve talked a lot about how leaders should act for their teams. What can people who don’t feel confident, internally, do so that they can be that person for their teams?
Sometimes I fall into that place, too. In those cases, sometimes the right thing to do is to say “I need 15 minutes to go look this up.” And then you’re in private, you can think through it. For me, information gives me confidence and I can take that time to collect myself. I get more confidence from learning about how this situation has played out in the past for other patients.
If you’re talking about real life leadership in a software situation, maybe you can call a mentor, or a trusted colleague who’s on another project. It’s a mistake to think that you can’t leave the stage and read your lines again, and then come back and continue the performance. If you don’t know what the right thing to do is, create some space for yourself and see if you can find out what the right thing to do is!
Being able to insert a time-out is really important. You don’t look like less of a leader because you want to be sure before you put your people on the line.
Any last thoughts?
Your crises will define how your team thinks of itself. It’s like winning the World Series, you’ll be like family forever. Crises are also opportunities, it’s where you can show the world how good you are. I think you have to remember that, in the middle of the crisis you have to remind everyone “This is how we prove how good we are.”
