Letters to the Clinical Editor

Re: Dynamic Leadership in the Cath Lab, January 2010 Dear Dr. Kern, I feel compelled to reply to your Clinical Editor’s Corner which appeared in the January edition of Cath Lab Digest. You are correct in noting that every lab in the country deals with the challenges of interpersonal dynamics on a daily basis. Although you did not mention our hospital by name, we are the only hospital in Venice, and the reference in your article did an injustice to the leadership and staff of our cath lab. You are correct in that the director of the cath lab is a tech, who came to us several years ago from a prestigious teaching institution with greater than 20 years experience in the field. He did bring many changes, such as the initiation of cross-training the staff. He challenged the staff who were comfortable in the roles they had solely performed to become cross trained to all roles, and provided them with the resources to make this happen. It’s somewhat ironic that the director felt attendance at the Cath Lab Basics course in December would promote increased engagement and professionalism for some of the staff members, and thus arranged for this group to attend. It’s interesting to note that in our Employee Satisfaction and Culture of Safety surveys, our cath lab staff has consistently scored their department as a very positive working environment. In addition, our cath lab director was recently named Director of the Quarter, having been nominated by his staff. Their support has been demonstrated by the reaction of the staff to your article. Multiple staff members, both those who were present at the conference and those who were not, reacted with disappointment to see their department portrayed in such a negative light. A staff meeting was held, and members are being asked to participate in solutions to move forward to promote team engagement. Does the cath lab staff overwhelmingly support the mission of their department and our facility? Absolutely! Do we still have interpersonal issues? Absolutely! Have they been ignored? No! Our hospital takes pride in the service we provide to our patients and to each other. We have achieved Joint Commission disease specific certification in both Stroke and Heart Failure care. We strive to be in the top 10% nationally in our Core Measure outcomes, and have been a Thomson Reuters top 100 hospital for four consecutive years. Our outcomes speak for themselves and can only happen with much collaboration and engagement of all our departments. We have learned lessons from this experience: staff members are more aware of the impact of positive daily interaction; the importance of addressing issues within the team on a peer to peer basis; the realization that spoken words have consequences and that silence might imply agreement. This team plans to communicate more openly, challenge negative behaviors and promote positivity within the group. Although I agree with the intent of your article, and don’t doubt that the comments expressed to you were taken at face value, please consider that there are many layers as you “peel back the onion”, and use discretion when naming a group or facility. Respectfully, Sharon DelPuppa Director of Quality Venice Regional Medical Center Venice, Florida Dear Ms. Delpuppa, I would like to apologize to you, your staff, your department and hospital if my article painted your institution in a negative light. I was impressed with the frankness and concern of your staff for the care they want to deliver to their patients, concern for their hospital and courage in discussing problems with me. I will be more careful in the future. The issues were certainly not unique, no matter how qualified or well intentioned the individuals who are perceived as difficult. I am certainly one of those individuals. Morton J. Kern, MD

Dear Dr. Kern, In response to your January 2010 article re: Dynamic Leadership in the Cath Lab, the phrase "tip of the iceberg" comes to mind. Your timely editorial highlights a problem that is, unfortunately endemic to staffing a modern cath lab. The lab I work in is probably typical for a larger teaching facility, our case load covers peripherals, cardiac, carotids and some EP cases, to name a few. Our hospital participates in many national studies; thus, we are "early adopters" for new technologies. The staffing mix utilizes fellows, nurse clinicians, nurses in all roles and RCIS techs. The scope of one’s responsibilities is often determined by one’s competencies, regardless of the job classification. Thus the potential for discord on a daily basis is great, but we manage as professionals. My one reservation is the apparent reticence on the part of management at all levels to effectively confront those individuals (and they are a small minority) whose behavior/job performance is disruptive. I have given copies of your article to my managers and hope they utilize the options you offer to foster "collaborative leadership" in my lab. Thanks for illuminating a very real and pervasive problem in the workplace. Respectfully yours, Walter Groesbeck, RN, BSN

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