The formation, elements of success, and challenges in managing a critical care program: part II.

Leaders of critical care services require knowledge and skills not typically acquired during their medical education and training. Leaders possess personality characteristics and evolve and adopt behaviors and knowledge in addition to those useful in the care of patients and rounding with an ICU team. Successful leaders have impeccable integrity, possess a service mentality, are decisive, and speak the truth consistently and accurately. Effective leaders are thoughtful listeners, introspective, develop a range of relationships, and nurture others. They understand group psychology, observe, analyze assumptions, decide, and improve the system of care and the performance of their team members. A leader learns to facilely adapt to circumstance, generate new ideas, and be a catalyst of change. Those most successful further their education as a leader and learn when and where to seek mentorship. Leaders understand their organization and its operational complexities. Leaders learn to participate and knowledgeably contribute to the fiscal aspects of income, expense, budget, and contracts from an institutional and department perspective. Clinician compensation must be commensurate with expectations and be written to motivate and make clear duties that are clinical and nonclinical. A leader understands and plans to address the evolving challenges facing healthcare, especially resource constraints, the emotions and requirements of managing the end of life, the complexities of competing demands and motivations, the bureaucracy of healthcare practice, and reimbursement. Responsibilities to manage and evolve must be met with intelligence, sensitivity, and equanimity.