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Coping with code red

Dr. Arky Ciancutti takes urgency in stride

by on
in Leaders & Managers,Management Training

In his eight years as an emergency room (ER) physician, Arky Ciancutti, M.D., managed crises with aplomb. Today he runs the Learning Center, a management consulting firm in San Anselmo, Calif. He’s also co-author of Built on Trust (Contemporary, 2000).

WS: How did your ER experience help you as a manager?

Ciancutti: The No. 1 principle in the ER is, “Whose emergency is this?” If a patient comes in confused and out of control and sees doctors panicking, the patient will get worse. As the doctor, you cannot be in an emergency yourself. As a manager, you cannot take on the problems of your employee. Your job is to supply resources to solve a problem.

WS: But in true emergencies, how can you not panic a little?

Ciancutti: You need to have rules to follow before the crisis hits. If you’ve prioritized first, you’ll be ready.

In the ER, we have the “breathing-bleeding rule” to help doctors decide whom to treat first when two patients come in at once. I’ll check breathing first on both of them before checking for bleeding on either of them. When you develop ordering principles, it guides you through a confusing situation.

WS: An ER doctor must make quick judgments, but can’t a manager get into trouble judging a situation too quickly?

Ciancutti: The key is how you express judgments. If I’m managing a poor employee, it’s better to start by asking “What’s happening?” rather than “Why are you failing?” Once the employee tells me what’s happening, it’s better to ask, “What can I do to help you?” not “You’re making us look bad. Shape up now.” It’s tricky not to judge quickly and harshly and make the employee feel bad.

WS: What’s the biggest obstacle that prevents managers from moving up the ladder?

Ciancutti: They may resist asking for help from the right people. And that isolates them. In the ER, I had to be able to hear a nurse tell me that she thought I was about to make a bad decision. ER nurses often know more than the doctor. That nurse is my subordinate, so I had to ask for help and get it in a way that did not diminish my authority.

WS: How did you do that?

Ciancutti: I’d wait for a calm moment and say to the nurse, “You’re an expert at this. There are times you know things that are critical to patient care, and I need your help. I’d welcome that information.” If you say something like that, employees ask questions and volunteer more.

WS: But doesn’t that make you look weak?

Ciancutti: You’ll be weak if you do not ask for help. It’s harder for a manager to earn respect than it is for an employee to earn respect. Employees don’t have the authority baggage.

WS: What if you prefer not to ask for help?

Ciancutti: Get over it! Listen, there are two ways to rise to the top—a negative way and a positive way. The negative way is to find out where the wars are, guess which side you want to be on and fight. The positive way is to eliminate the war, to get people to help you.

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