Name: Michael Cicero

Title: Medical Director, Emergency Department

Organisation: Advocate Health

Emergency Medicine physician for the past 17 years (including residency). I became assistant director of the ED in 2015 and medical director in 2018, overseeing an emergency department with 60,000 annual visits. I have also held various other titles as department chairs, committee chairs, and trauma director.

Thank you to the 2,000 leaders who’ve generously done the 7 Questions on Leadership!

I hope Michael's answers will encourage you in your leadership journey. Enjoy!

Cheers,

Jonno White

1. What have you found most challenging as a leader?

Emergency medicine requires complex multitasking unlike most other specialties. That doesn't change when one becomes a leader. What I have found most challenging is the balancing act between the wants and needs of staff versus those of administration. Whether it is better physician coverage, increased compensation, adding safety measures, or improving quality metrics, the various levels of my staff will have different opinions than administration. Educating all involved to maintain engagement and alignment is a must.

2. How did you become a leader? Can you please briefly tell the story?

Emergency medicine requires complex multitasking unlike most other specialties. That doesn't change when one becomes a leader. What I have found most challenging is the balancing act between the wants and needs of staff versus those of administration.

Whether it is better physician coverage, increased compensation, adding safety measures, or improving quality metrics, the various levels of my staff will have different opinions than administration. Educating all involved to maintain engagement and alignment is a must.

3. How do you structure your work days from waking up to going to sleep?

I do not have a typical schedule. I've never worked a 9-5 job in my life and I have no idea what that is like. The emergency department is a 24 hour operation with shifts times all throughout the day, including nights, weekends, and holidays. Every day, every week, every month is different based on my clinical schedule and my administrative time.

I therefore do not have any structure. Over the years I have been able to balance the needs of working clinically, administrative duties, and obtaining enough sleep to maintain health. Simple scheduling tricks such as stacking multiple meetings in a single day and scheduling immediately before or after shifts has helped to maintain the best possible framework of any structure.

4. What's a recent leadership lesson you've learned for the first time or been reminded of?

We recently had a member of our group pass away from cancer. When she was initially diagnosed, I struggled with how much information to tell to the group. I needed to be a pillar of support for her during her difficult times.

At the same time, I needed to update the group as best I could as to why our colleague needed extensive time off while maintaining confidentiality. I was reminded of a lesson I learned many years prior when there was another colleague that needed time off. I made the mistake then of divulging a little too much information which had gone against their wishes.

As close as coworkers and colleagues may become (and the emergency department is a tight knit group), leaders must take a step back and allow people to tell their own story. We need to let them share what they are comfortable sharing and we should never assume that they won't mind us sharing.

As leaders, we then take that information and apply it to support others in the group as needed, thereby making the best decision for the group that we can to move forward.

5. What's one book that has had a profound impact on your leadership so far? Can you please briefly tell the story of how that book impacted your leadership?

Crucial Conversations: Tools for Talking When Stakes Are High. This book taught me how to organize my thoughts prior to having critical and crucial conversations. Whether it is giving bad news to family members about the status of a loved one, or dealing with difficult employees, I have to speak clearly and effectively in a manner that all can understand, all the while maintaining calmness and composure.

This was put to the test early in my directorship when I was yelled at by an employee in front of others. They hadn't agreed with some recent decisions I made and they let me know it before subsequently storming off. The book teaches the importance of listening and not reacting, remaining calm and sincere, and engaging them to work out the differences. I use the same tools on a daily basis when dealing with difficult patients in the emergency department.

6. If you could only give one piece of advice to a young leader, what would you say to them?

It's OK to say No. It's one of the toughest things for a young leader to grasp. Young leaders want to be accepted and thought of as team players. They may not want to ruin any chances of future possibilities.

Therefore, they are eager to show their worth and may continue to take on tasks, even when some of the taks do not pertain to them. I worry of young leaders overloading their plate and encourage them to say no when appropriate.

7. What is one meaningful story that comes to mind from your time as a leader, so far?

My leadership skills were put to the ultimate test on March 12, 2020. That was the day Covid hit my emergency department. The night before, the NBA cancelled basketball games for the first time in years, leading to nationwide panic the next day. Like a tsunami, the ED was quickly overrun with patients. Schools and colleges were sending students in for testing. Businesses would not allow employees to work without being cleared.

I donned a haz mat suit and saw as many patients as I could. I had to remain calm and professional, while also trying to quell the anxiety and panic of my staff, including my own insecurities. I immediately implemented disaster protocols and separated the ED.

Extensive changes were made in the immediate days following to keep both patients and staff safe. Those skills helped me lead the department through a difficult time during a day that will live with me forever.ce.