Startup leadership lessons from A&E

At 10.15 am, semi-reluctantly, I was helped out of the back of the ambulance with an itchy grey blanket draped around me, and stepped into the Accident and Emergency Department. Within minutes I was sat on a bed as a nurse took me through a questionnaire in a calm, structured fashion that ranged from the names of my next of kin to denominational preferences. I joined the club and signed the forms.

From somewhere another nurse appeared and proceeded to take my blood pressure and pulse, strapping and tightening a wide black band around my left upper arm with needless ferocity. She smiled in a friendly and reassuring way, committing the findings to a chart with such nonchalance to suggest that only the most dramatic irregularities could ever give her occasion for anxiety.

She turned her attention to my temperature and pressed a small device onto my forehead, its digital reading consulted and apparently satisfactory. I recalled the old days when an instrument was placed under your tongue and shaken three time, similar to a backhand flick in a ping-pong match.

Am I going to survive? I asked. You’ve got a temperature was the response. I thought everyone had a temperature? I enquired, but she looked away ignoring my attempt at humour.

Next a white-coated consultant arrived to put me through my paces, standing beside the bed and silently scanned the reports. He spent the next few minutes still in silence, as he prodded, squeezed and kneaded my abdomen and lungs, his eyes reflecting inner contemplation of what he was encountered.

The diagnosis was pneumonia, and I was detained for two days of observation. An overnight stay gave me a snap shot of hospital life, with its byzantine array of moving parts layered on top of the unpredictable rhythms of patient comings and goings. I could see that a hospital is in a permanent state of flux.

Bound by paperwork, short on hands, sleep and energy, nurses are never short on caring or love of humanity. Equally, I concluded that the character of a physician is just as important as the medical knowledge he or she possesses. Whilst nurses are the hospitality of the hospital, leadership from the physicians is reassuring and offers firm guidance.

Being at the centre of emergency clinical service delivery, physicians are an ideal leadership role model for crisis leadership in a startup, which shares the same characteristics of ambiguity, complexity and uncertainty typical of the environment.

While medicine typically focuses on decision-making at the individual physician–patient level, A&E leadership involves stepping back and examining problems at a higher level with an immediacy that adds pressure, requiring the ability to view issues broadly and systemically. This has immediate parallels to a crisis in a startup, arising from either customer, cash or staff challenges.

The person who assumes the role of leader in either crisis setting must be able to readily analyse a complex environment, to make informed decisions rapidly, and be capable of ongoing assessment and adaptation to unfamiliar and rapidly changing conditions. So what are the leadership traits I observed during my 48 hours under medical care, that are needed for a crisis in a startup?

Trait 1: Operate with clear vision and values This is important for every leader in any situation. Since the primary focus of physicians is on their professionalism and practice, the importance of this trait increases intensely during emergency scenarios, when uncertainty and time pressure emphasise the need for an almost automatic judgement, responses and calls to action.

Trait 2: Take a moment to figure out what’s going on Often the first response when you get into a crisis if that everyone starts talking at once. The chatter is a nervous response, not constructive, so you have to quickly assert your judgement to impose order and leadership on a chaotic situation. Do nothing maybe the best immediate response until you’ve assessed the moment. I saw physicians putting order into noise, creating a structured analysis.

Trait 3: Listen Leadership means asking and listening, rather than doing the talking all the time. It’s trusting the people who know best at that moment in time. Your job is to quieten the noise of your own point of view in order to hear those with relevant information, and apply judgement. I observed some great action listening skills.

Trait 4: Act promptly, not hurriedly Following on from the points above, I saw doctors providing direction and responding to the situation in a timely fashion, but not acting hurriedly. You can act with deliberateness as well as speed. Be quick but don’t hurry. The antichaos effect is important for startup leaders in their decision-making, even when it may be tempting to back out, and avoid knee jerking to a quick-fix solution.

Trait 5: Demonstrate control When things are happening quickly, a leader must assume control even though they may not have control – that is you can control the response. A leader puts herself into the action and brings the people and resources to bear. If trouble strikes, you can direct the response with the perspective that comes from seeing the situation as a whole and the conditions that are having an impact. I saw a lot of this during my time in A&E.

Trait 6: Keep loose A hallmark of a leader in a crisis situation is their ability to change quickly; your first response may not be your final response. In these situations, a leader cannot be wedded to a single strategy. She must continue to take in new information, listen carefully and consult with the frontline folks who know what’s happening. The measure of a leader is often tested during a crisis, and those leaders who can engage directly, but still maintain their sense of perspective, are the ones that will help the organisation perform.

Trait 7: Communication and collaboration as a strategy Physicians’ daily focus is primarily one-on-one patient interaction. During emergency situations, leading effective team work in the heat of the moment demands coordination from everyone. Here, leadership is about developing the personal qualities of communication to work effectively with others.

Trait 8: Managing people and building their endurance During the frantic activity I saw in tense emergency moments, there was also time taken to continuously look after the team even in a disorganised setting, checking in with everyone as individuals to ensure they were both performing, but also mentally and emotionally coping.

Trait 9: Being assertive never ever involves shouting There is a need for emphatic, potent and unequivocal decision making in the moments of crisis, but shouting out orders doesn’t have a place in any workplace situation. Leaders, build trust which builds respect. No one likes a know it all and a leader is not that.

But in some cases, it isn’t the crisis itself that causes an organisation to flounder, too often it’s the leaders response to the crisis that causes the greatest damage. It’s a time when competent leaders prove their mettle and when pretenders reveal their impotence.

Trait 10: Control your own emotions In times of crisis, leaders invariably find themselves in the midst of a stressful and tense atmosphere. There are enormous mental, physical and psychological pressures that can lead you to become agitated or perhaps even lose patience with those around you. It may appear that giving up is the easier way.

Instead, stop and realise that you have a lot more control than you think you do. Now is the time to take charge of your thoughts, emotions and the way you deal with problems. Allowing emotions to get the better of you can cause your team to lose faith in your abilities, they can interpret this as a loss of control.

The lessons from my observations as in A&E for startups are that leaders should embrace the uncertainty, keep your nerves steady and your head on, keep your tone level and take some immediate and firm actions to control the crisis. Lead to get the situation into perspective.

Calmly and firmly share the facts, speak the truth, and avoid making the crises worse with excuses or made-up stories to your team – face the reality of what’s in front of you. Your colleagues and customers alike will appreciate your straight-forward, upfront candour, confidence and calm as you discover yourself in the midst of rough waters. Your calm is going to help the situation to be resolved with dignity and will rub off on everybody else.

No matter how optimistic you are, how good your ideas are, how skilled your team is, or how careful you are in the process, some things are bound to go wrong in your startup. You might miss a crucial launch date, or accidentally push a massive bug to your software. You might realise a horrible defect in your product just after a new shipment goes out, or make a relationship-compromising mistake with one of your best early customers.

Crises like these are individually preventable but you can’t predict everything, and sooner or later a crisis will pop up to test your recovery skills and put your startup on the line. Out of your vulnerabilities will come your strength. You never let a serious crisis go to waste – what I mean by that it’s an opportunity to do things you think you could not do before. What you shouldn’t do is let a crisis become a crisis about your leadership.

Startups are like the A&E hospital ward in which I found myself last year, in that they will find themselves facing unexpected situations. The problem or crisis may strike during any juncture, and it may occur in any form. In spite of taking all of the necessary steps and strategies for management, a crisis might catch a startup completely unprepared and unaware, and it’s the calibre of the leaders that most often makes the difference.

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