1. Implementing The Leadership Theory in Geriatric Teams D. Garfinkel, M.D.,T. Sinai, J.Ben-Israel, M.D., The Shoham Geriatric Medical Center ISRAEL D. Garfinkel, M.D.,T. Sinai, J.Ben-Israel, M.D., The Shoham Geriatric Medical Center ISRAEL For Treating a Patients with Severe Disfiguration

2. Leadership Theory (Bass 1982) Widely used in industrial organizations, much less in medical settingsWidely used in industrial organizations, much less in medical settings Main Concepts: 1. Group Empowerment 1. Group Empowerment 2. Reframing 2. Reframing 3. Leadership Modeling (personal example) 3. Leadership Modeling (personal example)

3. The Patient A 62 year old man with Squamous Cell Carcinoma (SCC) - a malignant skin cancer. The SCC was Neglected so that large parts of the face were destroyed resulting in Severe Disfiguration. Admited after Suicide Attempt Moderate- Severe Congestive Heart Failure Chronic Anemia (Serum Hemoglobin 4.5 g/dL)

4. The Task Preparing a Multi-Disciplinary Team for a deviate procedure  Preparing a Multi-Disciplinary Team for a deviate procedure  Overcoming Total Refusal of the Staff to Treat a Patient  Leading a Group Process in the Ward

5. METHODS - The Process  Twelve 3 hour sessions with all staff members with all staff members  Led by the Chief Physician & Headnurse, Monitored by the Consultant (Psychologist)  According to the principles & concepts of Leadership Theory (Group Empowerment, Reframing, Leadership Modeling )  12 sessions - 8 before, 4 after the patient’s admittance

6. The staff filled in Questionnaires at 5 Crucial points during the process  The staff filled in Questionnaires at 5 Crucial points during the process Parameters Parameters  A. Self esteem  B. Image of hospital  C. Image of patient  D. Job ranking  Factor analyses & multiple regression METHODS - QUESTIONNAIRE

7. Results  19 staff members participated in the process for 6 months  A linear positive correlation between time and all 4 factors  Positive ranking of the process was at its highest level 4 months after conclusion  19 staff members participated in the process for 6 months  A linear positive correlation between time and all 4 factors  Positive ranking of the process was at its highest level 4 months after conclusion

8. Results The most significant finding – 65 % of staff members changed position towards the patient - from complete refusal of all contact with the patient initially, to regarding him as “family” or “friend” 4 months later. The most significant finding – 65 % of staff members changed position towards the patient - from complete refusal of all contact with the patient initially, to regarding him as “family” or “friend” 4 months later.

9. Conclusions Leadership theory models may serve as effective tools for preparing multidisciplinary teams in long-term care facilities, to cope with difficult patients.  Leadership theory models may serve as effective tools for preparing multidisciplinary teams in long-term care facilities, to cope with difficult patients.  Through a group process, team members can significantly improve their attitude towards “difficult to treat” patient, while contributing to increase their own self esteem, job ranking and image of their institute.