Not born, but made: The ICU medical director

By Stephen Matchett, MD | CEO, Sound Critical Care 

Dr. Stephen Matchett

As CEO for Sound Critical Care, I have the privilege of overseeing some of the most well-rounded leaders in the hospital — critical care medical directors. The intensive care unit (ICU) demands a lot from those who work in it. Intensivists must have a comprehensive understanding of body systems and how they interact, the ability to think quickly and make snap decisions, and the mental fortitude to leap into action for the sickest patients, just to name a few. All intensivists, including myself, have gone through years of medical school, residency, and critical care fellowship to learn what to do for ICU patients. However, nowhere in this training is formal education on how to run an ICU. 

Critical care fellowship focuses on disease management and learning how to care for extremely sick patients. No one prioritized teaching new intensivists how an ICU works, what the economics look like, or the skills needed to drive multidisciplinary quality improvement programs. 

It’s a catch-22; this knowledge is not intentionally passed down, yet it’s required to be an effective ICU medical director. This results in creating intensivists who aspire to lead an ICU, or those promoted to the position based on tenure, who feel underprepared for the role. Leadership, like many skills, is something that must be honed. How does a critical care program like Sound’s ensure that the person at the helm of the ICU will do right by their crew? 

Skills to hone 

Sound Critical Care has been partnering with hospitals’ intensive care units for nearly two decades. In that time, we’ve thrived in cultivating and identifying ICU leadership candidates. Alongside a solid critical care medicine background, an effective ICU medical director can be identified by these important factors: 

Quality improvement through structure 

Bringing better to the bedside means never settling on the quality of patient care. That begins with understanding medical guidelines and recommendations, front to back. This includes embodying not only the latest and greatest practices in critical care but also the hospital itself. Fully understanding the current state of care empowers medical directors to identify areas that need improvement. 

Once these areas are identified, the medical director can then strategically implement changes, order sets, initiatives, and guidelines and measure their improvement. For example, a medical director may notice a trend in patients’ family members repeating questions or disrupting the flow of care. To drive improvement, they may implement a guideline for their teams to intentionally involve family members in daily multidisciplinary rounds. Measuring the change’s effectiveness with pre- and post-patient interactions is most important and will inform if the workflow is worth working into the DNA of the ICU. 

Multidisciplinary collaboration 

The medical director bears the responsibility of upholding the standard of care for every discipline working in the ICU. When employing a multidisciplinary model of care, it’s the medical director’s role to build highly effective teams and draw the best out of every person. 

An organized approach is required, and a team chosen specifically for their ability to work in a collaborative framework is essential. Synthesized plans of care, scripted bedside interactions, and summaries from all major players come together under an ICU leader who embraces discipline collaboration.  

Team management 

Leading and managing other clinicians is an interpersonal challenge that requires intentionality and skill. A medical director puts their team first by understanding the nuances of scheduling, recruiting, giving feedback, and recognizing successes. Building consensus on a team draws back to an understanding of quality — what is working and where can improvements be made to make the ICU better for every clinician? An active leader drives effectiveness with these questions. 

Hospital alignment 

While the medical director captains the ICU, it is still just one part of the larger hospital ecosystem. We expect our ICU medical directors to provide leadership not only in the ICU but as trusted and aligned members of the medical staff, seeking to make the hospital as a whole better and more efficient. Working to integrate the ICU into the fabric of the entire hospital staff limits problems created through isolation. Sitting on interdisciplinary committees and leading the ICU with the hospital’s goals in mind is critical to a medical director’s success in hospital alignment. 

Leading from the bedside 

Often, the most common advice is beneficial to a critical care leader: practice what you preach. In other words, lead from the bedside by modeling behaviors that achieve best practice. Leaders will encourage and educate their team through leading by example and exemplifying how everyone on the team should be performing at the bedside. 

Developing the ICU medical director 

Organizations committed to high-quality, multi-program care must focus on developing their leaders for the ICU. For Sound Critical Care, this sentiment is a cornerstone of our program. The hospitals who choose to work with Sound do so because they see intention in all we do — in our best practice models, in our recruiting, and in how we cultivate our leadership. 

Sound approaches clinician development intentionally and systematically. A complete understanding of the leadership traits I’ve detailed here informs our ability to identify and nurture leadership potential among our critical care clinicians. A great ICU leader doesn’t emerge overnight — it’s a process. 

Development as a process 

At Sound, a clinician’s didactic development begins on day one. A clinician may have leadership potential, but it is up to us to fill in the gaps that medical school doesn’t cover. Mentorship is a huge first step and offers opportunities to all clinicians who show interest. 

Sound facilitates growth programs that focus on bringing leadership-minded clinicians together to hone leadership potential through collaboration. Our national meetings also drive connections with regional medical directors who offer supervision, mentorship, and help on tangible opportunities. 

A clinician’s accountability scales with their growth. Quarterly presentations create a structured forum for clinicians to report on internal improvements and receive feedback on their processes. This culture of growth is steeped in Sound’s mission to bring better — to the bedside, our partners, and each other.  

Promoting from within 

A huge benefit of this culture of leadership growth comes when leaders are ready to take the reins. Critical care is a relatively newer field of medical practice, and new clinicians may not be able to visualize a career path beyond providing care daily in the ICU. Fostering that path is vital. 

When clinicians see upward mobility in an ICU’s leadership structure, it sketches a career path for them to follow. Systematically scaling a clinician’s responsibilities throughout their tenure rewards loyalty and reinforces the growth they’ve worked hard to achieve. By this point in a Sound intensivists’ career, we understand who they are, and they understand our mission and know how to guide others in it. It sets Sound Critical Care leaders — and the teams they lead — apart. 

Interested in learning more about Sound Critical Care? Visit our specialty page.