Michael S. Firstenberg – författare

There are few contemporary industries that are as complex and challenging to navigate as healthcare. The realities of constantly changing regulatory, financial, and legal environments, combined with increasing societal expectations for excellence and safe and quality care, have resulted in a unique combination of constraints and opportunities that require the best and the brightest of managers and leaders to successfully tackle. Yet despite a growing cadre of highly trained healthcare management professionals, there continues to be a paucity of high quality leaders across the industry. Moreover, even among those individuals, there is a significant amount of variability and heterogeneity of leadership styles and approaches.In an era of accountability to multiple stakeholders - from patients, to insurance companies, to local and national governments - the complex environment of healthcare requires visionary leadership, flexibility, adaptability, short-term tactical approaches, as well as long-term strategic thinking. Beyond the traditionally defined scope of services, the mission of institutions providing healthcare services has become much broader and far-reaching than just the provision of medical services within a specific geographic area. With hospitals and health networks progressively growing to become some of the largest aggregators of employment in the United States, it is not uncommon for healthcare institutions to function as guarantors of economic stability to entire towns, cities, and regions. Yet this must be carefully balanced with the challenges of maintaining sustainable growth and acceptable profit margins that help ensure that this "e;safety matrix"e; continues to function as intended.To be an effective leader in the modern healthcare environment, one must possess more than the knowledge and skills similar to other corporate environments such as having a fundamental understanding of relevant business models and their implementations, a high degree of emotional intelligence, conflict resolution, and a well-established repertoire of leadership behaviors expected of an executive. It takes someone truly special to translate the presence of diverse threats and opportunities - often in a climate rich with multiple types of diversely structured and organized competitors, multi-layered complex agendas that incorporate both personal and organizational goals, and an institutional "e;history and culture"e; that can be difficult to navigate, let alone change. Contemporary healthcare leaders must also possess a broad understanding of the nuances and intricacies involved in working with a multitude of care providers, inter-disciplinary teams, complex delivery platforms, and diverse patient populations.These efforts must translate into well-run healthcare systems that, although difficult to clearly and concisely define, are able to deliver excellent patient care, at the highest possible intersection of customer quality and value. For some other healthcare institutions, teaching and research missions can also be variables that must be considered and managed effectively in order for a hospital or healthcare system to be successful. Many of such organizations are the primary generators and providers of new provider talent to their communities and patients. Achieving all of the above goals is far from easy.As the editors of Fundamentals of Leadership for Healthcare Professionals, we were motivated by personal experiences, passion for the arts and sciences leadership roles, and the overarching goal to improve one of our most precious resources - the healthcare system. Each chapter in this text explores different aspects of healthcare leadership, provides valuable insights into how effective leadership functions, and offers practical perspectives on implementations of theory into practice. We hope that the reader will gain a better understanding of the full spectrum of challenges and opportunities that face healthcare leaders at all organizational levels.

The history of extra-corporeal membrane oxygenation (ECMO) reflects a true medical success story that has been the result of tremendous dedication, perseverance, teamwork, and years—if not decades—of hard work by countless providers, students, and advocates. This book, the final in a series of three on ECMO, traces the history of extra-corporeal support from the early years when therapy was offered as a last attempt at salvaging those patients who had lost almost all hope of survival, to the modern era and the role of ECMO in the contemporary management of critically ill patients, especially during the COVID-19 pandemic. The chapters illustrate how the technical aspects of ECMO have evolved, as well as the growing role of patient selection and team-based management. Although the role of ECMO for COVID-19 is still evolving, the chapters addressing this topic can serve as a foundation for the many complex systematic issues, beyond just the bedside care of ECMO patients, that must be acknowledged. Jorge Agustín Nicolás Ruiz de Santayana y Borrás, also known as George Santayana, has been credited with the quote: “Those who cannot remember the past are condemned to repeat it,” [George Santayana (1905) Reason in Common Sense, p. 284, volume 1 of The Life of Reason] a concept that clearly resonates with those involved in ECMO program development, patient selection and management. As such, the primary goal of this text is to help scholars of all levels better understand where we have been and where we are going.

Extra-corporeal membrane oxygenation (ECMO) is an innovative therapy that is used to support the physiologic needs of a patient during illnesses associated with acute severe respiratory and/or cardiac failure. ECMO is used in those life-threatening situations in which the oxygenation, ventilation, and circulatory support needs of the patient cannot be adequately maintained with a maximal conventional ventilator or pharmaceutical support. Essentially, ECMO is a simple pump circuit that can be used to support the role of failing lungs or hearts while therapies are aimed at organ recovery. While simple in concept and theory, this text illustrates the complexities associated with clinical use. The use of ECMO has evolved substantially overall the years–in part due to broader and growing applications, a better understanding of the technologies and how they can be used (especially in the context of long term human-ECMO circuit interactions), objective tools for patient selection, management protocols, and, most importantly, a growing body of evidence-based science and literature that demonstrates the effectiveness of this highly invasive, resource-intensive, and complex tool. The goal of this text is to draw from established thought leaders and experts around the world and present a comprehensive review of the rapidly-evolving and expanding literature regarding the spectrum of applications for ECMO. While by no means is this implied to be the final and exhaustive text on this topic, it does aim to be as comprehensive and up-to-date as possible which is, in itself, a challenge given how quickly this field is evolving. This text is aimed at students and providers, at all levels, who might have interest or be involved in the care of these critically ill patients. Chapters focus on how programs can be structured, the specific details of patient selection, management, and expanding roles of ECMO. Both basic and sophisticated concepts are presented with the goal that all may learn. We also present an objective assessment of some of the evolving challenges and limitations to ECMO in the context of the increased utilization and expansion of this therapy, combined with “sicker” patients, and the ongoing journey towards improved outcomes while offering a salvage therapy to patients who might otherwise die.

As demonstrated in the first book, the management of patients with profound respiratory failure or cardiogenic shock has evolved significantly over the years with advances in diagnostic and therapeutic options. While the mortality for these often-overlapping problems remains high, progress in the multi-disciplinary approach to these complex clinical problems has improved survival substantially. The focus of this second book is to explore some of the advanced topics and current literature regarding the management of patients requiring extra-corporeal membrane oxygenation (ECMO). As illustrated in the spectrum of topics discussed, ECMO is not only a complex therapy in itself, but the challenges, problems, and complications that arise in this unique area of medicine require engagement by many diverse disciplines. While there are many physiological issues such as organ protection, management of circuit complications, and optimal lung and cardiac protection for recovery, the use of ECMO also introduces a variety of legal and ethical challenges, particularly end-of-life issues (including brain death) in patients for whom recovery, despite extra-corporeal support, is most likely futile. Each of the chapters, written by world-renowned experts in the field, highlights a different important aspect in understanding the complex dynamics of extra-corporeal support and its impact on human pathophysiology. While many of the topics discussed involve sophisticated concepts, each chapter was written with the goal of providing a comprehensive review suitable for any level of training and experience. Many of the topic discussed highlight the state-of-the-art literature along with expert experiences and perspectives as we try to learn more about the overlapping art and science of a field of medicine that has only recently been accepted as a mainstream treatment option. Students of ECMO, ranging from early stage healthcare providers to master physicians, will benefit from the insights presented.