An example of participative clinical leadership was the start a single port minimally invasive thoracic surgery program in the Department of Thoracic Surgery in Ancona, Italy, in which I have been working for more than 20 years. In the early 2000s, the advent of minimally invasive thoracic surgery, keyhole surgery revolutionized our specialty. Our centre was experiencing a difficult period of reduced productivity.

There was a need of an effective change that could boost the image of the unit and attract referrals.

In that period I had the chance to observe this new technique from a famous surgeon. I immediately perceived this technique as a valuable change to introduce in our unit. A change that could: 1. Revitalize the morale and enthusiasm of the team and 2. Increase surgical referrals and productivity.

The most important leadership skill to successfully implement this technique in our unit was my ability to set direction and communicate this to my colleagues. In that situation, it was critical to convince the team about the strategic importance of implementing the new technique. Communication was the key to the success of the program. In fact, the first step was to communicate my vision to the other team members and buy them in. I presented and discussed my vision and objectives with my colleagues in the context of the emerging needs of the unit. Using a participative leadership style I encouraged my colleagues to share their ideas and opinions engaging them in the process. This was important as they all felt part of the project even if they initially were not directly involved in the surgery. The stepwise approach was well defined since the start in order to avoid misunderstanding and win resistance. Taking into consideration the opinions of my team members, I was able to set direction by building a guiding team consisting of two surgeons, who started to learn and apply this technique and subsequently were able to tutor the rest of the team. This lead to increased surgical activity and productivity of the unit again.