I took on the role of the head of the ophthalmology department of the Hospital of San Bassanio, in Bassano del Grappa, Italy, in October 2008. I started straightaway with two obstacles: I am a woman, and I am younger than the five doctors working under me. The four male and one female doctor were all between the ages of 44 and 50 years old. This was a difficult starting point for me.

I decided that my first objective was to be accepted by the staff and then to find the right methods to motivate them. At the same time, I also needed to define and organize my own duties.

My first month was dedicated to understanding the hospital's infrastructure and staff organization. During the first staff meeting, at the beginning of the second month, I asked each doctor what were the most important problems we needed to solve to help them work better.

They all mentioned one problem in common, which became my first challenge as department head. The hospital expects all physicians to do night duty. Because we are eye specialists, our knowledge of other areas of the body is somewhat limited. Everyone found this responsibility stressful, knowing they might be faced with difficult problems they could not solve alone in the middle of the night.

I promised that I would find a solution to this problem. I immediately began working on it, and I communicated my progress continually to my coworkers through text messages, e-mails, and telephone calls.

By the beginning of February, I was able to announce that the problem was solved. The enthusiastic appreciation expressed by my colleagues made it clear that I was on the right track to be accepted by them and to motivate them. They began to show respect and confidence in my ability to run the ophthalmology department.

NEW RESPONSIBILITIES, BETTER COMMUNICATION
Responsibility is a great motivator. My next strategic move was to create sections within the department and make each doctor responsible for his own area.

The female doctor, Danise Zanotto, MD, with whom I have a good working relationship, became head of the corneal segment department, with total responsibility for both surgical and medical areas. The most senior physician, Romeo Altafini, MD, was made head of an independent glaucoma department, also with medical and surgical areas.

The youngest, and probably the most motivated, physician in the department, Antonio Toso, MD, was given responsibility for the surgical vitreoretinal department, and subsequently he became an even more motivated, trustworthy, and efficient member of the department. Giovanni Rappo, MD, who had expertise in diabetic retinopathy, became head of the diabetic retinopathy department, medical and surgical.

Claudio Spadaro, MD, who is not a surgeon, was given responsibility for the surgery annex and the medical retinal pathology department. My goal is to teach him anterior segment surgery.

I also implemented changes to improve communication, not only between the physicians and their patients, but also among the physicians. All of us communicate each day about all types of topics relating to our jobs. We have a departmental meeting every 2 weeks. During these 1-hour meetings we discuss the latest news, and the doctors are invited to report on the most recent congress they have attended and to summarize the information they gathered there.

Each departmental meeting addresses different subjects; one meeting may be a technical update regarding ophthalmology, and the next could be about departmental organization. The meetings usually last from 1 to 2 pm, during which time we share a small lunch. Even though we are in communication every day by phone and text message, we sometimes schedule an extra meeting when necessary to communicate urgent information.

OPERATING THEATER
I and my colleagues spend a lot of time in the operating theater. I have implemented a number of changes there.

Cataract surgery is the most common ophthalmic surgical procedure, so I believe that every member of the department must be an expert on microincision cataract surgery (MICS). I usually attend in the operating theater as the second surgeon with each of my colleagues, offering advice and pearls to use in MICS as well as everyday techniques for all type of cataracts.

I also assist all of the surgeons with their own patients who present with other pathologies. For example, if a surgeon has a patient with macular pucker, I scrub in and help the doctor to do the surgery according to their own ability, building their personal experience day by day. I do this even for corneal transplants, refractive surgeries, retinal detachments, and other pathologies.

Two of my coworkers, Drs. Toso and Altafini, have been given the responsibility of maintaining the surgical theater, the surgical patient list, and the machines and instruments.

ADMINISTRATIVE TASKS
Certain administrative tasks have also been divided up among my coworkers. Dr. Zanotto is involved in communicating with the general medical and administrative management of the hospital. She is in charge of the patients' information folders and diagnosis-related group (DRG) coding. This is vital coding information by which the hospital is reimbursed by the government for surgical operations, so it is an important responsibility.

Dr. Rappo, the diabetic retina doctor, has responsibility for this large section that acquires substantial government funding for our ophthalmology department.

Dr. Toso is the instrument shopper for the department. He is in charge of buying technical hospital instruments when we need new ones for medical or surgical activities. This is a demanding and complex job, but Dr. Toso is the perfect fit for it.

Dr. Altafini, the glaucoma expert, has his own independent department. In the beginning, I had some communication problems with Dr. Altafini because he had also been a candidate for the department head position. After I received the position, he was unmotivated for a period of time. His attitude changed when the general director of the hospital allowed us to create a special department for medical and surgical glaucoma management, which received extra money from the government for the purchase of new instruments and surgical glaucoma devices. Also at that time, I explained to my colleague my personal plans and goals for the department, and he has once again become a motivated and enthusiastic colleague.

MAINTAINING MOTIVATION
In my own effort to obtain the maximum contributions and results from my coworkers, I strive to study their personalities and involve them in activities that they will be devoted to and interested in. I also encourage the physicians to attend national and international congresses and seminars, giving them the possibility to learn new methods and gain information about their subject areas.

Because of the need for international contact, Dr. Toso hired a language teacher who helps us to practice and improve our English. Marijke De Moliner gives us weekly lessons, not only to learn the English language in general, but also to practice and simulate our congress and seminar events. She has plenty of experience in those areas. Additionally, she has become a good friend to the physicians in the department.

As the head of the ophthalmic department, I do my best to be not only a friend to my colleagues but also a person who helps them to work better, who endeavors to improve their working conditions, and who provides motivation when needed. We now all work hard together as a team to improve our jobs, knowledge, and service, and we constantly strive to build a better and more efficient ophthalmology department.

I invited my colleagues to contribute their points of view on this topic. Their comments accompany this article.

Simonetta Morselli, MD, is Head of the Ophthalmology Department at Bassano del Grappa City Hospital. Dr. Morselli is a member of the CRST Europe Editorial Board. She states that she has no financial interest in the products or companies mentioned. She can be reached at e-mail: simonetta.morselli@gmail.com.

OVERCOMING NEGATIVITY
By Romeo Altafini, MD
I am the senior physician in the ophthalmology department at Bassano del Grappa City Hospital, where I have worked since 1990. I was the deputy head of the department for 1 year and was made to believe that I would be the future director of the department. When I was informed that the new head of my department would be a woman from another city, and that she was younger than me, I was floored. I went into a deeply unmotivated period.

This negativity lasted for 2 months. In December, before the holidays, I asked my new boss for a private talk. I wanted to clarify my position and to understand what her program was for me and for the department. I also asked her for help, to introduce some incentives, and allow me to find motivation again.

Dr. Morselli was happy to help me. She told me she realized that I was a valuable member of the staff, and she consequently gave my situation a high priority. She said she needed my help to motivate all the department members. She also asked me to work together with her to improve the department's position in the hospital, as I know all the staff well.

She also promised that she was going to help me to create an independent glaucoma department where I would be the director. Sure enough, I have been the director of the glaucoma department since June. Dr. Morselli is now also helping me to perform new and different types of surgery.

We work together to prepare presentations for international seminars. She is helping and teaching me how to prepare videos for my presentations.

With all of these changes, I am now very motivated. I love my job, and, thanks to my department head, I like to work again. I have great dreams for my future in the profession, and Dr. Morselli is helping me to achieve those.

MANY TYPES OF MOTIVATION
By Giovanni Rappo, MD
Motivation is different for every person. For some, money is important; for others, it is acknowledgement of their efforts. Many things motivate me in my work in ophthalmology.

Doing something that is useful and helps others is motivation for me. Our work in ophthalmology improves patients' quality of life by saving or preserving their vision.

The appreciation of patients is also a great motivator for me. This is a reward one can find only in certain medical positions. For example, anesthesiologists do important work, but they are seldom remembered or acknowledged by their patients. I see my patients periodically after surgery for check-ups.

It is motivating to have a department head who continuously praises and stimulates us. We know that we are part of a team—all working toward the same goal, not just as individuals. One person's problem is everyone's problem, and we are all therefore worth so much more. This helps us all to strive to reach our target.

Another motivator is that our department head encourages us to learn, to go to conferences, to improve our practical experiences, and to practice new techniques. Our experiences have broadened greatly as a result of this.

Dr. Morselli also transmits positivism and gives us security. No problem is ever too big, and it is always solvable. She gives positive feedback and supports us when we face problems. These are some of the reasons we love her work so much.

If you want to succeed in anything in life, you first need to believe that it is possible—have faith—and see that it is possible by hearing about others' successes. The point of motivation is not just to do something once. One act of motivation does not last long; it must be a continuous process.

As Aristotle said, "We are what we repeatedly do. Excellence, then, is not an act, but a habit."

FEARS PUT TO REST
By Claudio Spadaro, MD
When our new department head arrived at our hospital, I became involved in a new type of job. I was quite worried before she arrived. Some resentful members of the staff had described her as an ice queen. Because of these negative comments, I was even considering changing hospitals before she took over. Thankfully, however, when Dr. Morselli arrived in October 2008, I had a private talk with her and realized she was completely different from the image that preceded her.

Dr. Morselli is continually teaching me. I am now starting to learn anterior segment surgery. I am not completely convinced that this is the right direction for me because I feel slightly disoriented, but she wants to help me define a new position for myself. She tries to involve me in our department and our new operating methods.

LESSONS IN MOTIVATION
By Antonio Toso, MD
In order to develop the skills of a staff of physicians, a manager or department head first needs to motivate them. Many physicians do not need to be motivated because they already have a sense of duty and self esteem. The greatest challenge, therefore, is to motivate those others who have lost interest in some activities or areas of their jobs.

In my opinion, the way to motivate people is to make them feel they are involved in decision making and are not simply following orders.

The first step is to understand what people like to do, as well as what they dislike. A good leader has to talk to his colleagues about every aspect of their jobs, thus helping emphasize their best qualities and their special strengths. This is true in surgery as well as in the departmental organization.

The second step is to give all colleagues the opportunity to improve their abilities and give them responsibilities in their preferred areas. Opportunities to grow and to undertake new responsibilities are great motivating factors.

The third step is the greatest challenge: One must convince colleagues to do even what they dislike. It is important to change the perception of supposedly boring activities, for example by having regular meetings and discussing the issues surrounding the activities in question. It involves making acceptable that which was an annoyance. In this way, each coworker feels that he is an important member of the team.

Finally, it is important to carry out the main responsibility of every department head: to develop and improve the abilities and competences of all members.

In my opinion, the department head should give coworkers the satisfaction of learning new things, such as new surgical or diagnostic techniques. Dr. Morselli likes to teach, and she loves to be of service, so she helps each of us to improve our surgical skills and our work habits. It must be a beautiful sensation for a teacher to see his pupils improving constantly. I consider myself a lucky (and motivated) coworker.

As Albert Schweitzer said, "I don't know what your destiny will be, but one thing I know: the only ones among you who will be really happy are those who will have sought and found how to serve."

RESPONSIBILITY BRINGS SATISFACTION
By Danise Zanotto, MD
Since October 2008, my work life has changed completely. I thought it was normal to say "yes" and do the work without asking why or thinking about what I was doing. Now that the department head has given me the responsibility of the corneal department, I feel that I am responsible for my own work. I am stimulated to learn new therapies for our patients and to think about new surgical options.

Dr. Morselli was able to motivate me despite that fact that the volume of my job has doubled. I am working hard but am happy and stimulated.

LEARNING WHILE TEACHING
By Marijke De Moliner
Motivation is developed internally from a personal desire to achieve goals that are important both to the individual and to the organization. Motivation is the force that prompts one to take action. As the motivational expert Howard Shore, of Activate Group, has said, if you are having trouble getting someone to achieve your goals, you are probably failing to understand their goals.

Dr. Morselli certainly knows and understands her staff's goals and ambitions. In one of the many articles I have read on motivation, I happened upon a 15-point suggestion list, and thinking of her motivational skills I could happily tick off all of them.

As the department's English teacher, I am not involved in the politics or day-to-day operations in the ophthalmology department, so I can be objective about the personnel and their boss. It is a pleasure teaching there, as I feel that I am one of them and am treated as a friend. It is amazing the respect and love the personnel have for Dr. Morselli. She does not expect anything of her staff that she would not do herself.

I have seldom seen someone with such energy, enthusiasm, and knowledge, all of which she is happy to impart to her staff. I am sure she works by the motto, "A leader is as strong as her staff," and she is strengthening her staff. She motivates, teaches, helps, and all of this with a smile. She does many things that are spot-on when it comes to motivating her staff. I am only too happy to be a part of Dr. Morselli's department.

Romeo Altafini, MD; Giovanni Rappo, MD; Claudio Spadaro, MD; Antonio Toso, MD; and Danise Zanotto, MD; are physicians in the Ophthalmology Department at Bassano del Grappa City Hospital. Marijke De Moliner is a lecturer in Business English and Public Speaking, with experience training international students and professionals in business communication.