My name is Darren E. Wethers, and I am the past President of the Medical Staff at SSM St. Mary's Health Center in St. Louis. When asked to speak on the topic of courageous leadership, it prompted me to think about just what those words mean. The word "courage," to me, evokes a sense of heroism. And that made me think back to those comic-book heroes of my youth -- the Justice League Superheroes such as Batman or Flash. Suddenly my head filled with visions of doctors, nurses, administrators and support staff as caped crusaders for quality health care. I imagined Sr. Mary Jean Ryan as Wonder Woman, flashing her gold bracelets to ward off medical errors and scuttle operational waste.

But I also remembered the words of Dr. Wayne Sotile, who spoke here three years ago at the Physician Leadership Session. Dr. Sotile said that heroes are ordinary people who create safe spaces. In the medical setting, this means creating safe spaces for our patients, their families and guests, and our co-workers. We do this, in part, by bringing our best efforts to our work; by admitting mistakes and correcting them when possible; by meticulous attention to detail, so that patients get the exceptional care they deserve. That is always our intent. But does it always happen? Consider this story.

You're the president-elect of the medical staff; the president of the medical staff is out of town and can't be reached. Your cell phone rings one evening while you're at church.

A distraught hospital supervisor is on the phone. She tells you that a surgery that should have lasted three hours has stretched into seven. The surgery - for a patient who has a tumor -- is intricate. The supervisor is not only worried about the patient, but also about running out of the blood supply for the rest of the hospital. She wants you to intervene, to have another surgeon brought in.

You call the OR and speak to the anesthesiologist on duty, who believes that the surgeons in the operating room are capable of closing the case. You also learn, during the conversation, that another anesthesiologist first assigned to the case had raised a concern about whether these surgeons had enough experience to do this kind of surgery.

Tick, tick, tick. The supervisor is waiting for your answer. Questions swirl in your mind. As president-elect of the medical staff, do you have the authority to act? What is the protocol for such matters? Despite the first anesthesiologist's concerns, the surgery had been allowed to proceed.

Now you have to make a decision. Do you let the surgery proceed or do you stop it? What's in the best interest of the patient? I tell the supervisor to let the surgeons proceed. And indeed, the surgical team closes the case. Still, the patient does not survive the night.

In hindsight, courageous leadership is called for in situations like this. When it is unclear whether something should be done, or when to intervene, or who should intervene, or whose interests need to be protected, the medical staff leadership must summon the courage to do the heroic thing and that is to protect the patient. Always. Always…

Fortunately, we have now adopted a culture in which anyone in the process can bring the train to a halt. Still these issues remain enormously complex.

Courageous leadership means being able to say to a friend or colleague, "No, you can't. I'm afraid you're not prepared to do this and we won't allow it here." Doing so will not make you popular, but taking a stand will make our hospitals better, safer. Now that's truly heroic. Thank you!