As a leader in a Department of Surgery, it is easy for you to become completely booked with meetings and focused on the important projects for the department. It is surprising how suddenly long stretches of the year can slide by. It is absolutely critical that you as a department leader make, and insist upon, time to meet with your superiors.

During the meetings, it is critical to provide updates on important projects, and to inquire about institutional initiative and plans. However, it is also important to leave some time unstructured to explore areas that are not sufficiently mature to have made it onto a “to-do” list. It is essential to have an institutional perspective to guide the department in ways that best contribute to the whole. You cannot get that perspective without one-on-one conversations.

In any meeting, pay attention to the last 5 min. Whether the meeting lasts 20 min or 2 h, it is common that an issue introduced right at the end is the most important information. This is when one of the parties may finally bring up the topic that they promised themselves to mention.

Trust is critical to a strong working relationship at any level, but especially in leadership. As an important part of the institutional team, you should be both constructive and supportive. The institutional leaders should be assured that they can count on you to maintain confidentiality and to understand the importance of “the cone of silence” for discussing ideas that may ultimately not be implemented. In those discussions, you should be willing to be critical, or to play devil’s advocate, for the proposal. Sometimes these discussions can be heated, though criticisms should never be personal. The discussion must then remain within the leadership group; a lack of discretion will be followed directly by being left out of the next conversation.

Once a decision is made, however, you should publicly support the plans. Dissent outside of the decision process can undermine the implementation process for a plan that the institution has adopted. You take the path of dissention at the peril of the institution, the department and your role. It is disruptive for other members of the department to observe this, and may undermine their commitment that is fundamental to department success.

Your commitment to behave in this way can be difficult in some circumstances. However, to remain central to the decision-process of the institution and to avoid undermining department goals, you must be viewed as a trustworthy colleague who will provide well-considered criticism in private, and strong support in public.

Surprises are great for birthdays, but constructive institutional reactions are built around anticipation. Particularly if there is the potential for bad news, then you should alert the institutional leadership at the earliest possible moment. It is not necessary for all details to be confirmed in this situation. A “heads-up” call followed by a subsequent reassurance is far preferable to a surprise disaster.

Leaders are in place in part to anticipate and recognize problems. It is frequent that leadership meetings are centered on addressing some problem or challenge.

When you bring a problem to institutional leadership, it is always necessary to bring at least one recommended course of action. It is preferable to bring a variety of two to three options with strengths and weaknesses, including costs, attached. It is never sufficient to bring only the problem, and to anticipate that the solutions will come from the institutional leadership. Even if the resources for the proposed solutions must come from the institutional level, rather than the department, the proposal should come from you as the person who presents the challenge.

Special projects delegated from one’s boss are usually an imposition. Being asked to run a search committee, lead a curriculum review, or chaperone a strategic planning process is rarely an opportunity that is on your wish list. The project may not contribute to the department goals for the year. The time to meet these new targets has not been anticipated in your plans. However, there is very little option to refuse a project assignment, and no real option for putting it off or doing it poorly.

It is perfectly reasonable to accept a project and to note that you will come back with some ideas on the necessary timeline and resources. However, once the project has been offered, then it must be completed, and it must be done well. This is not just because it is the boss’s project. Presumably, the project has important institutional implications, if the institutional leadership has decided to commit some of your time to it. Taking the project on and then doing it poorly, or late (which often go together) does a disservice to the institution and indirectly to your department members.

You should make this project a priority for your own team. Assign some of your best assets to supporting the work. Set an aggressive timeline internally, and get started right away. The opportunity to support the institutional agenda outside of your direct workflow is an important one for both you and the institution.

Your boss has a boss. That may be the hospital board, the university president, or some other hierarchy, but everyone reports to someone. It may be tempting at times to go around your immediate institutional leadership to achieve some goal that has been stymied through your usual channels. However, bypassing the boss in this way will likely undermine the remainder of your relationship.