Leadership in academic surgery is changing. Evolving needs, structures, and sensibilities combine to create demand for a different kind of surgical leader. The hierarchical, authoritarian leadership style of many past surgical leaders will no longer (and probably never did) yield the best return on institutional resources and faculty talents.1
At the extreme, those who exhibit the behaviors that have led to the popular characterization of surgeons as ego-driven tyrants will find themselves banished to the darkest corners of modern health systems rather than at the podium.2
The structures of academic health systems are also evolving rapidly. The internal structure is moving toward clinical service lines, which changes the roles of
departments and their leaders.3
This matrix structure contributes to an escalating demand for a different set of leadership skills, including collaborative goal setting, peer influence, and working as part of a team to be a good steward of the health system broadly. Moreover, as academic health systems evolve toward networks rather than hospitals, the demands for collaboration with a broader set of teammates will further accelerate these trends.4
The needs of leadership in science are changing as well. Investigators need to be facile in creating and leading multidisciplinary teams to be competitive in this era. True breakthroughs occur at the intersection of orthogonal fields, increasing the imperative for collaborative, interdisciplinary work. All of these changes combine to create an environment in academic surgery where a diverse set of leadership skills is required.5
Despite the knowledge that more is required of surgical leaders, specific strategies to foster leadership skills among practicing surgeons are lacking. Some health systems are providing leadership development programs to develop physician leadership competencies. These programs, however, are not specifically tailored to the needs of surgeon-scientists. Given the unique demands of leading surgeon-scientists, for any such program to succeed, especially among busy clinicians, it must be designed with the specific needs of the participants in mind.5
This chapter tells a story of how a leadership development program was created and how it evolved over time. There were many stumbling blocks along the way, and many aspects of the program changed over the years. This process provides one path for building such a leadership development program.
In January 2011, at an annual retreat, the journey began to deliberately develop the leadership skills of faculty. All surgical faculty are leaders in their daily lives, whether conducting a complex procedure in the operating room, leading a division, or chairing a committee in a national organization. But few faculty have had the opportunity to stop, reflect, and prepare for these opportunities. Surgical training is almost entirely focused on clinical care—developing technical skills and judgment—and appropriately so. An opportunity exists to prepare faculty as leaders by addressing these gaps.
To better understand the needs of our faculty, interviews were conducted with 24 surgical faculty members who were candidates selected to participate in the first round of the program.6
Voluntary participants were solicited for the program, including any faculty member who wanted to develop leadership skills at any rank, from Assistant to full Professor. Most had an existing leadership role or were anticipating (or hoping for) new leadership roles. All applicants were accepted, and only new faculty within 3 years of starting were not permitted to participate. These individuals should still be working on early career priorities—building clinical practices, starting research programs, and learning how to teach residents and students. These individuals did participate in a future year of the program.
Motivation to Participate
To understand the participant’s motivations to participate, qualitative analysis was conducted of participant interviews.6
These analyses demonstrated three key themes regarding faculty motivation to participate in a leadership program:
Recognition of key gaps in preparation for leadership roles: Many participants were acutely aware that traditional medical school and residency training did not prepare them well for leadership roles.
Appetite for personal improvement: Participants found themselves in leadership roles and were seeking opportunities to grow their skills.
Seeking guidance while at a crossroads in their career: Participants found themselves at a point in their career where they must take on leadership responsibilities to continue to grow (Figure 7.1
Perceived Needs of Participants
This qualitative analysis informed development of a competency model and curriculum.6
There were four areas of focus for educational content:
Leadership and communication: Learn effective communication and conflict resolution skills, and develop a compelling vision to motivate others.
Team building: Learn to create collaborative, effective, diverse teams.
Business acumen/finance: Learn about the basics of finance, marketing, strategy, and operations.
Understanding health care context:
Learn local context (e.g., organizational structure, and policies and procedures) and develop a greater understanding of health policy context (Figure 7.2
The interviews were the basis for a competency model and guided development of the curriculum. One important insight from these interviews was that an “off the shelf” program would not fit the needs of the faculty. While there are many excellent
leadership development programs offered through business schools, locally and nationally, a decision was made to develop a unique program, tailored precisely to the needs of the faculty. In particular, creating a unique program allowed substantial time in the curriculum for discussion of the local health care context, i.e., issues specific to the department and institution. To accomplish this goal, the program incorporated health system and medical school leaders to discuss granular topics, such as strategic planning, financial statements, and how the institution interfaces with national health care policies. The curriculum was also able to foster discussions with local leaders on what surgeons need to do to be active participants in health system strategy.
Figure 7.1 Motivation to participate in leadership development.
Figure 7.2 Needs to be met in leadership development.
BUILDING A LEADERSHIP DEVELOPMENT PROGRAM
Since the needs assessment 8 years ago, the leaders have built and sustained a faculty leadership development program which has been sustained within the department of surgery. The program is repeated at intervals of 3 years, includes approximately 25 faculty, and more recently has included five to seven residents who are in their academic development time. The fourth cycle was recently completed, ushering more than half of the faculty through the program. The program became a key tool for reflection on departmental challenges and opportunities, a unique opportunity to build relationships across clinical silos, and a launching point for other faculty
development initiatives. The program shows commitment to relentless development of faculty potential.
The leadership development program curriculum is shown below in Table 7.1
The program is 8 months long and includes the following key elements:
8 Full Days of Didactics
The backbone of the program is monthly Friday sessions where the entire group is present for didactics, experiential learning, and in-person group projects.
Prior to enrolling, faculty are required to clear their schedule and commit to attend all sessions, as it is believed that “dropping in and out” would disrupt the cohort effect. For each of the 8 days, the program makes it a priority to include high-quality didactics, engaging speakers, and content that would be valuable to the cohort. These days are designed to support learning in each of the areas of competency, including leadership, team building, business acumen, and healthcare context.
Table 7.1 Curriculum of the University of Michigan Department of Surgery Leadership Development Program
Elements in the Program
Learn effective communication and conflict resolution skills. Develop a compelling vision to motivate others.
1 full day of didactics on “Leading Organizations”
Longitudinal independent reading assignments
360-Degree evaluations completed by all participants
2 sessions with an executive coach to debrief on 360-degree evaluations and to generate a personalized leadership action plan
Learn to foster collaborative, effective, and diverse teams.
2 full days of didactics on “Building Diverse Teams” and “Innovation”
Longitudinal independent reading assignments
Longitudinal team projects with an 8-mo deliverable (at program conclusion) as well as a 2-y plan to integrate the project into real-world activity within the Department of Surgery
Business acumen and finance
Learn about the basics of finance, marketing, strategy, and operations.
3 full days of didactics on “Understanding Financial Statements,” “Capital in Healthcare Systems,” and “Introduction to Operations Management”
Group exercise with hospital executive to teach how to interpret financial statements of health system and timeline for capital expenditures in the health system
Division administrators reviewing financial statements from the Department of Surgery
Learn local context (e.g., organizational structure, policies, and procedures) and acquire a greater understanding of health policy context.
2 full days of didactics on “Healthcare Policy” and “Strategy in Healthcare”
Multiple interactive sessions with local leaders (i.e., Hospital CEO, Medical School Dean)
Reviewing Health System Strategic Plan, including Clinical Network Strategy
360-Degree Feedback and Coaching
Each participant undergoes a 360-degree evaluation by their direct reports, peers, and supervisors. The instrument was developed using questions from other validated sources that were combined to understand faculty performance according to the competency model. It was also thought important to expose the faculty to executive coaching as a tool for personal improvement. Each participant had two sessions with a coach to debrief and develop a personal improvement plan.
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