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Feature: A Continuum of Leadership Development: A Model for Sustained Success for Women Leaders in Academic Medicine

By Page S. Morahan, Ph.D., Sally E. Rosen, M.D., Katharine A. Gleason, M.P.H., and Rosalyn C. Richman, M.A.

"The goal is for men and women to share the stage, to create a culture where they can express the full range of their capacities—so that women can express the forceful, dynamic leadership qualities they have without being penalized, and men can express the intuitive, empathetic qualities they have that are often not valued and that get suppressed by a totally male culture." —Kim Campbell, former Canadian Prime Minister

The 2008 Women in U.S. Academic Medicine Statistics and Benchmarking report shows that despite decades of women entering medical faculties and time for women to "fill the pipeline" in academic medical leadership, they are represented at only token levels of executive leadership positions in medical schools (Magrane, Alexander and Leadley, 2007). Why is it that the pathways to leadership are so challenging for women in academic medicine? And how can medical schools enhance leadership development while enhancing gender diversity and equity?

This article addresses the challenges of leadership development, paying particular attention to the circumstances of women leaders in academic medicine. It organizes the pathways to leadership as a leadership continuum, with specific phases supported by the development of fundamental competencies.

The Leadership Continuum Model

Rare is the senior executive who carries a single leadership position throughout his or her career. To achieve success in a new or current leadership position, skillful negotiation, adaption, and execution of the fundamental competencies is essential. These fundamental competencies are built into "The Leadership Continuum Model" and include: 1) self-efficacy, 2) political savvy, 3) personal & professional growth and 4) building communities of practice. Each of these competencies is refined through individual phases of preparing for leadership, transitioning into leadership, sustaining success in leadership, and transitioning again into new leadership positions.

The Competencies of the Leadership Continuum

Self-efficacy is defined as having realistic confidence that one can successfully perform an activity. It is developed through experience in performing tasks and jobs, seeing others like you being successful in jobs you aspire to, and having respected colleagues notice your competency.

Political savvy is the ability to "read" the political terrain—monitoring what people say and, in particular, their non-verbal cues to get insight into motivations, agendas, and possible reactions. Development of this competency requires a clear understanding of the organizational and political realities, which is achieved through political intuition and political skill. Kathleen Reardon (2005) speaks of political intuition as an "uncanny attentiveness to what others say and how they act". Political skill develops from taking a broad and strategic perspective, beyond the comfort zone of one's discipline, to view one's career as a game of strategy and political acumen (Gersick, Bartunek and Dutton, 2000).

Personal & professional growth requires self-awareness and long range priority-setting for self, family, and career. It includes the ability to move beyond the logistical focus of juggling professional and family responsibilities to a focus on professional "stretch" and strategic risk taking.

Building communities of practice involves membership in a close community of other leaders who can provide career advice and psychosocial support throughout the continuum. Obtaining support and advice from trusted advisers both from within an organization and those who are independent without vested interest is important (Merrill-Sands, 2005). It helps to remove the isolation that is so common for women in senior leadership positions and to build reciprocity and connections within these communities (Brown, Van Ummerson and Sturnek, 2001).

The Phases of the Leadership Continuum

Preparing: Moving Beyond Disciplinary Expertise

Disciplinary expertise and credibility are necessary but not sufficient for successful leadership. At some point after achieving the rank of associate professor or equivalent, those with leadership aptitudes and aspirations will need to broaden their organizational perspectives, visibility, and executive skills. It is a well established observation that women tend to view career advancement as a test of skill, whereas men tend to view it is a game of strategy and reputation (Gersick, Bartunek and Dutton, 2000). As a result, it is vitally important for women in particular to network, establish reciprocity, and develop a close community of trustworthy colleagues (Merrill-Sands, 2005). This is also the time for women to begin developing the skills that will be needed in subsequent job campaigns—interviewing, negotiating, and deciphering the organizational needs and culture.

To effectively develop the political skill and strategy to prepare for academic leadership, the aspiring woman leader should:

  • Obtain experience working with senior level administrators. Request and accept appointments for committees and task forces outside one's department that will put oneself on the "radar screen" for leadership assignments. Accept appointments that are challenging and that will add value to the strategic work of the committee or organization. Continue to bring visibility to oneself and others—make sure that all minority voices (gender, race, religion, etc) are heard during committee deliberations and task force meetings.
  • Seek line experience such as division chief or vice-chair positions that increase one's credibility as a candidate for executive positions. Today, women often need to show they have done the job, while men are given more latitude to prove themselves on the job. Moreover, women need to move beyond service related "staff" positions, and make sure that their position is visible, provides valued experience, and has advancement opportunities.
  • Develop a close community of advisers, supporters, confidantes, and mentors. This community will serve many functions over time—personal support, connections to professional development opportunities, and awareness and recommendations for leadership opportunities. Developing professional "social capital" and paying attention to one's community of advisors increases the opportunity to receive the kind of advice that only trusted friends and colleagues can provide during difficult times.
  • Learn to reciprocate. The act and art of mutual give and take strengthens networks with colleagues who are willing to contribute to one's welfare and initiatives. For example, agreeing to serve on a committee for the dean and doing the job well will be remembered later and increases the likelihood of being assigned to a new project. Women sometimes find this practice in conflict with their preference to reduce competitiveness and are more likely to "give" without asking for return favors. Gail Evans (2003) describes the importance of reciprocity among women in her book, "She Wins, You Win," by arguing that women need to learn how to help other women the way men help other men.
  • Develop self-efficacy in management and leadership. Additional experience in management of budgets and personnel, improvement of time management, guiding organizational change, and meeting facilitation skills are critical to success in one's leadership position. Women, who tend to have less confidence in the executive abilities than men, should take extra care to pursue professional development opportunities that will validate their competencies and broaden their horizons (Sloma-Williams, McDade, Richman, et al, 2008).
  • Become comfortable with strategic risk taking. Learn to take an informed leap, with good although perhaps not complete information about initiatives, to better personal positioning or organizational gain. This requires the ability to work with others to create a shared vision, to translate that vision into potential action, and to anticipate potential consequences.

Transitioning: The Job Campaign

The search for a senior leadership position—department chair or higher—may take as long as two years. This time is required to: clarify one's career goals and prepare supporting materials, get on the radar screen of influential people in the field, and progress through often prolonged search processes. It is not unusual to go through at least four to seven searches to develop the practical skills and experience to be a stellar candidate and to find the right fit between the organization and the candidate. Due diligence to determine the right fit is critical; short-term leadership tenures can result from lack of sufficient probing on governance issues and organizational culture.

To effectively transition into a leadership position, the women leader should:

  • Clarify career and job goals, and prepare job search materials, often working with mentors or a career coach. This includes preparing succinct career documents that highlight achievements, such as a cover letter with executive summary attached to the Curriculum Vita, and preparing for the interview process.
  • Gain visibility and credibility with the key "communicators." Identify and network with national leaders to get on the radar screen of search committees. It is critical for women to have highly credible men who can vouch for their capabilities.
  • Express a leadership persona as someone who is comfortable with having and expressing the power to change the system. Through graceful self-promotion, women let others know about their accomplishments and make themselves available in the nominations process for desired positions of interest.
  • Maintain the pre-established close community to provide triangulated data when assessing opportunities and to support for the inevitable emotional roller coaster of the job campaign.
  • Perform extensive "due diligence" to establish the fit between an organization's culture and context, the position, and one's interests and talents. There is extensive literature showing that women often do not consider all of the issues beyond salary and benefits that can be negotiated to ensure success.
  • Leave the former position. A trap that women can fall into is staying wrapped up in the old position out of loyalty to the former institution. Doing so is a disservice she may do both to oneself and to the organization by being a "lame duck."
  • Hit the ground running. "On-boarding" or how one makes the first 100 days successful is critically important to ensuring success in the new position.

Sustained Success: Staying the Course

In our resource-constrained environment, organizational effectiveness and fiduciary responsibility mandate that we recruit the best person with the best fit for the job and organization, and support them through the inevitable learning curve to success. Special challenges of women leaders include being more visible and not becoming isolated, i.e., being the "only," "first" or one of only a few. Such challenges often results in what has been described as the visibility: vulnerability dilemma (Hampton and Kram, 1998). A woman leader is highly visible, so any misstep, no matter how small, is noticed thus increasing her vulnerability. To achieve sustained success in leadership and to counteract these forces, the woman leader should:

  • Clarify, meet and publicize job expectations. Any leader must demonstrate rapidly that she is a problem solver and can get the job done by developing a vision and bringing together a team (Catalyst, 2005; Ibarra and Obodaru, 2009). Successful leaders must be able to see the "gray" as well as the "black and white" when dealing with the often conflicting goals of the teaching, research, and clinical service missions of academic health centers. For women, sustained success also requires graceful self-promotion of one's own and her team's accomplishments.
  • Develop a leadership style that has integrity. Numerous studies emphasize the need for transformational leadership rather than traditional command-and-control leadership (Eagly and Johannsen-Schmidt, 2003). A successful woman leader embraces the power of her position, becoming comfortable with power "with" and "over" people. This means developing an infrastructure of skilled staff, delegating to them, and publicly recognizing and rewarding staff success and contributions.
  • Maintain and add to the pre-developed community of practice. Because women's styles of leadership tend to be more collaborative and less hierarchical than men's, they may find themselves caught on a kind of "professional tightrope" of stereotypes. To prevent isolation and vulnerability that results from this "professional tightrope", women need to invest in the relationships of a variety of friends, advisors, and consultants who do not have a vested interest in the organization and that can give unbiased and trusted advice.
  • Develop political acumen and antennae. Constant monitoring is essential to assess the "goodness of fit" between job expectations and one's performance. When bosses change, one must be ready to provide evidence of the value of the current work and remain sensitive to the changing goals that may alter one's portfolio of responsibilities. Our fast changing environment calls for strategic flexibility, e.g., adapting research to fit areas of funding growth, staying ahead of the curve in the business of clinical practice, taking on a new position when the leadership changes, and with that, the direction of organizational initiatives.
  • Take time for reflection and restoration. Periodically step back to carefully consider questions such as, "Are we doing the right thing?" as well as "Are we doing things right?" The restoration from tending to one's own physical, mental, and spiritual health allows one to serve others better.

Transitioning Again: Moving On To New Leadership Opportunities

Leadership positions are typically finite and not tenure for life. Transitioning from one leadership position to another needs to be viewed as the typical process in leadership life. Women leaders need to understand and accept that is ethical to live in two professional worlds simultaneously, essentially as a "double agent", managing one leadership position and planning for the second. The first professional world is the current leadership assignment, where she strives to leave the organization better than when she came. The second professional world is the new position in which she uses her political acumen to tune into the changing scene and, as necessary, quietly performing the leadership continuum tasks of transitioning again. This involves making a Plan B (and C and D); leaders should always have backup plans (e.g. be "at the ready").

While leadership transitions may be planned or unplanned, it is important to recognize the opportunities in each and to develop skills in traversing from one important leadership position to another:

  • Be prepared for unplanned transitions. Negotiations to resign or step away from leadership to a neutral position can be quite sensitive. A myriad of insidious and subtle issues such as isolation, marginalization, and downsizing of ambition uniquely impact women during these times.
  • Maintain and link the previously developed close communities of practice. Women leaders, especially those at higher administrative levels, often lack depth in their professional support networks of support. This community is especially important in identifying and assisting the move to a "safe harbor" after an unplanned transition, where one can traverse again the leadership continuum phases of preparing for and transitioning into the next professional role.
  • Demonstrate resilience and grace, drawing on life skills, values and attributes (determination, integrity, etc.) that have sustained oneself inside and outside the workplace. Balance, restoration and reflection might be maintained through such activities as exercising, hobbies, and spending time with friends. With this type of balance and support, it becomes possible to maintain "grace under fire" and exit with an even stronger network.
  • Make meaning of the transition. Find ways to share experiences and tell your own story rather than letting gossip create a false and damaging one. This is vital to make sense of the situation for oneself, to educate other women, and develop a compendium of coping strategies (Ibarra, 2004).
  • Transition into the new position. When one moves from a leadership in one area to a new position with a different portfolio, such as from a department chair to an associate deanship for faculty affairs, one needs to quickly acquire understanding of a new literature, identify new mentors and role models to learn from, and build relationships with new colleagues and organizations. As with any transition, the previous steps of due diligence to assure the correct fit, negotiate for resources, develop an action plan, and build new relationships early in the new position are crucial to subsequent sustained success.
transition chart

Summary: The Elements of Essential Leadership Development Competencies

Recognizing that achieving and succeeding in senior leadership positions in academic medicine is neither serendipitous nor entirely within one's individual control, academic organizations will need to be attentive to all phases of the leadership continuum. Women preparing for leadership can purposefully work to develop competency in each domain that contributes to success across the continuum.

To achieve a level of diversity that enhances organizational effectiveness, academic medical leaders need to develop their faculty as leaders and promote systematic changes in their organizational cultures. The resulting critical mass of successful diverse leaders will produce the enduring fundamental change in the organizational culture that is crucial as academic medical centers re-invent themselves to meet the demands of the ever increasingly diverse workforce, students, and patients of the 21st century (Kanter, 1993; Ely, 1995).

References

1. Catalyst. The Bottom Line: Connecting Corporate Performance and Gender Diversity. New York: Catalyst, Inc., 2004.

2. Kramer VW, Konrad AM and Erkut S. Critical Mass on Corporate Boards: Why Three or More Women Enhance Governance. Wellesley, MA: Wellesley Centers for Women, 2006.

3. Ely RJ, Foldy EG, Scully MA. Reader in Gender, Work, and Organization. 2003;.

4. Ely RJ, Meyerson DE. Theories of Gender in Organizations: A New Approach to Organizational Analysis and Change. Boston: Center for Gender in Organizations, Simmons School of Management, 2000.

5. Meyerson DE, Fletcher JK. A Modest Manifesto for Shattering the Glass Ceiling. Harvard Business Review 2000;78:127-36.

6. Kanter RM. Men and Women of the Corporation. New York, NY: Basic Books, 1993.

7. Ely RJ. The Power of Demography: Women's Social Constructions of Gender Identity at Work. Academy of Management Journal 1995;38:589-634.

8. Morahan PS, Bickel J. Capitalizing on Women's Intellectual Capital in the Professions. Academic Medicine 2002;77:110-2.

9. Magrane D, Lang J, Hershel A, Leadley J and Bongiovanni C. Women in U.S. Academic Medicine Statistics and Benchmarking report, 2006-2007. Washington DC: Association of American Medical Colleges, 2007.

10. Reardon K. Its All Politics. Doubleday 2005.

11. Gersick CJG, Bartunek JM, Dutton JE. Learning from Academia: The Importance of Relationships in Professional Life. The Academy of Management Journal 2000;43:1026-44.

11. Merrill-Sands D. Reflections 2005;6.

12. Brown G, Van Ummersen C, Sturnick J. From Where We Sit: Women's Perspectives on the Presidency. Washington, DC: American Council on Education, 2001.

13. Wenger EC, Snyder WM. Communities of Practice: the Organizational Frontier. Harvard Business Review 2000;:139-45.

14. Evans G. She Wins, You Win: The Most Important Rule Every Businesswoman Needs to Know. New York: Gotham Books, 2003.

15. Heim P, Golant SK. Hardball for Women: Winning at the Game of Business. Plume, 2005.

16. Valian V. Why So Slow? The Advancement of Women. Cambridge, MA: MIT Press, 1998.

17. Sloma-Williams L, McDade SA, Richman RC, et al. The Role of Self-Efficacy in Developing Women Leaders: A Case of Women Leaders in Academic Medicine and Dentistry. In: Women in Academic Leadership: Professional Strategies, Personal Choices. Stylus Publishing, 2008:3.

18. Hampton MM, Kram KE. When Women Lead: The Visibility-Vulnerability Spiral. In: Klein EB, Gabelnick F, Herr P, ed. The Psychodymanics of Leadership. 1st ed. Intl Universities Press, 1998.

19. Catalyst. Women "Take Care," Men "Take Charge": Stereotyping of U.S. Business Leaders Exposed. New York, NY: Catalyst, Inc., 2005.

20. Ibarra H, Obodaru O. Women and the Vision Thing. Harvard Business Review 2009;87:62-70.

21. Eagly AH, Johannsen-Schmidt MC. Transformational, Transactional, and Laissez-faire Leadership Styles: A Meta-analysis Comparing Women and Men. Psychological Bulletin 2003;129:569-91.

22. Ibarra H. Working Identity -- Unconventional Strategies for Reinventing your Career. Cambridge: Harvard Business School Press, 2004.

23. Morahan PS, Fleetwood J. The Double Helix of Activity and Scholarship: Building a Medical Education Career with Limited Resources. Medical Education 2008;42:34-44.

24. Dannels SA, McLaughlin JM, Gleason KA, McDade SA, Richman RC, Morahan PS. Medical School Deans' Perceptions of Organizational Climate: Useful Indicators for Advancement of Women Faculty and Evaluation of a Leadership Program's Impact. Academic Medicine 2009; 84:67-79.

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