Everyone in academic medicine will at some time find himself or herself contemplating a leadership position. Those who say “yes” to that offer will find themselves responding to the greeting of “Congratulations! What do you hope to accomplish in the first six months?" This feature article explores that question through expert advice and two case discussions.
Ciampa and Watkins, the authors of the book, Right from the Start, note that the first six months of a leadership position should create momentum for sustained improvement. They point to the importance of paying close attention to three related elements:
- addressing the vexing problems of the organizational unit you have been called upon to lead,
- laying a foundation for deeper change, and
- building credibility with bosses, subordinates, employees, and governing boards.
Ciampa and Watkins identify seven actions for successfully managing leadership transitions:
- A new leader has two to three years to make measurable progress in changing the culture and improving financial performance.
- On arrival, the new leader should already understand the organization’s current strategy and associated goals and challenges and should have formed hypotheses about its operating priorities. During the first six months, these hypotheses must be tested and either validated or changed.
- New leaders must balance an intense, single-minded focus on a few vital priorities with flexibility about when and how they are implemented.
- Within the first six months, the new leader must make key decisions about the “organizational architecture” of people, structure, and systems. Most crucially, the new leader must decide whether the composition of the inherited team is appropriate and whether the organizational structure must change.
- By the end of the first six months, the new leader must also have built some personal credibility and momentum. Early wins are crucial, as is beginning to lay a foundation for sustained improvements in performance.
- The new leader must earn the right to transform the organization. The initial mandate from the Board and the CEO is never sufficient, nor will it remain static. It must be diligently and regularly reassessed. The new leader must also work actively to build coalitions supportive of change.
- There is no single best way to manage a leadership transition. New leaders’ approaches will inevitably be shaped by the situations they face, their prior experience, and their leadership styles.
Ross, Gilmore, and Blaylock offer advice specifically for Deans of medical schools in their article, "From Saying Yes through the First 100 Days: Making the Most of a New Leadership Role" (Academic Physician and Scientist March 2006), while avoiding crippling mistakes. While the notes are written for Deans, much of the advice can be generalized to other administrative leadership positions. Their suggestion is to approach the new job as a cultural anthropologist in the days before formally assuming responsibility so that you can observe the language and behavior of the institution to better understand its culture. This will help with planning a successful entry strategy.
Whether you are recruited from outside the institution or tapped as a long-time contributor you will benefit from the following activities:
- Reviewing data pertinent to the regulation of administration of the unit, e.g. LCME reports, ACGME guidelines, and institutional policies.
- Probing the local environment and relationships to political perspectives, university and medical center structures, etc. Listen and look for discrepancies between internal and external perceptions. Compare perceptions to the data you have collected on outcomes and trends.
- Identifying informal leaders—top producers, awarded researchers and teachers, thought leaders inside and outside your department or institution. This can be accomplished by interviews that not only provide you with information and perspective but also extend your network of influence and may result in valuable mentoring.
Ross, Gilmore, and Blaylock remind us that an effective strategy for entering the new position is to “under-promise and over-deliver!” Plan your first public steps. Consider what you hope will be your legacy after leaving this position in five to ten years. What steps can you take to begin that script? Communicate your priorities early and persist with the messages until you see progress, then adapt your message to help people see how that progress fits into the big picture. In the first 100 days you should:
- Be seen early in a variety of venues—town hall meetings, various campuses. Reach out to stakeholders such as key, active donors, board members, department administrators; members of the search committee (remember they recruited you. They can be gateways to the organization as well as ardent advocates).
- Listen visibly to build goodwill and show respect for diverse abilities and values. When you speak, avoid reacting too quickly or too much.
- Get briefed by your staff with a short written analysis of key issues gathered and written by an accountable senior staff person.
- Find your thinking partners—cultivate a group of thought leaders who share your vision.
- Build your team.
- Manage upward with regular and frequent reports to your supervisor, whether that person is the department chair, an associate dean, the president or provost. Aim for clarity in your relationship to any board or other governing authority.
Finally, every source on leadership transition reminds us to be mindful of our personal lives and family. Dr. Petersdorf’s advice on “Survival in the Deanship” contains thoughts on “personal survival”: take at least half a day each week for research, reading or clinical medicine (if in a full time administrative role), ration travel, take vacations, and always plan for life after this position is ended!
Case Discussions on Leadership Transitions
How does this advice on transitioning to leadership roles play out in real life? Consider two cases—an assistant professor offered his first leadership position as a departmental clerkship director and a seasoned chair considering an offer to become a dean of a medical school. How do the pathways to leadership, the preparation to assume the position, and the impact compare?
- Case: John Smith’s First Leadership Position - Negotiating for the Clerkship; written by Dr. Susan Cox, Professor of Obstetrics and Gynecology, Associate Dean for Professional Education, University of Texas Southwestern Medical School
- Case: From Department Chair to Medical School Dean - Transitioning to a Greater Circle of Influence; written by Dr. Eugene Rich, Professor and Chair, Department of Medicine, Creighton University and 2006 Council of Deans Fellow
On Senior Leadership
- Ciampa D, Watkins M. Right from the Start: Taking Charge in a New Leadership Role. Harvard Business School Press, 1997
- Clawson DK, Wilson EA. The Medical School Dean, Reflections and Directions. McClanahan Pub, Lexington KY, 1999
- Gilmore TN. Making a Leadership Change. Authors Choice Press, Lincoln NE 2003
- Ross WE, Gilmore TN, Blaylock E. "From Saying Yes Through the First 100 Days: Making the Most of a New Leadership Role," Academic Physician and Scientist, March 2006.
On Directing a Clerkship
- Margo K, Fincher RME, Espey E. Ch 1."The Role of the Clerkship Director." In: Fincher RME,ed. The Clerkship Director’s Guidebook, 3rd edn 2005. http://allianceforclinicaleducation.org/resources2.
- Elnicki DM, Hemmer PA, Udden MM et al. "Does Being a Clerkship Director Benefit Academic Career Advancement: Results of a National Survey." Tech Learning Med 2003;15:21-24
- LCME: Functions and Structure of a Medical School, Part 2, June 2005. https://www.lcme.org/standard.htm.