Keywords
leadership - training - characteristics - culture
Leadership was, in the past, an undefined and existential quality sought after by
institutions and departments of medical specialties that could only be gained by hiring
in “leaders.” Recently, business schools have begun teaching leadership and a number
of publications about leadership have increased over the last decade. Unfortunately,
medical education has not caught up with business in this effort to train leaders.
Rather many institutions continue to rely on happenstance to find leaders in health
care specialties. Surgery as a specialty has started training leaders at a national
level, with special courses available through the American College of Surgery for
fellows of the college. Individual departments of surgery have an opportunity to create
a culture of leadership and develop leadership training within the department for
all members of the department, regardless of the experience of the individual member.
This provides the opportunity to shape careers, enhance function within the department,
utilize innovation, and improve care for our patients because we can enhance or capture
the potential of each member of our department of surgery. What follows is the why,
who, when, what, and how to create a leadership program in a department of surgery
based on our experience at the Department of Surgery, Baylor University Medical Center
in Dallas.
Who?
All members of the department should be considered as candidates for leadership training:
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Faculty: Whether private practice, employed or academic, full-time or part-time
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Fellows: Regardless of specialty
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Residents: At all levels
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Students
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Staff and administration.
The integral group of educators for creation of the leadership training program includes
the psychologist who lives in the leadership space, the residency training program
director, the division chiefs of specialties within the department of surgery (including
the division of surgical education), the senior leadership team within the department
of surgery and the department chairman. The decision to move forward with training
in surgical leadership was made by all of these individuals as part of the department
strategic planning process.
How?
The practical steps of establishing a culture of leadership in a department of surgery
can occur in any order. The only absolute initial requirement is for the chief to
embrace and declare support for the concept of creating a leadership culture. After
this pivotal event, the process can flow in many different directions.
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Constant emphasis on the culture of leadership by department leadership brings the
focus of the membership in line with the idea. There needs to be a shared vision throughout
the department to make this a sustainable effort.
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Develop a program to establish a culture of leadership, agreed upon and supported
by the governance council of the department. Specific plans are important to keep
all in alignment.
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Assign the vice chair of faculty development to make leadership position recommendations
to the governance group. The chief is sometimes not the best person to identify potential
leaders within the department due to limited exposure to daily behavior.
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Develop a leadership curriculum with a psychology director, surgical education director,
or vice chair of faculty development which can be delivered in multiple settings to
individuals at multiple levels of experience. The seminar setting is very appropriate
for faculty at all levels but may not be as effective for trainees who are potentially
intimidated by a group discussion. In those circumstances, a didactic format with
opportunity for discussion or moderator led panel may be accepted.
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Establish a curriculum focused on the levels of experience possessed by the participants.
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Students and residents require basics of emotional intelligence and leadership concepts
to understand the implications of their own daily behavior on their potential for
leadership in their current setting. They will come to understand the implications
on their future decisions and applications for graduate and postgraduate training.
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Junior faculty may not realize the need for leadership training until offered a monthly
seminar specifically about leadership available opposite regular department educational
conferences. This approach does not add to the burden of time demands on the junior
faculties who have families and activities of daily life requirements. Leadership
skills and options for approaches to daily leadership situations can enhance performance
during patient care and while participating at a committee meeting.
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Mid-level and senior faculty who are committed to leadership positions may benefit
more from classes at an offsite advanced learning institution which reduces the distractions
of daily practice and institutional commitments. A mixture of leadership and business
management skills training will lead to a comfort level in decision making that should
improve performance in their home institution. Department, institution, or foundation
funds need to be available to support this effort.
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Develop a reward system within the department to entice junior faculty to attend a
monthly seminar on leadership. While certificates are worth only the price of the
paper they are written upon, they indicate a level of participation that indicates
leadership potential. As the certificates appear on faculty walls, their value will
rise. This becomes a reward to upwardly mobile individuals in the department. As a
result, others will recognize this as a reward for their commitment to leadership
education. This can only succeed when assignment to leadership positions is tied to
prior participation in the course. Intradepartmental recognition for completion of
the program will guarantee the value of the education.
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Develop a mentorship program at all levels of the department with emphasis on resident
mentoring and using leadership trained individuals as mentors. The mentor program
must be maintained by an assistant program director in the residency program for it
to be successful. Quarterly reports of meetings between resident and faculty mentor
are key to the success. All mentors must receive short training in mentorship based
on one of several publications within surgery that deal with the specific needs for
surgical residents in training. Faculty mentorship can also be beneficial and can
be established with or without departmental structure. A yearly lunch with junior
faculty has helped me as chief to understand the goals and desires of the newest faculty
members over the years.
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Provide opportunities for leadership for newly educated faculty. It is helpful to
keep a list of those opportunities that need appointments and the corresponding list
of faculty members that qualify. If the leadership position can be rotated through
various faculties on an intermittent basis, it is helpful to keep track of the performance
by each person who has been in the position. A required report from the leader is
helpful to accomplish this process. As years pass and the junior faculty member grows
into a senior leader, it will be important to track the service for that individual
in their curriculum vitae as a record of service and documentation of team membership
and leadership function.
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Discuss and communicate metrics of success for practicing leaders. It is often confusing
for new leaders to understand how their performance as a leader is measured. Personal
success should not be judged in a vacuum since other people have contributed to the
outcome. Team success reflects positively on the leader, unless the leader professes
that the outcome was due only to leader participation. “Reflected light” from the
success of others should become the goal of any successful leader. Once this concept
is understood, true leadership begins.
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Encourage societal membership and leadership positions by including these events in
promotion criteria. A focus outside of personal surgical practice brings a new recognition
of opportunities to improve the overall care of patients and broadens the world view
of the surgeon. This is a benefit to the institution and department and should be
supported with travel funds to send representatives to national and regional societal
meetings. Time away from practice should not be compounded by requiring the faculty
member to pay their own way to a meeting. The justification for travel should include
presentation of research material or participating in national committee business,
all of which provide exposure for the home institution. The higher a faculty member
rises in the national society, the greater the exposure for their home institution
and the more likely the faculty member will bring home leadership skills to benefit
the department.
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Utilize innovative ideas as opportunities for individuals to create and lead a program.
Not all leadership is experienced in an existing structure. In fact, much of leadership
is exhibited in the setting of innovation where no structure exists. The establishment
of a program, process, or project requires an elevated level of leadership to be successful.
While junior faculty often start programs as a part of their recruitment to an academic
position, the learning about leadership that takes place is phenomenal. Support during
this time is essential and the freedom to make mistakes during that time is essential.
Formal training in leadership during this time will be very important and provides
a practical example for application in real time. The lessons learned then become
ingrained.
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Utilize national organization leadership training available for members of the specialty
society. The American College of Surgeons (ACS) has the most readily available leadership
training for surgeons. It is important to send potential leaders to the ACS Spring
Leadership summit in Washington, DC and assigned leaders within the department of
the ACS surgeons as leaders conference in Chicago, which provide networking opportunities
and exposure to the leaders of surgery in the United States. This exposure to the
ideals of leadership can change a career as the individual sees what could be.
Conclusion
This description of starting a leadership training program is based on the practical
implementation of a leadership culture in our training program at Baylor University
Medical Center in Dallas. It is the result of 5 years of learning about leadership
within the department of surgery professionalism emphasis taught by Dr. Anthony Picchioni.
His experience as a professor of psychology at Southern Methodist University and a
leadership consultant for businesses has added greatly to the ability of our department
to beginning our leadership culture. A focus on leadership enhances every aspect of
departmental function and strengthens our ability to attract outstanding individuals
to our department at trainee and faculty levels. It is our desire to provide unlimited
opportunities for success for all who interact with our department.