|SYMPOSIUM: LEADERSHIP AND TALENT MANAGEMENT IN ACADEMIC MEDICINE
|Year : 2016 | Volume
| Issue : 1 | Page : 83-88
Developing leaders among your faculty members
Department of Emergency Medicine, St. Luke's University Health Network, Bethlehem, PA, USA
|Date of Submission||01-Dec-2015|
|Date of Acceptance||29-Jan-2016|
|Date of Web Publication||2-Jun-2016|
St. Luke's University Health Network, 801 Ostrum St., Bethlehem, PA 18015
Source of Support: None, Conflict of Interest: None
Background: Complexities in medical care delivery and an increasing focus on value in health care has spotlighted the need to develop physician leaders within healthcare organizations. Academic medical centers and their faculty are uniquely situated to further the healthcare industry through teaching of medical students and residents, introducing research and technology, and providing the body of knowledge that is the framework within which medicine is practiced.
Methods: Through in-depth literature review, pertinent information about the role of faculty leaders and the methods to develop them will be presented.
Results: Literature suggests that health care organizations with physician leaders provide higher quality care and that academic productivity can be enhanced by leadership development among faculty. Various processes of physician leadership development exist, including the simple mentor-mentee relationship, a less formal facilitated small group format, and a more formalized leadership development course. There is no research literature to suggest the superiority of one method over another to develop faculty members.
Conclusions: It is important that healthcare organizations consider the role of physician leaders in their strategic planning to provide quality, high-valued care while maintaining the goals of academic leadership and performance.
The following core competencies are addressed in this article: Interpersonal skills and communication, Practice based learning and improvement, Professionalism, Systems based practice.
Keywords: Faculty development, leadership development, physician leadership
|How to cite this article:|
Jeanmonod D. Developing leaders among your faculty members. Int J Acad Med 2016;2:83-8
| Introduction|| |
As we move into the 21st century of health care, it has become increasingly clear that the complexities of healthcare organizations and healthcare delivery will require the development of a new generation of leaders. Previous physician autonomy has been progressively replaced by interdisciplinary and interprofessional care, which requires better teamwork and communication. As well, the previous individual physician-patient model of healthcare delivery has been replaced with a focus on population health and healthcare delivery. Although traditional views of leadership have asserted that there are innate characteristics in men and women that make them natural leaders, it is now known that although there are some inherent characteristics, such as charisma, that individuals can utilize to lead, many skills that we attribute to natural leaders can be learned and developed.
There are a number of ways that academic institutions and their faculty influence the growth and development of the medical field. Academic medical institutions are uniquely positioned to train physician leaders of the future, with the ability to foster the requisite skills and attitudes within medical students and residents as they progress through their education. Academic institutions cultivate medical research and technology innovation, deciding where resources will be allocated, and ultimately determining the trajectory of future medicine. Moreover, a significant amount of the medical literature is produced in academic institutions, thereby providing the body of knowledge of medicine. Within these institutions are multitudes of faculty with varying abilities to provide vision and direction to others around them. If medicine is going to remain a politically and economically viable entity, it will be important to develop appropriate faculty leadership.
Why is it important to have leaders among your faculty?
Of the 18 “Honor Roll Hospitals” ranked by the U.S. News and World Report in 2013–2014, 10 had physician leaders including the top 5. Further research has determined that there is a strong positive correlation between physician leadership of a hospital and quality measures of that hospital, with reported quality scores that are 25% higher if the hospital is physician-led. It stands to reason that the best physician to run an academic medical center would be an academic physician who has undergone further leadership training. The reasons why physician leadership has been able to deliver improved quality has not been fully elucidated, but it is likely that clinical experience and patient focused care are integral to the delivery of quality, high-valued health care. Despite these facts, the US hospitals have seen a 90% decline in CEO leadership between 1935 and 2008.
Research has also demonstrated that there is a positive correlation between the amount of publications of a university president and the university's overall academic ranking in the “Academic Ranking of World Universities.” In addition, there is a strong positive correlation between the president of a university's overall number of publications and the improvement in the academic performance of a university over a 9-year period. Facilitating the leadership development of faculty has been demonstrated improve their ability to produce research to further institutional academic advancement. In addition, being a producer of knowledge allows one individual to become a leader of his field. Take the example of Dr. Michael DeBakey, who during his lifetime innovated cardiac surgery with new procedures and technology and published more than 1000 medical reports, research papers, and book chapters. A review of the data in the Doximity database of U.S. physicians demonstrated that physicians with leadership roles within their institutions had more than 2 times the publications as nonleaders. The question remains whether the research propelled them to the role of leader or whether leaders are more likely to be published.
An evaluation of the first three classes of scholars who participated in a leadership development program at the University of Michigan demonstrated significant increases in the 35 participants academic productivity precourse versus postcourse including increased promotions, development of new educational programs, increased national presentations, and journal publications, and increased grant awards. In the University of Washington Teaching Scholars Program, participants linked educational innovation, educational advancement, and educational implementation to participation in the program.
Organizational leadership and the development of these leaders are believed to be a keystone to improving quality and efficiency in healthcare. The results of a series of qualitative interviews with healthcare leaders demonstrate that leadership programs are thought to provide four important opportunities to improve quality and efficiency: (1) Improving the caliber of the workforce, (2) enhancing efficiency in educational and development programs, (3) reducing turnover within the organization and the associated expenses in recruitment of new talent, and (4) focusing organizational attention on specific strategic priorities. Systematic reviews of nursing leadership have found a positive correlation between positive leadership traits and patient satisfaction, reduced patient complications, and reduced patient complications., However, there is a paucity of scientific research defining the role of positive physician leadership traits with attaining quality measures.,
How do you develop leadership skills?
Original thoughts on leadership believed that certain men and women contained an innate character that made them good leaders. They were thought to be charismatic, strong, and single-minded to persevere through perilous situations. Recent research supports the fact that there may be heritability of certain leadership traits. Researchers have identified a genotype associated with occupying a leadership role and have estimated that leadership traits may be 24% heritable. The converse of this would indicate that for the majority of individuals involved in health care leadership, the skills of leadership can be fostered and developed.
Although the leaders themselves are individuals, leadership development is not an individualized endeavor. Because there are resources required to foster a good leader, leadership development must have institutional buy-in. It has been suggested that there is a need to develop a “local leadership mindset” rather than a focus on an individual's ability to lead. The previous transactional leadership approach, where a strong individual exerted their will over the masses, does not function well in the increasingly collaborative environment of modern medicine. It is suggested that there is an alternative view of leadership, where an individual cannot control the culture of an organization, but instead influences its direction in a transformational manner. Through collaborative effort, an area of change is identified, and change is executed through the realization of the vision. In the complexities of medical institutions, a combination of transactional and transformational techniques [Table 1] should be utilized. In addition, institutional financial support is required to support the reduced clinical time that is required for developing leaders to focus on their curriculum and academic innovation.,
Leadership development and teamwork are context-specific. Whenever possible in the development process, organizations should take into account the environment that the leader will operate within. The feedback to the team and the team leader should be timely and again be context-specific, because the leadership development process occurs through experience  with the most growth occurring when the leader is functioning at the edge of his or her comfort zone. Through feedback and reflection in the setting of appropriate coaching and mentoring, individuals can develop into leaders.
There is little known about which leadership style is preferred in the medical setting. Leadership theory has evolved over the past 80 years, and current leadership development often revolves around the six styles of leadership described by Goleman  outlined in [Table 2]. Among a group of medical directors from the United Kingdom who self-reported their own leadership traits, the affiliative and democratic styles of leadership were most commonly reported. Broadly, there are six competencies that are required of good faculty leaders including: (1) Technical knowledge and skills (i.e., of operations, finance and accounting, information technology and systems, human resources, strategic planning, legal issues in healthcare, and public policy), (2) knowledge of healthcare (i.e., of reimbursement strategies, legislation and regulation, and quality assessment and management), (3) problem-solving prowess (i.e., around organizational strategy and project management), (4) emotional intelligence (i.e., the ability to evaluate self and others and to manage oneself in the context of a group), (5) good communication skills (i.e., in leading change in groups and in individual encounters, such as in negotiation and conflict resolution), and (6) a commitment to lifelong learning.
| The Backbones of a Leadership Development Course|| |
In general, participants in a leadership development course are recruited as an interdisciplinary group from within and beyond the institution. Participation is either elicited through an application process or direct recruitment of individuals within the institution who could benefit from leadership development. Through the application process, participants can demonstrate their previous experience from which future success can be predicted. Individuals can describe their goals in developing themselves as faculty so that, if selected, the curriculum can be tailored toward their goals. The application process may require submission of a proposal of a scholarly project to be developed during the course of the leadership development program. Finally, a letter of support from their department chair is required to ensure sufficient protected time and institutional support.,,
Through half day weekly meetings, participants in leadership development courses are introduced to various topics that cover the gamut of academic leadership [Table 3]. Weekly symposia may be presented by experts in a given field from within or outside the institution or symposia topics may be organized and presented by participants in the leadership development program as part of their own development process. Frequently, assigned presentations will be required to be in a group format to foster interdisciplinary activity and collaborative efforts to improve leadership and teambuilding skills. Important to the process of leadership development is appropriate, constructive, and timely feedback to the presenter if they are a participant in the leadership development program. Whenever possible, the skills required for leadership are best learned through experiential learning rather than a focus on theory and terminology. Leadership must be learned rather than taught.
|Table 3: Basic components of faculty leadership development course curriculum|
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Through the course of study, “class time” is protected for participants to work on scholarly projects. With exposure to experts and their peers, participants can develop and implement their ideas with the goal that as the project is completed, it can be presented at a regional or national meeting on academic innovation. Furthermore, there are opportunities to prepare a brief narrative of their project for publication in a medical education journal.
There are multiple models that exist to provide a framework for leadership development courses. These could include the experience, reflection, and feedback model of the Authentic Leadership Development course where participants use previous experiences and experience from in-class exercises to provide the content on which they reflect. From this, the students become aware of their motivations, beliefs, values, strengths, and weaknesses. These reflections are presented within the group, who provides constructive feedback. Another model, known as the “ACS Model,” provides an assessment of the participants' leadership skills, challenges that force the participant to practice outside of their comfort zone, allowing them to more effectively acquire the skills of leadership, and support in the form of feedback and coaching. Ultimately, there are nine key elements that have been determined to be best practices in leadership development including (1) reinforcing and building a supportive culture, (2) ensuring high-level sponsorship and involvement, (3) tailoring the goals and approach of the program to the context, (4) targeting the program toward a specific audience, (5) integrating all features of the program, (6) using a variety of learning methods, (7) offering extended learning periods with sustained support, (8) encouraging ownership of self-development, and (9) commitment to continuous improvement of the program.
| Developing Leaders Through Focused Attention|| |
Many institutions do not have the resources to provide their faculty with a formalized faculty development program. In lieu of this, they may be required to find alternative methods to develop their faculty. Often this form of leadership development will take the form of mentoring or faculty coaching by senior faculty [Table 4]. In the mentoring process, a long-term relationship is developed between two individuals, where the senior faculty helps the junior faculty realize his or her dreams and career goals. This relationship is built on mutual respect and requires compatibility between the two individuals involved. The faculty mentor is positively motivated by a sense of professional stimulation and a sense of giving back to the community, building a legacy of mentoring. Although it may occur by happenstance, in the case of an informal or spontaneous mentoring relationship, this is less common and mentoring is often not possible for marginalized groups, such as minorities and women. Through mentoring relations like this, a faculty mentor in a leadership position may be able to facilitate leadership skills in an appropriately motivated individual.
A formal dyadic mentoring process where protégés are appropriately matched with their mentor through common goals are often met with failure because of the perceived forced, superficial relationship, and the significant time constraints of both parties in the mentoring relationship. In addition, there are often not enough experienced leaders to provide direct mentoring to those who are junior. An alternative mentoring relationship based on facilitating a group with common goals has been envisioned and has demonstrated success in academic medicine. In this model, an experienced facilitator helps to guide a group of more junior faculty. Peer collaboration and sharing of individual experiences leads to the development of both the individual as well as others in the group. This facilitated group experience allows for personal empowerment, exposure to multiple areas of expertise, development of personal awareness, and lacks the power differential that might exist within a dyad mentoring relationship.
There is no research published in the medical literature to suggest that one method of faculty leadership development is superior to another. As stated, the solution should be centered around the role that the leader will take, should be pertinent to the goals of the academic institution, and should take the form of experiences that push the would be a leader to the edge of his or her capabilities.
| Conclusion|| |
Medical care in the 21st century and beyond is moving from a physician-patient oriented practice to a global health care delivery to populations. Within this context, academic physician leaders are ideally situated to further the goals of providing quality patient focused care. To this end, medical institutions will need to make investments in developing the leadership skills of faculty to facilitate their ability to drive innovation and change.
Further research should focus on the comparison of methods of leadership development to identify if there are superior methods to developing the skills within physician leaders. In addition, more research should be focused on whether particular leadership traits and styles can affect patient care goals of quality, cost, value, and mortality.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]