Learning to Lead in the Academic Medical Center: A Practical Guide

221 Pages·2015·7.07 MB·English

by  Jeffrey L. Houpt

Learning to Lead
in the Academic
MMMeeedddiiicccaaalll CCCeeennnttteeerrr
A Practical Guide
Jeff rey L. Houpt
Roderick W. Gilkey
Susan H. Ehringhaus
123
Learning to Lead in the Academic Medical Center

Jeffrey L. Houpt (cid:129) Roderick W. Gilkey
Susan H. Ehringhaus
Learning to Lead in the
Academic Medical Center
A Practical Guide
Jeffrey L. Houpt , MD Roderick W. Gilkey , PhD
Dean Emeritus, University of North Professor in the Practice of Organization
Carolina School of Medicine & Management
CEO, Emeritus, University of North Goizueta Business School
Carolina Health Care System Professor of Psychiatry and Behavioral
Chapel Hill , NC , USA Sciences
Emory University School of Medicine
Susan H. Ehringhaus , JD Atlanta , GA , USA
Senior Manager, Offi ce for Interactions
with Industry
Partners HealthCare
Boston , MA , USA
ISBN 978-3-319-21259-3 ISBN 978-3-319-21260-9 (eBook)
DOI 10.1007/978-3-319-21260-9
Library of Congress Control Number: 2015946606
Springer Cham Heidelberg New York Dordrecht London
© Springer International Publishing Switzerland 2015
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Foreword: Leadership Really Matters
If there is one thing that is evident from my more than 100 visits to academic health
centers in the USA and around the world, it is the importance of leadership. I have
seen leaders succeed and fail—and many who struggle. As I have gotten to know a
good portion of them on a personal level, I have learned a lot about leadership skills
as well as the process that brought them to leadership positions. Because academic
health centers are complex institutions facing a highly challenging environment,
with big budgets and many moving parts—not to mention egos—a high level of
leadership skill is required. The necessary skill sets for these positions are usually
discussed in broad general terms, such as “has vision,” “is a good communicator,”
“works well with others,” and so forth. But the tools to assess these characteristics,
much less nurture them in potential leaders, are strikingly absent from the dialogue.
More importantly, the key leadership attributes that involve personality factors, such
as emotional intelligence, are even more rarely discussed.
What’s needed is a handbook for current and aspiring leaders—hence the impor-
tance and relevance of this book. Houpt, Gilkey, and Ehringhaus do an extraordinary
job of presenting both a broad overview of the dynamics of the academic health cen-
ter and a granular “how to” for the myriad of situations that demand skilled leader-
ship. This volume is abundantly fi lled with meaningful examples and worthy insights.
It is not surprising that in the world of academic health centers most leaders
come from the academic ranks. This is both fi tting and just, in that a deep-seated
understanding of and respect for the core ethos of academia is indeed essential.
Many such leaders are accomplished researchers, department chairs, institute and
program directors, or come from other specialty-focused positions. They often have
served at a high level in specialty societies, edited journals in their fi eld, and been
appointed to NIH study sections. But an insight I have obtained through my visits
and personal contacts with academic health center leadership is that academic skills
do not necessarily translate into leadership skills (Fig. 1 ).
Intellectual achievement, of course, is critical for academic success, whether it
be in the creation of new knowledge, the development of a new program, or insight-
ful commentary. However, intellectual ability does not necessarily imply that the
necessary leadership behavioral skills are present, such as emotional intelligence
v
vi Foreword: Leadership Really Matters

Fig. 1 Academic skills versus leadership skills [1]
and the ability to negotiate, which are well defi ned in this book. Most academics
develop a specifi c and necessarily narrow knowledge base as a requirement for
deep expertise in a specialty or research area. Yet, the successful leader of an aca-
demic health center must cultivate broad interests to effectively manage the institu-
tion, such as the “non-academic” pursuits of human resource departments,
budgeting cycles, and public relations. Academically successful individuals are
generally highly self-motivated in that their achievements are judged by what they
do to benefi t their careers. However, leadership of an academic health center
requires institutional motivation in the sense that success is institutional, not per-
sonal. Institutional leadership therefore demands institutional results, which are far
more diffuse and more diffi cult to sharply defi ne than markers of individual suc-
cess. The successful academic rises up the promotional and reputation ladder,
whereas the successful leader must learn to “manage 360°,” being rewarded by the
achievements of others. (Of course, a strong work ethic, an honest character, and
sound judgment are essential in any position.) There is thus much to learn for an
aspiring leader who comes from a traditional academic background, and this book
presents an excellent platform.
T he pathway to leadership of an academic health center generally follows the
timeworn tradition of academe by largely relying on a “search committee” that
seeks an accomplished academic achiever. It is not unusual, therefore, for individu-
als with successful academic careers to fi nd themselves 1 day in the position of
“accidental leader,” whereby success in one’s fi eld is assumed to automatically
translate into successful institutional leadership. Or, perhaps, talented faculty who
might be outstanding leaders eschew leadership, referring to it dismissively as “the
suits” who are “sitting on a pile of money and not giving me enough of it.” The
problem thus is threefold: leadership is often opaque and vague to the faculty; aca-
demic success, as previously pointed out, is not necessarily the ticket to leadership
success; and the search process for leaders is often fl awed.
T he authors conclude the book with a discussion of the challenges in fi nding the
right leaders. I agree with much of what they say. Finding the “right” leader for a given
institution is indeed a signifi cant challenge. The actual search process, to the appli-
cants and others, often appears unfocused and somewhat diffuse. Search committees,
Foreword: Leadership Really Matters vii
instead of concentrating on specifi c leadership abilities, often fi nd themselves looking
for the Deus ex machine, generally in the form of a physician–scientist, who will lead
them into the Promised Land. In compiling a handbook of best search practices [2], I
have suggested a set of guiding principles and basic management strategies to increase
the likelihood of a successful search.
In brief, leadership searches should be given the highest priority, and the institu-
tion must be cognizant of the extent to which the search refl ects on the culture and
reputation of the institution. In many cases that I’ve observed, the search has been
delegated to a search committee that often consists of institutional leaders with their
own agendas about what is best for the institution. The search committee’s role must
be clearly defi ned and differentiated from that of the decision maker, who ultimately
determines the terms of the contract to be signed, and who must be fully engaged
throughout the entire process. It is essential that a broad and diverse pool of candi-
dates be considered, and that the search process be well organized, preferably into
three distinct phases: pre-search, active, and on-boarding.
Houpt, Gilkey, and Ehringhaus meet a critical need with this book. While the
book reads logically from start to fi nish, the reader may want to prioritize certain
sections. After brushing up on how the academic health center functions in Part I,
the reader might try to recall personal situations in the past involving interactions
with academic health center leaders that may or may not have come out well. These
situations, for example, could involve negotiation, confl ict resolution, or simply run-
ning a good (or bad) meeting. By reading the relevant chapters through a personal
lens, the important lessons of the book become meaningfully individualized and
then go on to serve as a platform for reviewing the remaining sections of the book.
(Of course, this is just a suggestion, and I’m sure many readers will simply read the
chapters in order.) Another thought is for the reader to discuss the various manage-
ment scenarios presented in the book with a mentor or others in a small group set-
ting, if that is possible, to both gain a deeper understanding and to practice specifi c
skills. But please keep in mind that this book is more than a manual: it should be
viewed as a highly personal journey toward a deeper understanding of one’s strengths
and weaknesses, and how this journey can enable successful leadership.
Academic health centers face a number of signifi cant challenges in the twenty-
fi rst century. These include, among others, signifi cant disruption with new care
delivery and payment mechanisms, scientifi c and technological advances, and con-
tinued patient empowerment. It should be obvious that skilled leadership is essential
to weather this perfect storm. The key to success in this environment, I believe, is
the leader’s ability to align the various missions (education, research, and patient
care) so as to have each support and inform the others. Ultimately, the successful
leader will be able to do so by changing culture and behavior. This book is a good
place to start the journey.
Washington , DC , USA Steven A. Wartman, M.D., Ph.D., M.A.C.P.
Association of Academic Health Centers
viii Foreword: Leadership Really Matters
References
1 . W artman SA. Future shock or future success? The transformation of academic health centers:
meeting the challenges of healthcare’s changing landscape. Elsevier; 2015.
2 . W artman SA. Searching for leadership. Washington, DC: Association of Academic Health
Centers; 2014.
Introd uction
W e always wanted to know what’s in a book before we decide to invest the time to
read it. And we thought you would, too, so here you are.
T here are fi ve parts to this book. The fi rst three parts are narrative which are
intended to help you learn to be a better leader. The fi rst part looks at the AMC as a
social system; the second at the role of personality; and the third at a set of neces-
sary skill sets. The fourth part is a series of case vignettes to solve based on the
material in sections which preceded it. The fi nal part provides a set of solutions to
those cases.
Part I attempts to take the mystery out of how the academic medical center
(AMC) works. It can be intimidating to the novice leader with its size, built-in con-
fl icts, and pressures to meet fi nancial goals. Further, if the new leader begins, as
many do, with a belief that its only control mechanisms are formal vertical hierar-
chies (dean to chair to division head), he or she is destined to play with one hand
tied behind his or her back. Many novice leaders recruited from outside an institu-
tion compound the dilemma by mistakenly believing that what worked at their old
institution will work at the new one. The reality is different. Each AMC has its own
unique culture with its own control mechanisms that the leader needs to adapt to and
actively use.
W e suggest that you begin by looking at the AMC as a group—nothing more and
nothing less—and by focusing on how a group functions. If you can understand how
a group maintains control with both formal and informal mechanisms, how it clings to
its values, why it rewards some and punishes others, how there are different interests
within the same group, how and why the group bestows authority on its leader, and
what the group wants from its leader, you are equipped to make decisions and to lead
the organization to new heights. If, however, you veer off this pathway and violate
deeply ingrained cultural norms, you will not be successful until you address these
forces. Unfortunately, many new leaders have no awareness of these powerful forces.
The fi rst part of the book provides ways to understand these issues, which we
have framed in terms of group dynamics. The same dynamics occur for a dean
(albeit on a more complicated level), chair, division head, training director, ward
ix