Traditionally, the entire administrative skill set necessary for leadership in a complex academic health care environment has not been fully considered when selecting departmental leaders. New departmental executive officers (DEOs) in academic medicine are charged with the leadership and management of important human and financial resources. This charge is so critical for institutional and departmental success that the University of Iowa Carver College of Medicine (CCOM) chose to place greater emphasis on leadership development. This approach occurred during a time when several new DEOs were added to the college of medicine in a relatively short period of time. We then asked these DEOs about their experiences and perceived value associated with this approach. Our experience and the feedback we received from participants have underscored the benefits of such leadership development. We posit that similar cultivation of leadership skills should be pursued more often to ensure smooth transitions and effective management within the academic medicine environment.
Coaching for Success
Previous work highlighting the value of executive coaching for physicians has been less focused on the academic missions and more focused on the patient-care mission. However, there is value to be gained from the information obtained from those experiences.
McKenna and colleagues1 conducted a survey assessing three leadership areas: the most important competencies for effective physician leadership, the activities that are indicative of physician leadership, and the methods most effective for development of competencies. The critical leadership competencies identified included interpersonal and communication skills, professional ethics, and social responsibility. In the area of leadership activities, McKenna and colleagues' survey identified the ability to influence peers to adopt change and administrative responsibility in health care as important factors leading to success. Their results demonstrated that coaching or mentoring from a leader and on-the-job experience were the most effective means of developing leadership competencies. Our experience complements those findings. The new DEOs who participated in leadership training at CCOM acknowledged that receiving outside input and talking to others in similar positions were important ways to develop skills. Arguably, leadership competencies similar to those identified by McKenna and colleagues are required for a new leader of an academic department, with the emphasis on communication and ability to influence others to adopt change.
Fairchild and colleagues2 note a growing group of academic leaders who have interest in working at the interface of clinical medicine, management, finance, and health care. Fairchild et al define this group as academic physician administrators and leaders and further advocate for the development of administrative and leadership electives for them. Although Fairchild et al seem to relate these positions more to individuals working as chief executive or chief operating officers of health care systems, the principle can be extended to DEO development, given the increasing complexity associated with leading a clinical department.
Inherent Value of Coaching
An executive coach facilitates development of key leadership skills, including humility, self-awareness, work–life balance, focus, collaboration, and accountability.3 A coach can give immediate feedback, move conversations from the broad to the specific, provide support while challenging ideas, and model active listening. With such coaching, the probability of leadership success is greatly increased, although certainly not guaranteed.
A coach can also complement some of the traditional methods of leadership skill development, including mentoring by trusted colleagues, self-directed reading about specific topics, or taking courses in a specific skill area. Many successful and competitive leadership courses specific to the academic medicine setting are already offered through institutions such as Harvard (http://www.hsph.harvard.edu/ccpe/programs/LDP.html), the Association of American Medical Colleges (AAMC; http://www.aamc.org/meetings/eds/2008/start.htm), and Drexel University (http://www.drexelmed.edu/ELAM/index.html), to name a few. Together, all of these established approaches can provide the framework to enhance an individual's chance of success in a new and challenging position. We learned from participating DEOs at our institution that additional resources, including courses offered through specialty societies, independent reading material on specific topics (e.g., communication), and advice from trusted colleagues, were considered valuable tools in leadership development.
Institutional Value of Executive Coaching
During a two-year time frame (2004–2006) at CCOM, five new clinical DEOs were offered executive coaching. Almost all (four out of five) of those coached were initially unenthusiastic about the possibility of participating in the coaching experience, but nonetheless agreed to do so. The college paid all coaching expenses for the first year. Retrospectively, all five wanted coaching to improve their skills for facilitating organizational change; four also wanted assistance in improving their administrative and managerial skills. The participating DEOs also expected the executive coaching experience would offer an external person as a sounding board with whom to discuss issues, assist in personal change, enhance existing skills, and help develop personal careers. During the year of engagement, most (three out of five) of those who used the coaching experience met with their coach at least monthly, and the others met with the coach every other month. This difference was primarily due to scheduling issues and availability.
DEOs perceived the most beneficial aspect of the experience as the ability to receive external advice about specific issues, but they also appreciated assistance with implementation of organizational change, career guidance, and time management. One DEO commented that he was just beginning to understand how best to use the resource when the yearlong coaching experience ended. Most (three out of five) said that they would continue the relationship with the coach after the conclusion of the year's experience. Four out of five DEOs agreed that this experience had improved their leadership skills. As a testament to the value of this coaching experience, all participants stated that they would recommend the use of a coach to others in new leadership positions.
Can Changes Be Quantified?
The answer to this question is most likely no, at least in the true quantitative sense. But there is clearly perceived qualitative improvement that cannot be ignored. Three of the DEOs had maintained their coaching relationship beyond the official one-year period, which leads us to believe that participants perceived an inherent value to the relationship. Participants felt that the training helped retain or develop important skills, including time management, conflict management, listening skills, leadership enhancement, and the career development of others. Additionally, three had attended the AAMC chair development conference and one had attended the Harvard program, underscoring the perceived value in focused leadership development.
In retrospect, DEOs indicated the experience would have been enhanced through devoting more time to the exercises for self-development, developing methods for periodic self-assessment, developing a leadership program for division directors, starting the executive coaching a little later into their headship after getting the general impressions of the place, and/or stretching it out longer. But the experience as it was certainly led to changed behavior. One DEO, for example, changed his approach to a collaborative project after talking it over with his coach. Another noted that he learned more about the strengths and weaknesses of his leadership team through direct use of the coach's expertise. This led to changes in personnel and responsibilities that might have occurred much later—or not at all—if the coaching expertise had not been available. A DEO coming from outside the institution started his coaching experience before beginning his new position. His coach provided valuable assistance in framing his message, plans, and approach to make a strong first impression.
Our experience with executive coaching for new department heads has resulted in an increased willingness to accept this approach as a way to enhance leadership skills for new leaders, to facilitate problem areas, or to positively impact current leaders, thus making them more effective. Of the DEOs who were coached, three have encouraged division directors, colleagues, and other department heads to consider executive coaching. Other DEOs have identified coaches for new leaders in the department or for use as external mediators in difficult situations. These positive results have led us to believe that such focus on leadership skills development can greatly enhance the effectiveness of departmental leadership transitions, and we recommend similar practices elsewhere.
Our participants enjoyed many benefits from their executive coaching experiences, but as with any new program, we learned that our approach had strengths as well as weaknesses to address. We used a single coach for all DEOs, which ensured standardization of techniques and approaches, as well as of the evaluation instruments used to determine the characteristics and signature strengths of the individual DEOs. One drawback to this model is potential conflict of interest, particularly if the coach is working with two individuals who are at cross-purposes. In addition, outcomes might be affected by how well the personality of the DEO meshes with that of the coach. A single coach will certainly not relate well to everyone brought into the institution. As the use of coaching has gained more widespread acceptance, more coaches have been involved in the process. This has enhanced CCOM's opportunities and experiences with a wider variety of approaches and styles.
Of course, the cost for these services must be considered. The spectrum for the types of services is very wide and should be negotiated at the beginning of the activity. In the current economic times, it is important to ensure that there is a return on investment. This return may not be obvious in the initial year after coaching and may take time to be fully realized. It may also be useful to develop ongoing DEO assessments that include the information from the coach as another measurement.
Investing in Leadership
CCOM has used executive coaching to support new DEOs in the clinical departments. As this approach has gained acceptance, we have also encountered a willingness to expand the activity within departments to newly hired division directors, program directors, or faculty changing career direction. Anecdotal reports from participating DEOs suggest that coaching can make a significant impact on leadership abilities. Expanded use of executive coaching has also allowed us to broaden the inventory of the individuals who offer services, giving us a wider array of talents to support our new leaders. Although quantitative outcomes to date are limited, on the basis of qualitative assessment and feedback we have continued to “mandate” coaching for new DEOs and have encouraged all DEOs to extend this approach more broadly within their respective departments while outcome data collection continues. In our experience, executive coaching for new leaders in the academic medicine setting has proved a valuable investment in the future of our leadership. We encourage others to consider similar approaches.
The authors wish to thank Peter Densen for helpful insight into the project and for manuscript editing. We also thank the department heads for their time and input.
This study was approved by the institutional review board of the University of Iowa.