More than 2,000 U.S. medical school faculty members are currently serving as department chairs.1 Retention of first-time chairs in both clinical and basic science departments has declined, especially among those in larger clinical departments and those who were older when they began.1 The median range of a chair appointment has been declining during the past 20 years and is now 7.9 years in clinical departments and 8.4 years in basic science departments.1 Ten-year retention of most department chairs is less than 50%.1 When the inevitable turnover of department chairs occurs, two-thirds of chair replacements, whether in basic science or clinical departments, are chosen from within the department.
Chair transitions can prompt concerns about the stability and vitality of the department and of the medical school at large. Although orderly transitions can occur when key leaders retire or advance, an abrupt or unexpected departure of a department chair is always possible, and these unplanned transitions can be chaotic. Succession planning helps identify chair replacements in advance to facilitate smooth and timely transitions, thereby improving the institution’s legacy (and efficiency).
The purpose of this Commentary is to describe succession planning as a strategic and rational approach to maintaining a vital organization by promoting successful leadership transitions. Although we were unable to locate any publications in peer-reviewed journals that specifically addressed succession planning of medical school department chairs, this Commentary benefits from blending the experiences of a long-serving clinical department chair (W.R.), a former vice dean for faculty and administrative affairs (K.G.), and a current medical school dean (L.B.).
Models of Succession Planning
Succession planning is critical in the military.2 In combat situations, loss of a leader requires immediate replacement to minimize casualties and meet strategic objectives. Long-term succession planning in the military includes identifying qualifications for specific leadership positions, developing a slate of qualified officers, assigning these officers to positions that permit development of leadership skills, and selecting “best fit” candidates, especially for top military positions. Unlike the military, where individuals commit to serving a certain number of years, academic medicine faculty are not required to stay in any position. Thus, faculty-sensitive transitions in leadership are essential.
Although there are significant differences between academic and corporate environments, talent development is in the best interest of any large organization. An emerging trend in the business world is “succession development,” which involves mentorship and development of a protégé. Many of the organizational units that were traditionally identified as “human resources” are now labeled “talent management,” stressing the concept of training successors—even if there is a possibility that a potential successor may leave to take a post elsewhere.3
A survey of chief executive officers at U.S. hospitals in 2012 compared participants’ responses with those from a similar survey in 2007 and revealed that more emphasis is now being placed on succession planning, especially in the highest-ranking positions.4 The fact that more respondents reported in 2012 that their institutions were using succession planning is a positive development. Management studies indicate that internal promotion creates higher economic returns and more successful organizational performance than does external recruitment.5
Most U.S. medical school department chairs do not have fixed term lengths, even though a fixed term would seem to lead to a smoother and more orderly succession. Even when instituted, a fixed term would not obviate the need for succession planning. Department chairs at Canadian medical schools have term limits, yet Craighead and colleagues6 found that when they “were challenged to consider the impact of losing many senior leaders all at once,” the strategic plan of Canadian medical faculties paid little attention to leadership succession. These authors reported that they were unable to locate “any explicit initiatives for the development of individual leadership skills in these faculties in 2009.”6
Considerations About Succession Planning
Successful chairs should understand their dean’s expectations about succession. Individual chairs may feel less threatened by and more accepting of succession planning when their deans explain that it is routinely discussed with all chairs. The prudent dean will include a requirement for succession planning in each chair appointment letter.
Having a plan for an immediate replace ment is essential in case of emergency situations. Should a chair become unex pectedly unable to fulfill his or her duties, the medical school dean and department would benefit from a clear, up-to-date emergency succession plan. Every chair should designate an individual who is willing and able to take his or her place. The plan should be updated at least annually, should be on file within the department, and should be communicated to the dean for final approval. Fortunately, implementation of an emergency succession plan is rarely necessary.
Five-year retention rates of basic science and clinical department chairs have consistently remained at 70% during the past 30 years.1 Recognizing this, it seems reasonable that chairs begin to consider some succession plan after their first formal department evaluation or by five years. By that time, chairs should be acclimated to their responsibilities and know what knowledge, skills, and behaviors are desirable for their leadership position.
Developing chair candidates from within the department
Although the role of department chair is always evolving, it remains critical to know what skills the future department leader will need. With the dean’s support, some chairs have structured their departments to provide enhanced leadership opportunities to one or more qualified colleagues (e.g., vice chair or division chief). These qualified faculty members can greatly assist successful transitions by assuming many of the administrative and financial responsibilities.
Data from the Association of American Medical Colleges (AAMC) Faculty Forward survey published in 2013 favor institutions that value faculty development and provide internal opportunities for advancement.7 Thus, it is appropriate that the chair build “bench strength” by identifying and developing faculty members who desire to be groomed for leadership and potential chair positions. When faculty members are developed as potential chair candidates, the institution benefits from having succession options that balance the advantages of an internal candidate who already fits the institutional culture with the advantages of a candidate who is new to the chair role and may bring new approaches to existing challenges. If an internal candidate is selected and successfully completes a trial period, the transition may be shorter and smoother overall, and the institution would likely incur less recruitment cost.
The annual (or perhaps semiannual) faculty evaluation process provides the chair with an excellent format for strategic mentoring of faculty who express the desire or potential to become chairs in the future. Certain attributes are critical: ability, aspiration, engagement, and “fit.” A potential successor should be encouraged to plan for future opportunities by acquiring key leadership abilities: business and administrative experience, emotional stability, fit with organizational guiding principles, strong communication skills, ability to build a team, encouragement of gender equity and diversity, and inclination to develop potential in others.8 A checklist of desirable skill sets to be mentioned during performance reviews for faculty with leadership aspirations would allow the chair to more objectively assess faculty members’ interest, gauge their leadership progress, and explain what constitutes the right “fit” for the chair position.9,10
Because women continue to be underrepresented in leadership positions at U.S. medical schools, mentorship can be especially important to ensure that interested women faculty acquire the necessary skills for success as a chair.9 The numbers of department chairs who are women and persons from other groups underrepresented in medicine will likely increase, and limited evidence suggests that retention rates among these groups are on par with retention rates among other groups.1
The dean’s role in succession planning for department chairs
The dean should engage in a depart mental evaluation with the current chair at least annually to ensure that the institution is best positioned for potential leadership change when the time comes. A regular departmental review allows the dean to determine the chair’s insight into the reality of the current strengths, weaknesses, opportunities, and threats for the department. The dean can then determine the degree to which the current chair understands dynamic change. Even the most beloved, long-serving chair may not recognize or agree on certain opportunities that should be addressed. The dean and current chair should have forthright discussions about the dean’s expected level of involvement or distance in department matters.
Conversations between the chair and dean regarding planned succession should be clear and should avoid evoking negative emotions whenever possible. Before meeting with the dean, each chair should carefully prepare his or her thoughts and remarks so that the discussion is thoughtful yet open, and meets the needs of the current chair as well as the dean. It would be appropriate for the current chair to express his or her intention to engage in developing and coaching potential faculty as successors.
Either the current chair or dean can initiate nonemergency succession planning. However, in the event that the dean has concerns about the current chair’s performance or about his or her continued suitability to continue in the role (either acutely or repeatedly), transition planning must be initiated by the dean. In such cases the dean should discuss these concerns in frequent face-to-face meetings with the chair. Potentially transient or modifiable issues, such as health concerns or family matters, may not warrant a change in leadership. Frequent and open communication is necessary to determine the proper course of action.
Finally, the dean and departing chair should also discuss whether the departing chair has a role within the institution. A departing chair could return to the faculty for research, education, or clinical duties. Alternatively, a chair may want to reflect on his or her personal and professional goals, pondering several questions: What do I want to do afterwards? Where do I want to be? On campus or elsewhere? Near grandchildren, children, or aging parents? What values do I bring to the organization? Are these values accurate perceptions of my capabilities? For those contemplating retirement, developing a formal retirement plan eases stress and engenders a feeling of confidence about the future.
The Search Process and Managing the Transition
The dean needs to be certain that departmental productivity and stability are not diminished when the current chair steps away. The desirable period between the chair announcing his or her intent to resign and the actual resignation depends on the chair’s reasons for vacating the position. Unless there is an illness or a deadline for another opportunity, we recommend that the announcement take place about 6 to 12 months in advance of the current chair’s departure. The dean may request that a chair in good standing remain in the position until his or her successor is either named or physically present.
Unlike other models of succession, replacement of a department chair takes significant time—often a year or more. Careful attention to process and institutional transparency are essential for a fair and egalitarian succession plan. In some situations, the dean may view it as his or her prerogative to oversee the planning and search processes. In other situations, another leader is assigned to oversee the search committee. Often, schools recruit from the outside in the hope of finding candidates who will bring innovative approaches to current challenges within the department, but there is no evidence that this approach works any better or worse than recruiting from within.
Deans who lead top-performing organizations want to recruit department chairs who understand the importance of mission alignment and organizational vision. It is important to discern desirable characteristics of the next chair before initiating the search process. Department and institutional perspectives should be considered. These desired characteristics should be articulated in the position description, job posting, and national advertising materials. As a search committee is appointed, the desired characteristics should be described explicitly to search committee members and to any search firm professionals retained to assist in the process.
It is essential to engage department faculty to assess their concerns and goals for the leadership transition. It is useful for the dean to know where there is overwhelming support for an internal candidate or a strong desire to seek leadership outside the institution. Thoughtful and balanced attention to each person involved in the transition is important. Ultimately, the dean makes the final selection.
When necessary, appointment of an interim chair as part of succession planning can be useful for on-the-job training of an internal candidate. Interim leadership provides an excellent opportunity to “open the door” for others to gain and demonstrate their leadership skills.11 If there is more than one internal candidate, the selection of an interim chair should be approached carefully, recognizing that there may be awkwardness if one internal candidate is selected above others or if candidates are simply viewing the interim position as a starting point to consider opportunities elsewhere.
Despite carefully calculated plans to manage succession, the manner in which the chair steps down is often beyond his or her control. Regardless of how the outgoing chair is viewed, that person will be remembered as much for his or her final year as for the first year. The departing chair should maintain a respectful yet distanced relationship with the incoming chair and should demonstrate his or her role as a team player through support for all faculty during the transition.
Turnover of department chairs at U.S. medical schools is more common now than it was long ago. The great value of having emergency and nonemergency succession plans is that efficient institutional performance will not be lost during these inevitable transitions. Medical schools and teaching hospitals need assistance to prepare for periods of department leadership change. Chairs should speculate about and plan for their own future before undertaking planned succession initiatives. We support the recommendation that the AAMC and individual chair societies aid current department chairs in succession planning. Current chairs should be able to reflect on their present positions as well as on their personal strengths and weaknesses, and to manage the talent of faculty who have the leadership attributes of a potential future department chair.
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