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Design Principles for Building a Leadership Development Program in a Department of Surgery

Dimick, Justin, B., MD, MPH*,†; Mulholland, Michael, W., MD, PhD

doi: 10.1097/SLA.0000000000002424
SURGICAL PERSPECTIVES

*Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI

Department of Surgery, University of Michigan, Ann Arbor, MI.

Reprints: Justin B. Dimick, MD, MPH, Center for Healthcare Outcomes and Policy, University of Michigan, 2800 Plymouth Rd, Bldg 16, Office 136E, Ann Arbor, MI 48109. E-mail: jdimick@umich.edu.

Dr Dimick receives grant funding from the National Institutes of Health (NIH), the Agency for Healthcare Research and Quality (AHRQ), and BlueCross BlueShield of Michigan Foundation; and is a cofounder of ArborMetrix, Inc, a company that makes software for profiling hospital quality and efficiency.

The other authors report no conflicts of interest.

Six years ago, we began implementing a Leadership Development Program in the Department of Surgery at the University of Michigan. This year, we will sponsor the third iteration of the program. The program is conducted every 2 to 3 years and includes approximately 20 faculty participants. For our department, with approximately 150 faculty, running a program every 3 years allows us to incorporate new recruits, faculty who are emerging as leaders, and established leaders who want to grow their skills. Our program lasts 8 months, with a full day once per month supplemented with other longitudinal learning activities, including team projects, case studies, assigned reading, and personal improvement projects.1,2

We have found the program valuable to build leadership skills among enrolled faculty and also as a means to influence culture. In prior publications we described our curriculum design and our formal evaluation of participants’ perspectives on what they learned (or did not learn) from the program.1,2 However, we are often asked about the details of implementing this program, which are not included in this prior published work. This perspective provides several practical design principles (Fig. 1), which we hope will be useful to others aiming to foster faculty leadership development through similar programs.

FIGURE 1

FIGURE 1

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TARGET THE RIGHT PARTICIPANTS

Selecting the right participants at the right time in their professional lives was the key to the success of the program. Surgeons need to be in the right phase of their careers to optimally benefit from leadership development.

First, participants need to be far enough into their position so their clinical practice (and/or research program) is off the ground. Once junior surgeons have their own house in order, they can benefit more from learning about how to lead others. Consider creating a complementary program targeting surgeons earlier in their careers.

Second, participants need to be externally open to improving their leadership skills. The saying that “you can bring a horse to water but you cannot force him to drink” applies here. Participants need to be open to constructive criticism and have humility about current leadership skills.

To select participants for our program, we invite all faculties who are more than 3 years out training to apply. Some but not all participants will hold leadership roles at the start of the program. We believe that all faculties would benefit from leadership training because they lead teams, run committees, and/or build clinical programs. We strive to include all faculties who apply but the chair and/or division chief may ask some faculty to reapply during the next cycle if they need more time to work on building their clinical practice or academic program.

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ENSURE A HIGH-QUALITY EXPERIENCE

Surgeons are busy and will quickly be dismissive of any event they perceive is wasting their time. Thus, we found it important to find high-quality faculty—that is, those that were talented speakers and also delivered content that would be relevant and valuable to the enrollees.

For example, when selecting faculty, consider visiting your business schools and seek out other opportunities to listen to speakers in advance. Only invite the highest quality speakers and facilitators. Ensuring high-quality content is always a work in progress. After our first program, we read our program evaluations carefully and made changes to speakers and formats that were perceived as less beneficial.

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COMBINE THEORY WITH PRACTICAL INFORMATION

Theory on leadership, strategy, finance, and other topics is important. Didactics on these topics raise the sophistication of participants’ knowledge and helps them develop new mental models. Many participants will take these new models and use what they learn in their daily lives.

However, we found it valuable to add practical context and interaction with hospital and department administrators whenever possible. For example, 1 session focused on the theory of healthcare strategy in the morning followed by our health system CEO presenting our strategic plan in the afternoon. Exposure to health system leadership reinforced learning points and was received very favorably by the participants.

As another example, in our session on finance, we devoted the morning to the principles and vocabulary necessary to read financial statements. We then followed this session in the afternoon by having our department administrator walk the participants through our own financial statements, both hospital and department. We also invited the division administrators to attend and broke out into smaller groups so faculty could see their own division's financial statements.

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FOCUS ON FEEDBACK AND COACHING

Teaching surgeons new mental models is important. But learning accelerates dramatically when people understand where their existing models are incomplete or wrong. We all have our blind spots. Finding and addressing these blind spots is essential to becoming a better leader.3 We believe that 360-degree feedback is the best way to discover where to improve leadership skills. For this feedback to be useful it needs to come from a diverse set of individuals and it needs to be anonymous. There are many instruments available for conducting these evaluations. In our experience, the most useful feedback comes from the qualitative written comments. Assessments need not be complicated or expensive.

How do you help participants improve once they receive feedback? We have found executive coaches to be extremely valuable. Each surgeon in our program was given the opportunity to work with an executive coach. Each engaged with a coach to digest the 360-feedback and develop a personal improvement plan. Because personal coaching can be expensive, we have worked with several local coaches who agreed to offer 2 sessions at a reduced rate, for which the department pays. At the end of 2 sessions, the coach will have debriefed on the 360 evaluation and helped craft the improvement plan. Many individuals in our program opted to continue coaching relationships by assuming ongoing costs.

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CREATE LEADERSHIP AUDITIONS

All participants were given opportunities to build leadership skills in the form of leadership auditions. As mentioned above, some but not all of the participants held formal leadership positions at the start of the program. Many of the participants in the program are “emerging leaders.” We feel strongly that those creating these programs should commit to creating leadership experiences for high-potential individuals.4 Offering these opportunities for personal leadership growth is often a win/win—the individual develops a new set of competencies, and the department gains by an important project or program moving forward. These leadership auditions were often under the discretion of the chair, such as associate or vice chairs, but were also other roles within education or hospital administration. Because this is a tryout, there should be clear expectations about what constitutes success in such a role.

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INCLUDE DEPARTMENT LEADERSHIP IN THE PROGRAM

We made the decision to involve our chair in all activities of the leadership development program, including group projects, 360 evaluations, and coaching. We believe this is important for many reasons. Chair participation demonstrates commitment of the administration to the program. It allows for the chair to model being externally open during the sessions—that is, if the chair is taking it seriously, you should too. Finally, being present allows the chair to appreciate when young surgeons are ready for a new leadership audition.

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RIGOROUS EVALUATION

Given the amount of time allocated to these activities by surgeon participants it is important to evaluate the impact of the program on growth and leadership development. We conduct evaluations at the end of each session and program exit. We also conduct formal qualitative analysis of interviews conducted with participants at 1-year and 5-years to formally understand the long-term career impact of the program. We have previously published the results of the 1-year evaluation, which demonstrated growth in 4 main areas: self-empowerment to lead, self-awareness, team-building skills, and increased knowledge in business and leadership mental models.2

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CONCLUSIONS

We have come to believe that leadership development programs can be highly influential in shaping the culture of a department. First, and most importantly, creating such a program sends a strong message to the faculty that you care about their development. Job satisfaction—no matter the job—depends on having challenges and opportunities for personal growth. Although the challenges are everywhere in academic surgery, opportunities are less common.5 Second, when conducted every few years, these programs serve as an important source of cultural rejuvenation for a department. As young leaders are developed, and audition opportunities are created, engagement increases, bringing higher levels of discretionary energy to move the department forward.

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REFERENCES

1. Jaffe GA, Pradarelli JC, Lemak CH, et al. Designing a leadership development program for surgeons. J Surg Res 2016; 200:53–58.
2. Pradarelli JC, Jaffe GA, Lemak CH, et al. A leadership development program for surgeons: first-year participant evaluation. Surgery 2016; 160:255–263.
3. Nurudeen SM, Kwakye G, Berry WR, et al. Can 360-degree reviews help surgeons? Evaluation of multisource feedback for surgeons in a multi-institutional quality improvement project. J Am Coll Surg 2015; 221:837–844.
4. Stoller JK. Recommendations and remaining questions for health care leadership training programs. Acad Med 2013; 88:12–15.
5. Rosengart TK, Kent KC, Bland KI, et al. Key tenets of effective surgery leadership: perspectives from the Society of Surgical Chairs Mentorship Sessions. JAMA Surg 2016; 151:768–770.
Keywords:

faculty development; leadership; surgery

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