Introducing a formative approach to developing better leaders in academic medical institutions
Peter S. Craighead, MD
ARTICLE
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The quality of medical leadership in academic institutions has been the focus of increased interest for the past 20 years, with many claiming that we are in a crisis because of an insufficient number of high-quality leaders. Alberta’s medical landscape has changed significantly over the past 8 years after super-regionalization of the entire province, which led to serious challenges in attracting leaders and convincing them to stay. This study shows that, by establishing a Leadership Development Office, supported by a formal advisory board, the Department of Oncology in Calgary has been able to lead succession planning, develop skills in a large cohort of emerging leaders, and attract broad-based interest in leadership at all levels. A description of the practical steps required to integrate leadership development within a department and the limitations of this approach in smaller departments is included. This study demonstrates that integration of leadership development within large academic medical departments is both practicable and economical, and integration has enabled the oncology department to stabilize the medical staff environment in cancer services in Calgary.
Key words: leadership development, academic medicine, integrated leadership program
Society talks openly about the absence of strong leaders and their importance to communities and organizations. At the World Economic Forum in 2015, 86% of several thousand attendees agreed that the world was in a leadership crisis, with evidence suggesting that it was not confined to government and public circles, but extended across all sectors.1 Several academic think tanks have also raised concerns about leadership gaps in medical schools.2 Top
Although these pronouncements have been interpreted as showing that there are insufficient numbers of leaders, the crisis is more likely related to poor quality of leadership. Quality of leadership has been broadly defined by Feigenbaum3 as the ability of leaders to perform superiorly, because of developed personal traits, characteristics, values, and behaviours. Major leadership training centres have quantified this quality by linking competencies with superior performance.4
Is mediocrity in leadership performance prevalent in academic medical institutions, and can it be remedied by developing certain skills in leaders? Given that medicine faces the same societal challenges as other industries, it is probable that academic medical institutions are as threatened by poorer quality leadership as other domains. Whereas industry and larger medical schools strongly support the notion that leaders become better by being trained in certain competencies, this concept has not been widely embraced by all medical institutions.5,6 Others in health care have postulated that increasing these critical competencies or skills is the first step to raising the overall quality of leadership.5 Top
In 2010, two years after Alberta’s health system had been coalesced into a single entity, the Tom Baker Cancer Centre/Department of Oncology (TBCC/DOC) in Calgary was forced to address the challenge of finding and recruiting leaders. Between 2008 and 2010, it had been difficult to attract senior leaders, and there was a risk that it could lose current leaders. The organization recognized the need for regular succession planning, the importance of skills training for emerging leaders, and the need to improve its ability to identify potential leaders.6 The TBCC/DOC also reached agreement on the skills and competencies required of leaders at various levels by using a Delphi method that tested members’ expectations across the department. It became clear that TBCC/DOC could not address this task within its administrative structure and, therefore, it formed a task group to start the process by conducting a needs assessment and environmental scan. Top
One of the major decisions made early on was to consider leadership at TBCC/DOC at three levels: emerging, mid-level, and senior leaders. Emerging leaders are potential leaders, most of whom come from generation Y (and are technologically savvy). Mid-level leaders are those who have some experience leading small groups. Senior leaders are those who have led large (or strategically important small) groups, including regional and provincial entities. Although TBCC/DOC considered hiring an external agency to tailor programs to address its needs, the expense made this prohibitive. The original task group, which began work on the needs assessment, eventually evolved into the Leadership Development Office (LDO).
The overall goal of this study is to show that the establishment of a departmental LDO has led to a more coordinated approach to recognizing gaps in leadership and developing leaders as early as possible. This report will allow TBCC/DOC to evaluate whether the LDO is an investment worth continuing and whether it is also a solution for other large academic medical departments concerned about future leadership challenges.7 Top
Methods
This qualitative study was undertaken in 2015 by the LDO, which had been established in 2010. It is based on the hypothesis that better coordination of leadership development provided by the LDO would result in:
To test this hypothesis, the LDO obtained the following information from the TBCC/DOC:
The author then examined the factors that allowed the formation of an effective LDO, evaluating the challenges and steps to implementing such an office. Top
Results
The LDO has facilitated a proactive approach to leadership development that involves data gathering, succession planning, skills training, coaching, and identification of people for both training and positions. Coordination of this leadership development function addressed the study hypothesis by demonstrating that there has been:
Steps required to establish an effective leadership development office
1. Create a sense of urgency through data gathering and assessment of group perspectives
The department executive felt that, without data to demonstrate what needed to be done, it was powerless to address inertia. Thus, the first step was to develop a comprehensive plan for moving forward, using data from:
Once there was a clear understanding of what had to be done, the LDO moved to coordinate succession planning, organize training of leaders, and negotiate with external programs.
3. Develop a module for formal skills training for emerging leaders
One of the important first steps for the LDO was to develop a module that would provide training in leadership skills to emerging leaders. A human resources consultant was hired to develop a module to be offered in a classroom setting.
Based on results of the needs assessment survey and recommendations from the consultant hired to provide advice on internal programs that could be offered, LDO created a seminar series for emerging leaders. These modules increase self-knowledge/self-awareness and the ability to build teams, drive team effectiveness, lead change, and resolve conflict. Top
Although it is impossible to identify all aspects of these changes, it is relevant to describe briefly the major changes. A formative approach has been introduced in the TBCC/DOC, based on the principle that high-performing organizations should have strength at multiple leader levels, with an initial emphasis on emerging leaders. In terms of skills development, the major focus has been on teaching self-awareness, team-building, leading change, and resolution of conflict, with emerging leaders showing interest in attending such seminars.
LDO has yet to demonstrate that the skills taught have resulted in changed behaviour, although the TBCC/DOC has succeeded in attracting many of these “graduates” into leadership roles. Top
Integration of a leadership development service into a large academic medical department is achievable. In Calgary’s Department of Oncology, the establishment of a dedicated office has increased interest in skills training seminars and coaching for leadership skills development, is associated with a significant decrease in leadership vacancies, and has interested more members in leadership roles outside the department. One of the major benefits of this integration has been the ability of the department to emphasize the importance of academic leaders and their relevance to sustainability. In the local setting, significant momentum was gained by gathering baseline data, which catalyzed the drive to better coordinate leadership development. Top
Could the increased focus on gaining leadership skills, improvement in the leadership environment, and reduction in leadership vacancies in the department have been achieved without the integration of leadership development? It is quite possible this could have been achieved using other strategies; however, the relatively low investment needed to achieve the successful outcomes reported here — about 250 h of administrative time and about $80 000 over five years — justifies the approach described in this report.
The cost, even conservative estimates, of providing these services by external agencies would have prohibited this department from offering leadership development to as wide a group of leaders as was targeted in this initiative. For example, skills training seminars for 90 people would have cost $270 000; executive coaching for 25 people would have cost $150 000; and consulting costs for five years of annual succession planning would have been $20 000. These estimates are likely low, as they do not include travel. Top
The strong connection between the sustainability of a healthy organizational culture and effective leadership makes it critical to develop strong leaders.11,12 In mid- to large-sized medical schools, the best solution for individual departments is likely the establishment of a centralized faculty career development office that serves all departments. Many mature academic medical institutions have successfully created such offices and this would have been a preferred, less expensive solution for TBCC/DOC.11-14 Unfortunately, many medical schools have yet to arrange career development centrally. Large academic departments that are not supported by a central office should consider integration of leadership development in a manner similar to the one described in this report.
There are limitations to recommending this approach to academic departments. First, this study did not address mid-level and senior leader groups comprehensively, and it may be that the major benefits of this approach are to emerging leaders and in terms of long-term succession planning. Top
Second, smaller academic departments may not have sufficient administrative staff to accommodate the office workload generated, nor enough participants to make this strategy practical. The financial investment and time commitments likely make it feasible only in larger academic departments (with more than 200 members). The TBCC/DOC, with its 250 members, experiences sufficient transitions in leadership to make this approach viable. Nevertheless, smaller departments should perform succession planning regularly, so that they can identify gaps and solutions needing to be addressed by external agencies.
Third, a venture like this would not likely have gained momentum without senior leaders who were committed to push for this change. In groups where such synergy does not exist, it would be more prudent not to entertain such a strategy, but rather develop budgets that support a narrower spectrum of identified individuals for leadership training by external agencies. Top
Finally, the approach we have described here should not be considered comprehensive, nor ideal for all departments. For departments ready to evaluate where changes are needed and able to coordinate initial changes, this approach will serve them well. However, it cannot be expected to address more complex issues (e.g., strategic planning, ethical issues, conflict resolution, negotiation techniques), and the department is now working directly with other executive bodies to offer programs for advanced mid-level and senior leaders.
What are the alternatives to using the described approach for larger departments without central offices? Some people suggest that all development programs overestimate benefit, as all leadership roles eventually get filled, with or without developed individuals. Others contend that good leaders rise to the occasion spontaneously when needed, or that external executive programs are better at leadership development than internal approaches, such as the one described. Some assume that “someone else” in their institution is responsible for this development activity and do not concern themselves with succession issues. Top
Evidence shows that relying on any single one of the above approaches is likely to fail and that providing multiple elements within an office is far more likely to succeed.15,16,17 The LDO in Calgary should be regarded as a hybrid approach to providing a career development focus within an academic medical department. It now offers multiple elements, starting with the classroom teaching/experiential learning and qualitative feedback approaches described in this report, but it has expanded to offer coaching and strategic planning training through external agencies. The major benefit of the office is its ability to coordinate both internal and external elements. It also relies on some services provided by the medical school.
The TBCC/DOC takes the mandate to prepare young leaders for the future seriously. It believes that, if it is to advance medical sciences, care for patients, and lead teams, then the development of leaders has to be at the forefront of its consciousness.7,12 Ultimately, our ability to develop leaders will enable our departments to be places where academics make a global contribution. Large academic departments must consider their responsibility to develop potential leaders, and consider the formative approach described here as a possible model. Top
References
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Author
Peter Craighead, MD, FRCPC, is a senior radiation oncologist at the Tom Baker Cancer Centre in Calgary. He was recently appointed to lead a new Leadership Development Office in Oncology, with the goal of creating academic leaders who are committed to making a global impact.
Correspondence to: Peter.Craighead@albertahealthservices.ca