Introducing a formative approach to developing better leaders in academic medical institutions

Peter S. Craighead, MD



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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




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:


  • A significant increase in the number of emerging leaders receiving skills training
  • A reduction in leadership vacancies within the department
  • A willingness to fill external leader positions, shown by the increased number of Calgary academics in regional, provincial, and national roles


To test this hypothesis, the LDO obtained the following information from the TBCC/DOC:


  • An analysis of department demographics, as part of a university-wide assessment in 2012
  • An environmental scan of the essential components of a leadership development program, completed in 2012 by SCI Sargent Consultants
  • Results from a 2012 department-wide survey to evaluate the needs of department members (providing a list of motivators and obstacles to integrating leadership development and the competencies needed for leaders to be effective)
  • Estimates of leadership gaps provided by annual succession plans (2012–2015)
  • The number of skills-training seminars offered to internal candidates and the number of people attending them
  • An estimate of leadership vacancies between 2009 and 2015


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




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:


  • More emerging leaders receiving training: Between 2010 and 2015, the department trained 90 emerging leaders internally, in two half-day seminars on six occasions. All attendees were able to create their own life plans during the seminars and completed “thinking style” assessments.8 Before 2010, there were no formal leadership skills training courses for this group of leaders.
  • Coaching: During the study period, formal coaching was coordinated for 25 senior leaders, increasing the number of people exposed to leadership coaching by 300%.
  • Reduction in leadership vacancies: All senior leadership positions were filled over the past five years, with 10 internal and two external appointments. Since implementing this explicit approach to developing leaders, only one leadership position has remained vacant for more than four weeks. In comparison, between 2008 and 2011 the department was unable to fill three senior positions for more than a year, and four mid-level leader roles were unfilled for two years.
  • Broader influence: Since 2014, five members of the department have assumed major provincial, national, or international leadership roles, whereas in 2008–2013, there were only two such appointments. Several members have been appointed to executive positions in national oncology societies. This is a subjective assessment, as we are uncertain whether this outcome was merely a result of the creation of new roles. Top


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:


  • Needs assessment survey: Between May and November 2012, an online survey was undertaken to allow the LDO to understand the motivators and obstacles to leadership development (Tables 1 and 2), as well as the competencies that people needed. This snapshot of development challenges within Alberta’s cancer centres provided an opportunity to look at the issues within the Calgary staff subset. In Calgary, 340 staff members participated in the survey, of whom 50% were academics.
  • Demographic analysis of oncology academic staff: To understand the potential types of future leadership challenges, we used the faculty-wide assessment to examine the demographics of our department and show a breakdown of gender, age, and race in the clinical and academic streams.9 In terms of gender, race, and age groups, the proportions in oncology mirrored those of the whole faculty for both clinical and academic groups. There were no significant differences in ethnicity, gender, or age between academic and clinical streams. The most striking finding in both academic and clinical streams was the dominance of people in the 55–65 years age category (47%), 18% of whom would be retiring in the next five years (Figure 1). In addition, 52% of our staff are 31–50 years of age, which augurs poorly for sustainability unless we encourage development of emerging leaders.
  • Environmental scan: In 2012 an external consultant undertook a comprehensive overview of elements required for leadership development in academic medicine in cancer care. It used the experience from LEADS, the UK’s National Health Service, and larger faculties of development in medical schools to show the importance of establishing a comprehensive approach to developing physician leaders. Top


2. Clarify the role of an LDO with the support of an advisory committee

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.


  • The department head attempted to garner interest from external agencies to address the areas identified. When this proved too costly, the department head hired a consultant to determine what could be done internally and recommended that the division heads operate as an advisory committee for an expanded leadership development office. The advisory group agreed on the space needed, type of training to be offered, time required for support staff, and a budget for succession planning and skills training of emerging leaders.
  • The staff worked cohesively in the first two years, allowing for annual succession planning and coordination of skills training to occur. In 2011, a major breakthrough occurred with the implementation of the Georgia State administrative services succession planning tool.10 Between 2011 and 2015, this tool was used annually to identify gaps and highlight individuals ready for promotion. In 2013, the LDO expanded to support a resource library and oversee coaching opportunities for senior leaders.


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



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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:


This article has been reviewed by a panel of physician leaders.