Becker's Hospital Review

8 THOUGHT LEADERSHIP The successful department chief: Essential skills, considerations in a changing landscape By Alexa Kimball, MD, President and CEO of Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center A s new chiefs and chairs start to take on their new jobs during this dynamic era, it's clear that the role of the chief has changed dra- matically over time. Decades ago, chiefs were usually responsible for small departments, overseeing the research, clinical and educational mission of an academic medical center. Now, they often lead large clinical enterprises that expand to an entire healthcare network. Much has been written about the increasing need for management experience to ensure success in these important roles, and that urgency has increased as new clinical imperatives continue to expand. With these changes in mind, what should we be looking for in chiefs? What skills do they need to be suc- cessful? And how can we align incen- tives to further their success? What to look for in a chief The ideal chief would not only have expertise in the tripartite mission, but also some advanced manage- ment training or experience. No- tably, this requirement could work against some candidates, so it needs to be applied carefully. For exam- ple, people who have been doing challenging jobs in a more matrixed support role, such as residency di- rector or medical director, may have developed very robust skills that aren't recognized by our tradition- al criteria. In many cases, providing augmented, deliberate training and personnel in areas where a chief may need time to develop skills is a great way to onboard a highly emo- tionally intelligent and adaptable chief who has all the skills of a great leader but may not have traditional managerial experience. What skills do chiefs need to ac- quire for success? The two biggest gaps I usually see in new chiefs' experience are basic budgeting or fiscal vocabulary and managing disruptive faculty. Much of basic finance is intuitive and straightforward addition, subtrac- tion and division, but the vocabu- lary and syntax may not be obvious without a little training. Just as a nonmedical professional might not understand or be able to put into context what a normal sodium level is, some of the data, such as what is the recommended days cash on hand, may not make sense unless you have some experience. The gap in managing faculty is two- fold: lack of experience in handling disruptive physicians and the panic that there will be a patient care gap or an unmanageable research conse- quence if someone is put on leave or terminated. In my experience, how- ever, no one ever says, "We broke up too early." While most situations can be improved with a matter-of-fact conversation, it's also not uncommon for reported issues to be the tip of the iceberg, and in those cases more de- finitive approaches are required. Bet- ter to break up in many of the cases, as challenging situations often only get worse with time. Having experi- ence, or a human resources expert to help, can assist in identifying which problems are terminal and which can be changed with rehabilitation and communication or creative solutions. How do we align incentives to fur- ther success? Obviously there are a number of compensation levers that can be used to incentivize chiefs toward cer- tain types of performance. However, serious challenges can arise when the chief prioritizes performance indica- tors that he or she delegates to other team members who don't stand to benefit personally from that success, instead of working on them directly. A novel idea proposed by some is to incentivize chiefs to achieve certain goals by giving money back to their department for initiatives. This aligns nicely with the concept that chiefs often view their primary role as stew- ards of their faculty and department. In conclusion, it's important to recog- nize that a lack of managerial experi- ence should not be fatal to a good candidate for department chief. He or she can often learn those fiscal, HR or other managerial skills, while delegating them to experts at the start. Excellent communication skills, confidence in decision-making, deft "people skills" and emotional intelli- gence are essential attributes to look for in a chief. n e gap in managing faculty is twofold: lack of experience in handling disruptive physicians and the panic that there will be a patient care gap or an unmanageable research consequence if someone is put on leave or terminated.

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