Core Leadership Competencies

Diversity

Intentionally creates a diverse faculty workforce within a collaborative, supportive environment that encourages and promotes participation from all team members

Attributes  |  Assessment Questions  |  FAQ  |  Pediatric Insight Content  |  Additional Resources

Attributes

• Data and practice driven transparency of department’s diversity goals
• Established ongoing faculty Diversity Education & Training
• Diversity rewards and recognition
• Established URM and diverse faculty recruitment practices
• Documented improvement in URM, IMG and diverse faculty and faculty leadership recruits

Assessment Questions

• Do you consider the faculty in your program to be highly diverse in their makeup?
• What personal learning in the area of diversity and antiracism have you and/or your program undertaken?
• How have you demonstrated building a diverse community is a priority for you?
• How do you measure progress in diversity in your program?
• What is your most successful diversity focused recruitment effort for your program.
• What are your program’s year-over-year trends in faculty diversity and equity?

Pediatric Insight® Content

• Responsibilities of the Chair of a Search Committee
• What is a Diverse Search?

Core Leadership Competencies

Clinical Excellence

Builds clinical cultures and programs known for excellence in the delivery of high-quality patient care

Attributes  |  Assessment Questions  |  FAQ  |  Pediatric Insight Content  |  Additional Resources

Attributes

• Top quartile patient satisfaction scores
• Top quartile faculty engagement scores
• Top quartile patient outcome national benchmark scores (appropriate by specialty)
• Established plan for continuous quality and patient safety improvement
• Documented provider of choice
• Ongoing effort to maintain or achieve U.S. News Ranking(s)

Assessment Questions

• What clinical quality measures do feel are most important for your program?
• Do these measures align with your hospital partners.
• What are the clinical strengths and weaknesses of your program? Provide 3-5 steps for improving each weakness.
• Do opportunities exist to build clinical expertise and competency?
• What metrics, rating services, … do you utilize to determine patient satisfaction, quality of patient care and position in marketplace?
• How do you assure that your clinical programs are equitable?
• Describe a quality improvement initiative you successfully led for your program.
• How would you rate the safety of your care delivery?

Academic medical centers (AMC) have usually enjoyed the reputation as providers of innovative, evidence-based, superior clinical care. This has been especially true in institutions that deliver pediatric care, most likely because of their focus on the special clinical conditions and needs of children and their families.  Several challenges exist however, in insuring that such high quality care is actually being delivered.  Those challenges include:

1. How to measure clinical excellence;
2. How to construct quality improvement activities to identify and correct measured deficiencies;
3. Potential competing priorities of faculty members in providing patient care, teaching, and producing scholarship;
4. Maintaining a high level of performance in each of those latter three domains; 5. maintaining equitable reward systems for faculty who provide high quality clinical care.

These challenges and others can potentially detract from the overall goals of AMC’s and healthcare systems to provide the best clinical care possible, especially as the US healthcare system becomes more complex and competitive. Thus, these challenges must be recognized, managed, and mitigated in order to optimize the clinical success and the educational value for students and trainees.

• Measuring clinical excellence – quality metrics in healthcare are often cumbersome to measure and frequently imprecise. This is especially true for pediatric AMC’s that treat unusual or relatively infrequent medical and surgical conditions, or that treat a relatively smaller number of patients compared to institutions treating adults. Consequently, proxy measures for clinical excellence are often used that include things that are more easily measured, such as numbers of patients treated, clinical revenue, or relative value units (RVU). Outcomes measurements are far more difficult to define and quantitate in pediatrics because of smaller numbers, relatively low mortality for most conditions, and relatively infrequent complications. So again, proxy outcome measurements are sometimes proposed, such as hospital lengths of stay, resources used, or overall charges billed; few clinicians consider those proxies as adequate measures of their quality of care.

One improvement in the measurement of pediatric clinical outcomes is the development of several collaborative, national, specialty-specific databases (examples include the Vermont Oxford Neonatal database, the American College of Surgeons Peds-NSQIP, the Extracorporeal Life Support Organization database, United Network of Organ Sharing, etc.).  The data in such databases is usually high quality and provides a comparison of one’s own institution to peer institutions. These data are often capable of adjusting for risk as well, an important factor particularly for AMC’s that frequently end up treating higher risk patients. In addition, these data can potentially identify institutions with demonstrated best practices, which when shared with other database participants can lead to widespread process and outcome improvements.

Unfortunately, the costs associated with these databases are significant, and when multiple clinical leaders each ask for their respective specialty-specific databases, the collective costs can be hundreds of thousands of dollars per annum for each AMC. Given these high costs, many AMC’s limit their use of such collaborative databases to clinical programs that are of high risk, in regards to morbidity, institutional reputation, or resource utilization.  This limitation often means that many other clinical programs will not have reliable data to verify clinical outcomes.

One measurement of outcome that is frequently used is patient (or family) satisfaction.  As an overall assessment of how well an institution is meeting their patients’ needs, this is a sound metric. Where it is possibly less accurate is at the individual faculty or provider level. Physicians often lament that the patient experience scores are impacted by “system issues” that are out of their control – things like parking, waiting times, staff interactions, etc. Nevertheless, comparison among physicians in a similar practice or specialty at the same institution can help identify both positive and negative outliers; lessons can then be learned from the former and the latter can be coached or assisted to perform at a higher level.

When a lack of good outcome measurement tools exists for a specialty program, process metrics can be substituted. Examples might be faculty-specific ordering of  diagnostic tests or medications for specific index diagnoses, or compliance with clinical pathways and protocols.  Other process measures include timeliness of communication to referring primary care physicians. While such process measures might not link directly to outcomes, there is usually a correlation.

Pediatric Insight® Content

• Strategies for Building Clinical Research Infrastructure
• Strategies for Building Clinical Research - Pediatric Insight: Passing Leadership Wisdom To The Next Generation Topic: Strategies for Building Clinical Research Our goal as pediatricians is to improve patient care and outcomes. Our panel discusses how and why clinical research is critical to that goal. We also emphasize how clinical research improves interactions among faculty; extends collaboration to other departments; schools, […]
• Considerations in Building a Pediatric Outreach Program

Core Leadership Competencies

Healthy Cultures

Develops dynamic faculty cultures that promotes professional wellness, cohesive teams and the retention of faculty talent

Attributes  |  Assessment Questions  |  FAQ  |  Pediatric Insight Content  |  Additional Resources

Attributes

• A Healthy Culture (HC) builds trusting relationships that realize and foster the potential of everyone.
• Your organizations character is defined by the health of your culture.
• A HC enhances relational practices that improve communication and collaboration.
• Effective leaders instigate and support practices that encourage a HC among faculty and leadership – moving your organization towards positive “C- Change” (Culture-Change).
• Creating a HC requires investment, persistence, repetition, & intention.
• The Values and Principles of an organization with a HC help to define the workplace atmosphere and how anyone joining your organization can be expected to be treated.  (Examples – transparency, integrity, compassion, excellence in clinical care, community service, etc.).
• A HC supports the building of professional skills of faculty and staff.
• A HC demonstrates concern over faculty personal success and well-being.
• A HC supports programs that establish on-boarding and mentorship programs.
• Consistent understanding of the established core values of the culture.
• A HC allows for adaptability in times of significant external change or challenge (i.e. COVID, environmental disasters…).
• A HC actively champion and supports a culture of equity, diversity, and inclusion.

Assessment Questions

• Do you currently believe that your program’s culture can be described as healthy?
• What key words would you use to describe the current culture?
• What five initiatives could you start that would enhance the culture of your program?
• What programs have you developed to actively promote diversity, equity and inclusion?
• Do faculty wellness programs exist? Are they structured, evaluated, etc.? Are your faculty actively involved in these programs?
• Describe the top retention challenge that your program faces.
• What initiatives have you led to improve faculty retention?
• What programs have you either developed or utilized for faculty professional development?
• What mechanisms do you utilize for provider satisfaction, performance of meaningful exit interviews, process to resolve disputes?
• What measures have you enacted to ensure your culture continues to be healthy in the face of ongoing COVID and/or other external challenges?

FAQs

Does your department mission/vision statement(s) demonstrate core values of support for a HC?

Every leader working with the faculty and staff to define the mission and vision for the organization needs to articulate the core values and principles that will ignite and inspire the community. Generally, 5- 7 values are selected to serve this purpose and every initiative, program, hire, action are guided by these values. This can be some of the hardest work for any new leader but the time and effort taken to first assess the health of your organizations culture and then to articulate the goal of making change that will develop a HC are critical skills of a successful leader.

Do you share, honor and celebrate on a regular basis the core cultures of your organization?

Just as every initiative must align to the vision and values it is imperative that the organization reinforces these values by sharing success stories, honoring achievements and celebrating both small and large steps of every new initiative. Faculty and staff need to be recognized for their contributions and how their actions have been critical to any achievement. Communication must be often and open – no one should fear sharing ideas or barriers that are impeding success. Fear of retaliation should never be tolerated nor occur.

Pediatric Insight® Content

• Time Management - Succession planning is a critical factor in the long-term success of an academic health department.
• Strategies for Building Clinical Research - Pediatric Insight: Passing Leadership Wisdom To The Next Generation Topic: Strategies for Building Clinical Research Our goal as pediatricians is to improve patient care and outcomes. Our panel discusses how and why clinical research is critical to that goal. We also emphasize how clinical research improves interactions among faculty; extends collaboration to other departments; schools, […]
• Responsibilities of the Chair of a Search Committee
• Fostering Healthy Cultures

Additional Resources

Articles

Osseo-Asare A, Balasuriya L, Huot SJ, Keene D, Berg D, Nunez-Smith M, Genao I, Latimore D, Boatright D. Minority Resident Physicians’ Views on the Role of Race/Ethnicity in Their Training Experiences in the Workplace. JAMA Netw Open. 2018 Sep 7;1(5):e182723. doi: 10.1001/jamanetworkopen.2018.2723. PMID: 30646179; PMCID: PMC6324489.

Burns KEA, Pattani R, Lorens E, Straus SE, Hawker GA. The impact of organizational culture on professional fulfillment and burnout in an academic department of medicine. PLoS One. 2021 Jun 9;16(6):e0252778. doi: 10.1371/journal.pone.0252778. PMID: 34106959; PMCID: PMC8189486.

Bunton SA, Corrice AM, Pollart SM, Novielli KD, Williams VN, Morrison LA, Mylona E, Fox S. Predictors of workplace satisfaction for U.S. medical school faculty in an era of change and challenge. Acad Med. 2012 May;87(5):574-81. doi: 10.1097/ACM.0b013e31824d2b37. PMID: 22450175.

Pololi L, Kern DE, Carr P, Conrad P, Knight S. The Culture of Academic Medicine: Faculty Preceptions of the Lack of Alignment between Individual and Institutional Values. J Gen Intern Med 2009 Dec;24(12):1289-1295. Doi:10.1007/s11606-009-1131-5

Pololi L, Conrad P, Knight S, Carr P. A Study of the Relational Aspects of the Culture of Academic Medicine. Acad Med. 2009; 84:106-114.

Zimmermann EM, Mramba LK, Gregoire H, Dandar V, Limacher MC, Good ML. Characteristics of Faculty at Risk of Leaving Their Medical Schools: An Analysis of the StandPoint™ Faculty Engagement Survey. J Healthc Leadersh. 2020 Jan 8;12:1-10. doi: 10.2147/JHL.S225291. PMID: 32021533; PMCID: PMC6955602.

Books

Jameson, C. (2016) Creating a Healthy Work Environment. Balboa Press.

Booysen, LAE & Gill, P. (2020) Creating a culture of inclusion through diversity and equity. In Viera, A. J., & Kramer, R. Management and leadership skills for medical faculty: A practical handbook. Springer.

Webinar: Transforming Institutional Culture: Assessment and Intervention NIH’s Dr. Hannah Valantine and the AAMC’s Dr. David Acosta discuss organizational approaches to effect culture change. https://www.aamc.org/professional-development/affinity-groups/gdi/webinar-transforming-institutional-culture-assessment-and-intervention

Core Leadership Competencies

Business of Medicine

Successfully leads strategy design and operations and fiscal management of endeavors across all missions

Attributes  |  Assessment Questions  |  FAQ  |  Pediatric Insight Content  |  Additional Resources

Attributes

• • Clearly articulated strategic plan
  • Demonstrated understanding and utilization of:
    – Financial statements e.g., Balance Sheet, Profit and Loss (P&L), Statements of Cash Flows, etc.
    – Funds flow mechanisms and measures
    – Compensation and productivity models, e.g., Pay for Performance (P4P), wRVU values
    – Legal and HR documents and requirements
    – Institutional financial reconciliation/reporting standard practice guidelines and requirements
  • Demonstrated operations transparency
  • Effective management of clinical productivity and reimbursement models

Assessment Questions

• Do you understand your organizational funds flow and financial reporting?
• Have you developed disciplined financial planning to ensure you will reach your strategic objectives/priorities?
• Does your program have an established written strategic plan and priorities? Are those priorities aligned with those of the hospital, the department/medical school? Are the strategic plan and priorities widely understood and incorporated into local decision-making and actions?
• Do you have access to knowledgeable business administrative staff to assist you in all aspects of your financial operations/accountability?
• Do you have committed financial resources to match the established priorities?
• What percentage completion would you ascribe to successes in achieving the established strategic priorities?
• Is your program recognized as the market leader for clinical services? What five things could you do to increase market share?
• Are your revenue and expenses aligned to your strategic objectives/priorities?
• Do you have a transparent funds flow that aligns to the strategic objectives/priorities of your program?
• What percentile are you currently achieving for the business operations metrics established for your program?
• Do you have an established process for the continual evaluation of the fiscal and operational matters for your program?
• Are your faculty currently compensated at the 50% of AAAP?

FAQ

Do you understand your institutional funds flow?

One of the most effective actions a new leader can take is to learn the funds flow of the organization and develop relationship with those leaders (e.g. CFO, CEO, COO etc.) who oversee these responsibilities. To facilitate this learning, we have encouraged new division chiefs, chairs to proactively set up meetings with all officers in key roles of responsibility around financial operations and funds flow. These meetings can provide critical insight into the nuances of the institutions committee structure and decision-making processes. They are also important opportunities to meet and develop relationships within the organization that could/will be critical over the tenure of your appointment.

Have you developed principles to guide the choice of your compensation plan & guidelines?

There are a variety of compensation approaches used in medicine from fixed to 100% variable and those that are a combination of a fixed (guaranteed approach with an earned/variable/’at risk’ component. There are several key recommendations we believe are critical to the success of any compensation plan:

1. Compensation (faculty and staff) should be tied to the best available market data.
2. Performance expectations should be clearly defined.
3. Incentives should be tied to organizational objectives and goals.
4. Incentives should be provided by productivity beyond a minimum.
5. The rules and specifics of the program should be transparent and written.
6. Administration and leaders must be knowledgeable and available to assist.
7. Feedback on performance should be timely so adaptations can be made.
8. Changes to compensation should be implemented in a time frame that allows faculty to adapt.
9. Administer with fairness and consistency.
10. Plan for amendments.

What are some common pitfalls in setting up a compensation plan?

If a compensation plan becomes too complicated it may be difficult to understand and thereby loses the ability to incent the desired behavior. There is probably a fair amount of truth to the saying that if a faculty member can’t explain the plan to their partner or close friend in a few minutes it is probably too complicated.

The results of the program should be closely monitored periodically.  A faculty member who is not fitting into the overall academic character of the department may need to have their incentives reevaluated.  An example might be a highly productive clinical member who is maximizing income and not paying attention to educational responsibilities.

All activities of the faculty do not need to be covered by the plan.  An example might be administrative positions such as Vice chairs of education, research or clinical affairs and even Division Chief activities may be covered by specific agreements (% effort).  Some of these activities may have specific goals and incentives tied to their performance, however these types of incentives should be minimized to keep the plans as simple as possible.

Certain type of behavior should be expected before incentives are paid out for high productivity.  These so-called openers might include such things as quality measures, patient satisfaction, or evaluation of teaching performance.

What are some common difficulties in setting up benchmarks or guidelines for faculty salaries and productivity?

It is not uncommon to find various societies or groups publish salaries and productivity benchmarks for faculty by discipline. It is important to become knowledgeable on how these data sources were collected as they may vary significantly. There may be differences in how the data was collected that may make them difficult to compare. Some maybe more granular in how they define subspecialties. An example may include procedural cardiologists with different benchmarks than non-procedural pediatric cardiologists. It is possible you may need to use combinations of several sources to come up with what is a fair and equitable benchmark for compensation or productivity.

Pediatric Insight® Content

• Helping Faculty Transition to New Career Paths - One of the many challenges that academic medicine leaders face is helping faculty deal with significant changes in their career direction or emphasis.
• The Search Process for Candidates - The Child Health Advisory Council discusses best practices in the search process including changes that have evolved over the last few decades (e.g. Zoom interviews, impact of social media/employment platforms etc.) and their impact.
• The Innumerable Costs of an Unsuccessful (FAILED) Search in Academic Pediatrics - Pediatric Insight: Passing Leadership Wisdom To The Next Generation Topic: The Innumerable Costs of an Unsuccessful (FAILED) Search in Academic Pediatrics Valerie P. Opipari, MD, Bruder Stapleton, MD and Wesley Millican, MBA There are few responsibilities with more consequences to the leadership of an organization its divisions, departments, school, or hospital/health system than recruiting talent […]
• Strategies for Building Clinical Research Infrastructure
• Strategies for Building Clinical Research - Pediatric Insight: Passing Leadership Wisdom To The Next Generation Topic: Strategies for Building Clinical Research Our goal as pediatricians is to improve patient care and outcomes. Our panel discusses how and why clinical research is critical to that goal. We also emphasize how clinical research improves interactions among faculty; extends collaboration to other departments; schools, […]
• No Margin, No Mission – Fiscal Focus and Transparency
• Fostering Healthy Cultures
• Partnering for Successful Fiscal Management
• Considerations in Building a Pediatric Outreach Program
• Hiring a Department/Division Business Administrator

Additional Resources

Articles

1. Lakshminrusimha S, al. “Funds Flow” Implementation at Academic Health Centers: Unique Challenges to Pediatric Departments. J Pediatr 2022 Oct;249:6-10e4. doi: 10.1016/j.peds.22022.01.058
2. Kerschner JE, Hedges JR, Antman K, Abraham E, Negron EC, Jameson JL. Recommendations to Sustain the Academic Mission Ecosystem at U.S. Medical Schools. Acad Med. 2018 July; 93(7):985-989. doi:10.1097/ACM.0000000000002212
3. Andreae MC, Freed GL. Using a productivity-based physician compensation program at an academic health center: a case study. Acad Med 2002 Sep;77(9):894-9.doi.10.1097/00001888-2002090000-00019.
4. Spahlinger DA, Pai C-W, Waldinger MB, Billi JE, Wicha MS. New organizational funds flow models for an academic cancer center. Acad Med. 2004 Jul;79(7):623-7.doi:10.1097/000018888-200407000-00003.

5. Satyan Lakshminrusimha, Steven L. Olsen, David A. Lubarsky. Behavioral economics in neonatology–balancing provider wellness and departmental finances. Journal of Perinatology. 2022.

Books

1. 1. 1. Arthur M. Feldman. Pursuing Excellence in Healthcare: Preserving America’s Academic Medical Centers. ISBN-13:978-1439816578, ISBN-10: 1439816573
      2. AAMC Funds Flow: What you need to know. https://www.aamc.org/news-insights/funds-flow-what-you-need-know