Research

Core Leadership Competencies

Research

Effectively foster institutional and faculty research aspirations and accomplishments

Attributes

  • Establish a culture that encourages faculty toward clinical, discovery, and outcomes research.
  • Pursue a diverse research portfolio supported by external faculty funding
  • Establish institutional initial and “bridging” support programs for faculty research.
  • Support successful mentorship of early investigators.
  • Establish a culture that recognizes scholarly contributions and their impact on child health
  • Encourage and support participation in regional and national collaborative trials and outcomes studies.
  • Quantify and document research productivity and trends annually.
  • Generate shared facility and professional expertise to support research with information technology, biostatistics, epidemiology, and research nurse and assistant personnel.

Assessment Questions

  • Have you completed a research strategic plan?
  • What are your program’s research goals?
  • Describe your program’s research support portfolio and your program’s research productivity as measured against the program’s research goals.
  • Do you provide ongoing grant support for your faculty?
  • Can you describe your most successful research mentees?
  • Describe the national and regional research collaboratives in which your program participates. If none, which collaboratives are your best opportunity for advancing research in your program?
  • How do you encourage team science?
  • How have you incorporated DEI or health inequities in your research programs?
  • What shared facility and personnel support research at your institution?

FAQ

What measures of research productivity should we use?

Answer: Number and impact factors of publications and total and federal research funding per year.

What percent of faculty research time should be funder?

Answer: Funding should be for about 70% of research time and cost.

What percent effort for mentorship is reasonable?

Answer: This is highly variable and dependent upon faculty position, but 5-10% is reasonable.

How long should bridge funding be provided?

Answer: 12-18 months with a requirement for submission of multiple grant applications.

How do we initite participation in research collaboratives?

Answer: Subspecialists and division directors can provide lists of such collaboratives and evaluate the benefits of participation.

Pediatric Leadership Insight

 

Additional Resources

  1. Cheng TL, Goodman E, et al. Race, Ethnicity, and Socioeconomic Status in Research on Child Health. Pediatrics (2015) 135 (1): e225–e237. https://doi.org/10.1542/peds.2014-3109.
  2. Gitterman DO, Langford, WS, Hay, WW. The Frqgile Stqte of NIH Pediatric Research Portfolio. JAMA Pediatrics 172:287-293, 2018.
  3. Good M, McElroy SJ, Berger JN, Wynn JL. Name and characteristics of National Institutes of Health R01-funded pediatric physician-scientists: hope and challenges for the vanishing pediatric physician-scientists. JAMA Pediatr. 172:297-299, 2018. doi:10.1001/jamapediatrics.2017.4947

Recruitment & Retention

Core Leadership Competencies

Recruitment & Retention

Establishes and implements a faculty talent recruitment strategy capable of attracting and securing top-tier passive faculty talent

Pediatric departments/divisions which have developed search execution strategies and skills to enable the recruitment and retention of world-class faculty talent have the following attributes:

  • Recruitment processes are candidate-facing (not institutional-facing)
  • Established year-round candidate sourcing efforts with protocols for opportunistic hires
  • Proven track record of success in diverse faculty hiring and established processes that ensure DE&I best practices
  • Excellent track record of faculty retention and satisfaction
  • Established recruiting process training and education programs for both staff and faculty

Assessment Questions

  • Describe aspects of your program’s recruiting practices that ensure commitment to DE&I.
  • Outside of advertising and faculty referrals, describe engagement strategies utilized to identify candidates for open faculty positions.
  • Describe your strategy when forming a search committee.
  • What are established recruiting best practices utilized by your program?
  • Would your recruiting process be described as candidate or institutionally oriented? If institutional, how can you modify to become more candidate oriented?
  • Is recruiting for outreach practices a challenge for your program?
  • What can you learn from your most disappointing recruitment/retention failures?
  • What is the most common reason for a voluntary faculty departure in your program?
  • What steps have you taken to improve faculty retention?

 

Pediatric Leadership Insight

  • Recruiting and Retaining Top Talent: K Award Recipients - Pediatric Insight: Passing Leadership Wisdom To The Next Generation Topic: Recruiting and Retaining Top Talent: K Award Recipients The first years of academic appointment are often the most critical in the career of a physician-scientist. Frequently, the first external grant during this important period is the K Award from the National Institutes of Health. In […]
  • Hiring a Department/Division Business Administrator - Pediatric Insight: Passing Leadership Wisdom To The Next Generation Topic: Hiring a Department/Division Business Administrator What Non-Clinical Positions Do You Need to Support Your Pediatric Department? Leaders at every level within the academic pediatric department require strong administrative support. The Child Health Advisory Council discuss the importance of the partnership of a senior business administrator […]
  • Internal Candidates - Pediatric Insight: Passing Leadership Wisdom To The Next Generation Topic: Professional Treatment of Internal Candidates In this Pediatric Insight Conversation, the Child Health Advisory council tackles a crucial conversation of effectively guiding Internal Candidates through the leadership search committee process. While your efforts will literally affect one faculty member, the experiences of the one will […]
  • What is a Diverse Search? - Pediatric Insight: Passing Leadership Wisdom To The Next Generation Topic: What is a Diverse Search? Listen to what the Council has to say about the definition of a diverse search, preparation, selection process for best outcomes, candidate pool development, establishing purpose and metrics, executive firm expectations and more. Don’t have time to watch the full […]

FAQ

What are important charges to a search committee?

A. I always stressed confidentiality for search committee discussions and restraint in reaching out to candidates and their colleagues except for the Committee Chair.

What are important considerations in forming a search committee?
A. It is important to have gender and racial/ethnic diversity and to include relevant stakeholders from outside the department/division, including potentially a community member.

How involved should an incumbent division chief be in the search for their successor?
A. This should be determined by the Department Chair; however, in general, the current chief should be available as a resource for the search committee and to potential candidates with an interview during a recruitment visit.

Should the department Chair ever chair a division chief Search Committee?
A. The chair generally likes to receive options from a search committee to choose the final candidate. Separating the role of the search chair and the department chair offers an advocate for the candidate separate from the final decision. The chair should, however, be involved in the search and evaluation of the candidates throughout the search process.

What do you do if the Dean, Hospital CEO or Department Chair decides against the recommendation of a Search Committee?
A. This is an unfortunate situation and can be avoided in most instances by excellent communication between the executives and search committee chair. Including the institutional leaders in the interview process and valuing their input is important. Ultimately, the leaders who have the final decision must approve or the search then reinitiated.

 

Additional Resources

Articles

  1. Carroll JB, Wolverton M 2004. Who becomes a chair?  In: Gmelch WH, Schuh JH eds. The life cycle of a department Chair. San Francisco Ca.  Josse-Bass.
  2.  Grigsby RK, Hefner DS, Souba WW, Kirch DG 2004. The future-oriented department chair. Acad Med, 79:571-577.
  3. Rikkers L. 2013. The real job: Recruit, mentor, protect. JAMA Surg 148:515.
  4. Ross WE, Huang KHC, Jones GH 2014. Executive onboarding: Ensuring the success of the newly hired department Chair. Acad Med 89:728-733.

Book

  1. Mallon WT, Grigsby RK, Barrett M. 2009. Finding Top Talent: How to Search for leaders in academic medicine.  Washington DC: AAMC.

 

Philanthropy

Core Leadership Competencies

Philanthropy

Establishing philanthropy as a strategic priority for all faculty, recognized by the community and as a key contributor to the research and fiscal missions of the program

Attributes

  •  Established philanthropic strategic plan including established priorities with DO and foundations at hospital and university
  • Recognizes the importance of philanthropy for support of research and clinical programs.
  • Established philanthropy training and/or training program for faculty, including conflicts of interest
  • Clear plan for energizing and rewarding faculty around philanthropic contributions
  • Clear plan for community fund-raising events with clearly articulated goals/needs for each program
  • Established strong relationships with the institutional development offices
  • Create and assure grateful patient family giving program
  • Educated faculty on important aspects of conflict of interest

 

Assessment Questions

  • What is your current strategy for philanthropy?
  • Do you have multi- institutional support for philanthropy directed to your program?
  • How frequently do you meet with institutional development officers?
  • What is your program’s ‘brand’ and/or community reach?
  • Do surveys show that philanthropy is supported?
  • Are faculty educated and trained in philanthropic solicitation and know where/how to make referrals to development staff?
  • What was your most successful philanthropic accomplishment?
  • What donor disappointment taught you a lesson?
  • What conflict of interest programs are established and operational?

 

Pediatric Leadership Insight

FAQs

How did you offer fund-raising support for your faculty?
Answer. I worked closely with the Hospital’s Foundation office to engage a consultant who offered a training session for division leaders.

What were some key learnings from philanthropy training sessions?
Answer. Most important was to listen to the donor and what they wanted to accomplish. Before asking for a gift, carefully consider the goals of the donor and how the proposed gift will facilitate successful focus to the donor’s goal.

What has been a pitfall you have observed in fund-raising?
Answer. Sincere efforts to honor an individual led to the idea of a grass-roots campaign to establish a large endowment without having a major donor and without the support of the institution’s development office. The effort failed and the honoree was disappointed. For a large endowment, a major donor is needed and one should work with the development office to avoid donor competition and to take advantage of the Foundation’s infrastructure.

Have you encountered a donor whose expectations created a conflict of interest, crossed institutional boundaries or institutional policies?
Answer 1. A research program donor expected to dictate the focus for research and the methodologic approach.
Answer 2. A donor expected to visit our NICU at non-regular hours and to provide tours for lay people who did not follow HIPPA and infection control policies.

 

Additional Resources

Articles

Ekin J. The art and science of fund raising. When to ask. Nonprofit Pro, March 25, 2020.

Willians AV, A brief introduction to the science of fundraising. Council for advancement and support of education. May 2016.

Books

McFarlan FW. 2021. Effective fund raising. Wiley 2021

Brice E. 2020. Don’t make me fund raise: A guide for reluctant volunteers.

Faculty Coaching

Core Leadership Competencies

New Leader Engagement 

Fostering the development of people skills and the wisdom necessary for effectively addressing leadership, operational and personality challenges

Attributes

  • Established mentorship program for new and current faculty
  • Established coaching resource utilization plan for “problematic faculty” and as a part of an established faculty leadership development program
  • Established plan and protocols for managing challenging faculty/staff interactions?
  • Established cadre of mentors and external coaching resources
  • Established sponsorship to support mentorship and coaching initiatives

Assessment Questions

  • What are the coaching/mentoring opportunities for faculty in your program?
  • Do you have a mentoring program specifically for new faculty?
  • Is coaching and mentoring valued at your institution? Are surveys conducted to make certain these programs are functioning effectively?
  • How do you manage challenging faculty/staff interactions?
  • Are executive coaches available for faculty leaders at your institution?
  • Describe the successful mentoring/coaching experiences you provide to faculty.
  • Who was your most important mentor and why?
  • Do you currently have mentees?
  • What was the most interesting/important feedback received from a mentee?

 

Pediatric Leadership Insight

 

Additional Resources

Articles [to come]
Books [to come]

Leadership

Core Leadership Competencies

Leadership

Effectively building and guiding healthy teams in support of programmatic mission, vision and strategic priorities

Attributes

  • Established plan for regular and transparent communication
  • Make sure individuals understand their role in the organization
  • Known as an active champion for diversity, equity and inclusion and excellence in medicine and the health professions
  • Clearly articulated vision and program strategy implementation plan
  • Consistently recognized for availability, passion, integrity and collaboration by faculty and institutional partners
  • Established succession, retention, and faculty leadership development programs
  • Faculty are viewed as competitive for leadership positions within and outside program

 

Assessment Questions

  • What is your personal leadership statement?
  • Have you personally participated in meaningful leadership development programs?  Is this important or is life experience and self-directed learning as valuable?
  • Have you completed a personal leadership assessment?
  • Who is your current active leadership mentor?
  • Who is your current active leadership sponsor?
  • What faculty leadership development activities are offered by your institution?
  • What faculty leadership development activities are offered outside of your institution.
  • How have you developed trust with your faculty?
  • Describe the succession plans in place for your program.
  • How have you grown in your understanding of diversity, equity and inclusion?
  • Describe initiatives you have championed to promote diversity, equity and inclusion and excellence in medicine and the health professions
  • Are you familiar with the theories undergirding health equity and leadership?

 

Pediatric Leadership Insight

  • Hiring a Department/Division Business Administrator - Pediatric Insight: Passing Leadership Wisdom To The Next Generation Topic: Hiring a Department/Division Business Administrator What Non-Clinical Positions Do You Need to Support Your Pediatric Department? Leaders at every level within the academic pediatric department require strong administrative support. The Child Health Advisory Council discuss the importance of the partnership of a senior business administrator […]
  • Internal Candidates - Pediatric Insight: Passing Leadership Wisdom To The Next Generation Topic: Professional Treatment of Internal Candidates In this Pediatric Insight Conversation, the Child Health Advisory council tackles a crucial conversation of effectively guiding Internal Candidates through the leadership search committee process. While your efforts will literally affect one faculty member, the experiences of the one will […]

FAQs

What are the key components of a successful leader?

The successful leader has been able to establish a vision for the program and has clearly articulated this to the members of the department. Each member of the department should understand their role and how their success in helping to reach that vision will be measured. There are many important steps in accomplishing these goals but using this framework can often provide clarity when difficult decisions need to be made. An alternative view is the leader who is not a named leader but has displayed through action the elements of ethical leadership.

What are some important qualities of a good leader?

They should be a good listener and communicate on a regular basis. It should be easy to explain decisions made by the leader as being consistent with a set of core values. These values should be explicitly stated and referenced on a regular basis. An effective leader should make decisions in a consistent manner that can be usually be predicted by members of the organization. That having been said, adaptive leadership that is based on organizational justice principles recognizes the need to understand context, tensions and the need to accept that change is not only inevitable but necessary for progress. Effective leaders support awareness and movement towards change that support greater equity in clinical care, research, policy and leads to improved health outcomes.

What are some examples of core values a leader should value?

Many organizations find it useful to clearly delineate 4-6 core values that are used to guide decision making processes at all levels of the organizations. It is often useful to settle upon these values in an open manner such as a brainstorming session. The exact values often include such concepts as honesty, integrity, trust worthiness, and equity. The precise values chosen are not as important as the fact that are openly discussed and widely agreed upon. They can often prove helpful as a sounding board in complex decisions. A critical concept is inclusion of diverse perspectives based on self-identified identities and lived experience.

Why is communication so important in leadership?

It is important to understand the importance of bidirectional communication. Without this type of communication leadership tends to become insular and non-responsive to the needs of an organization. Successful leadership requires active listening and opportunities for voices to be heard. Communication with opportunities for feedback are a way to develop clarity, understanding and buy in to a position. This type of communication recognizes the need to adjust the balance of power and to aim for non-hierarchical processes that respect inclusive points of view.

Why is it important for leadership to promote strong mentoring programs?

Mentorship results in significant benefits to both the mentor and mentees. Research has shown mentoring results in higher rates of professional success for the mentees in clinical, educational and research activities. Mentors themselves often experience greater productivity, career satisfaction, and personal gratification. As a hedge against burnout, encouraging mentorship can have a significant positive impact on the faculty at large. In this context, it is important to note that mentorship is not sufficient and does not equate to sponsorship. Sponsorship goes beyond mentorship to actively engage and support the development of a faculty or trainee no matter the status of that mentee.

Additional Resources

Articles

Flores G, Mendoza F, Brimacombe MB, Frazier III W, .Program Evaluation of the Research in Academic Pediatrics Initiative on Diversity (RAPID): Impact on Career Development and Professional Society Diversity. Academic Medicine, Vol. 96, No. 4 / April 2021.

Pachter LM, Kodjo C. New Century Scholars: A Mentorship Program to Increase Workforce Diversity in Academic Pediatrics. Acad Med . 2015 Jul;90(7):881-7. doi: 10.1097/ACM.0000000000000669.
Edmonds BT, Tori AJ. Leadership in Academic Medicine: Purpose, People, and Programs. Skylar, DP. Academic medicine, Vol.93, no. 2, pp.145-148

Jagsi, R, Spector N. Leading by Design: Lessons for the Future From 25 years of Executive Leadership in Academic Medicine (ELAM) Program for Women. Academic Medicine, 95 pp. 1479-1482. doi 10.1097/ACM0000000000003577.

Lobas, R. Spector, N. Leadership in Academic Medicine: Capabilities and Conditions for Organizational Success. The American journal of Medicine, 2006, vol 119, no. 7, pp. 617-621

Books

David M Greer. Successful Leadership in Academic Medicine. Cambridge University 2022, ISBN 9781108923132

John P. Sànchez. Succeeding in Academic Medicine: A Roadmap for Diverse Medical Students and Residents, Springer 2020

Edited by Robert J. Sternberg, Elizabeth Davis, April C. Mason, Robert V. Academic Leadership in Higher Education: from the top down and the bottom up. Lanham ; Boulder ; New York ; London : Rowman & Littlefield, 2015

Edited by Margaret Plews-Ogan, MD, MS, University of Virginia School of Medicine, Charlottesville, VA, USA, and Gene Beyt, MD, MS Wisdom leadership in academic health science centers: leading positive change. Radcliffe Publishing, [2014], 239 pages

Jeffrey L. Houpt, Roderick W Gilkey, Susan H. Ehringhaus. Learning to Lead in the Academic Medical Center [electronic resource] : A Practical Guide. Cham : Springer International Publishing : Imprint: Springer, 2015. 219 pages.

Laraque-Arena D and Etzel RA. Organizational Change – Helping from Inside. In Leadership at the intersection of gender and race in Healthcare and Science: Case Studies and Tools. Laraque-Arena D, Germain L, Young V, Laraque-Ho, A. (Editors) First published 2023 by Routledge; 4 Park Avenue, Milton Park, Abingdonm Oxon OX14 4RN and by Routledge, 105 Third Avenue, New York, NY 10158.

Education

Core Leadership Competencies

Education

Pediatric Departments/Divisions which meet the demands of their academic mission while advancing continuing medical education and successfully training the next generation of academic physician leaders share the following attributes.

Attributes

  • Protected time and salary support for faculty contributions to educational mission
  • Faculty rewards structure that encourages innovation and continuous improvement for all educational programs
  • Established efficacy measures and metrics of success for education initiatives and for program graduates
  • Established faculty and trainee development programs devoted to education
  • Diversity in trainees and educational leaders
  • Succession plan for educational leaders

Assessment Questions

  • Do you have a mission statement (include goals/importance) for your educational programs (including CME)?
  • How have you selected the educational leadership for your program(s)?
  • Do your faculty have “protected time”/effort support for their leadership of, and/or participation in educational programs?
  • Are there faculty development programs at your institution that are focused on faculty educators?
  • Are there clear expectations, track descriptions, performance measures, and promotion criteria for faculty clinician-educators?
  • What innovations have you initiated or supported in your educational programs?
  • How do you monitor the quality, the success of your education programs?
  • What initiatives do you utilize to improve retention of faculty educators? Of the best trainees as faculty?
  • Are your training program(s) highly rated by trainees?
  • Are you satisfied with the quality/diversity of training program applicants? If not, what measures can be taken to improve?

Pediatric Leadership Insight

FAQs

Is a division chief role the likely next step for fellowship program directors?

Answer: Highly variable, depending primarily on the career aspirations of that program director, whether they are considering an internal vs. external chief position and on their strengths and weaknesses as a program director, especially related to the financial oversight of education programs.

What qualities do you look for in selecting new leaders for your educational programs?

Answer: With both external & internal candidates, look for evidence of leadership experience/skills (no matter the venue), commitment to medical education, contributions to educational scholarship and most important—desire to be a program director!

Several of my division chiefs also serve as their division’s fellowship program director. Do you recommend that?

Answer: Depends how successful these individuals are at both roles and how satisfied they are, which likely depends on the size (and growth?) of the division & training program.

Are there any organizations that residency and fellowship training program directors should be encouraged, supported to join, participate in?

Answer: Recommend both APPD (for residency program directors) and CoPS (for fellowship program directors)—good for career development and for continuous program improvements.

My medical school administration does not have a clinician-educator faculty track nor does it support protected time for faculty educators. While I continue to advocate for that, are there other ways I could provide support?

Answer: Consider supporting faculty educators’ application to institutional or national educator programs/conferences. Could also initiate awards that recognize faculty excellence as mentors or by their educational scholarship.

Additional Resources

  1. Uijtdehaage S et.al. Academies in health professions education: A scoping review. Academic Medicine 96: 1476-1483, 2021.
  2. Boucher D et.al. Early career development and graduate medical education leadership pathways. J Grad Med Ed 12(5): 644-46, 2020.
  3. Rees E, Guckian J & Fleming S. Fostering excellence in medical education career pathways. Ed Primary Care 32:2, 66-69, 2020.
  4. Mink R et.al. Council of Pediatric Subspecialties (CoPS): The first five years. Pediatr 130(2):335-341, 2012.
  5. Yager J et.al. What sustains residency program directors: Social and interpersonal factors that foster recruitment and support retention. Acad Medicine, 2022 (epub ahead of print) DOI: 10.1097/ACM.0000000000004887

Diversity, Equity & Inclusion

Core Leadership Competencies

Diversity, Equity & Inclusion

Intentional creation of a diverse faculty workforce within a collaborative, supportive environment that encourages and promotes participation from all team members

Attributes

  • Data and practice driven transparency of department’s DEI goals
  • Established ongoing faculty DEI Education & Training
  • DE&I 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 DEI and antiracism have you and/or your program undertaken?
  • How have you demonstrated building a DEI community is a priority for you?
  • How do you measure progress in DEI in your program?
  • What is your most successful DEI focused recruitment effort for your program.
  • What are your program’s year-over-year trends in faculty diversity and equity?

Pediatric Leadership Insight

  • What is a Diverse Search? - Pediatric Insight: Passing Leadership Wisdom To The Next Generation Topic: What is a Diverse Search? Listen to what the Council has to say about the definition of a diverse search, preparation, selection process for best outcomes, candidate pool development, establishing purpose and metrics, executive firm expectations and more. Don’t have time to watch the full […]

 

Additional Resources

Articles [to come]
Books [to come]

Clinical Excellence

Core Leadership Competencies

Clinical Excellence

Creating clinical cultures known for excellence in the delivery of high-quality patient care

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 US 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?

 

Pediatric Leadership Insight

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.

 

Additional Resources

Articles [to come]
Books [to come]

Healthy Cultures

Core Leadership Competencies

Healthy Cultures

Developing dynamic faculty cultures that promote professional wellness, cohesive teams and the retention of faculty talent

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 Leadership Insight

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

Business of Medicine

Core Leadership Competencies

Business of Medicine

Successfully lead and grow clinical, operational and strategic priorities

Attributes  |  Assessment Questions  |  FAQ  |  Pediatric Leadership Insights  |  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 Leadership Insight

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.


Books

    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