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 Leadership Insights  |  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 Leadership Insight

• 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 - Pediatric Insight: Passing Leadership Wisdom To The Next Generation Topic: Responsibilities of the Chair of a Search Committee Clarity in understanding the responsibilities of the Chair of a Search Committee is important to a successful process. The goal of the process is to identify the best candidate for the position that is to be filled. This […]
• Fostering Healthy Cultures - Pediatric Insight: Passing Leadership Wisdom To The Next Generation Topic: Fostering Healthy Cultures Every leader working with 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. A #1 priority is providing a positive work and learning environment that […]

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 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

• Helping Faculty Transition to New Career Paths - Pediatric Insight: Passing Leadership Wisdom To The Next Generation Topic: 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. How we as leaders deal with those challenging moments is very impactful both for the […]
• The Search Process for Candidates - Pediatric Insight: Passing Leadership Wisdom To The Next Generation Topic: 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. Key strategies for success are highlighted […]
• 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 - Pediatric Insight: Passing Leadership Wisdom To The Next Generation Topic: Strategies for Building Clinical Research Infrastructure This Pediatric Insight Conversation focused on needs, approaches, and strategies for doing the critically essential work of clinical research that is crucial to continuously improving patient care and outcomes in pediatrics. Listen to the Podcast: https://episodes.castos.com/6407ae35b23e84-50118483/1719640/c1e-rkmgvujz9k4a7vowm-xmzokk3ksv2g-iptave.mp3 Duration: 00:31:06 | Recorded on […]
• 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 - Pediatric Insight: Passing Leadership Wisdom To The Next Generation Topic: No Margin, No Mission – Fiscal Focus and Transparency The fiscal challenges in academic medicine are apparent to us all — particularly in academic pediatric medicine. The many pressures of increasing complexity of clinical care, decreased reimbursement (especially from government payors such as Medicaid), competing […]
• Fostering Healthy Cultures - Pediatric Insight: Passing Leadership Wisdom To The Next Generation Topic: Fostering Healthy Cultures Every leader working with 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. A #1 priority is providing a positive work and learning environment that […]
• A Partnership of the Department Chair and Department Administrator is Essential for Financial Success - Pediatric Insight: Passing Leadership Wisdom To The Next Generation Topic: A Partnership of the Department Chair and Department Administrator is Essential for Financial Success Financial management is often an area that physician leaders have not yet developed experience prior to assuming their leadership role. The complexity of clinical reimbursements, research funding sources and institutional compensations has […]
• Considerations in Building a Pediatric Outreach Program - Pediatric Insight: Passing Leadership Wisdom To The Next Generation Topic: Considerations in Building a Pediatric Outreach Program While there are many challenges in building, maintaining and evaluating pediatric outreach programs, the advantages of a successful outreach program to the community and the pediatric program itself can be considerable. This conversation highlights those issues and focuses […]
• 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 […]

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