[This article was originally published in Healthcare Quarterly 5(3)]

Medicine is dependent on strong leaders to advance innovation in the clinical care of patients. In most academic medical streams, there is no explicit system-wide approach for succession planning and leadership development. In late 2009, it was clear to the authors' department that they were at risk of losing high-potential individuals and division heads.

Succession Planning and Needs Assessment (SPAN) was introduced to the department executive in late 2009 and endorsed in mid-2010. An executive coach was hired to assist in identifying emerging leaders and the skills needing to be developed within a mentorship cycle for leaders to be successful. A group of emerging leaders plus observer senior leaders worked between June and October 2010 to develop a manual that would provide guidance to the department executive.

Since June 2010 a succession plan has been in place, allowing allocation of leadership roles. A group of 18 individuals has met four times to establish the elements of leadership development. A manual has been endorsed that includes elements such as the traits needed to be considered an emerging leader; the skills agreed on as important to develop; and the mentorship cycle needed. The group has also proposed a coordinator role and a budget for resource material.

Departmental leadership development initiatives are important for succession planning and engagement of high-potential academics, who eventually will become our future leaders. In this article, the authors propose a cohort approach to piloting department initiatives that make a difference to developing leaders.

Background

Good leadership is at the heart of motivating people and creating employees who have a sense of purpose. We often are reminded of the essence of strong leadership skills when business leaders successfully negotiate tough challenges, but how important do we regard these skills in leadership roles in academic medicine? Are they needed, and how does one use them in an environment that often strives for success in individuals rather than teams?

Perhaps the best way to demonstrate the dilemma we face in academic medicine is to tell a story. Let's call it the "Leadership Fable":

Imagine an academic medical department within a large city. A department head is recruited, and through goal setting and focused activities the department grows in prominence; it recruits good faculty, it reaches its research and education milestones and it engages effectively with its members. Then crisis hits: The department head is recruited elsewhere, and the faculty is faced with the task of replacing this person. How does it respond?

The faculty administration strikes a search committee, appoints an interim head and tries to ensure that consensus is reached around the kind of department head they feel is needed. During the next 12 months, there is significant disengagement of department members, with little forward movement. The interim head feels powerless to change this. After 12 months, the search committee announces the appointment of a candidate to the new head role. It takes a further 18 months to install this person and re-engage the department members. This department loses two years of potential effectiveness in the leadership transition. Does this story sound familiar?

We contend that the result of this leadership fable can be quite different if an appropriate interim head is selected and a system is in place to develop leaders for the future. Furthermore, the notion of a "leadership pipeline," with opportunities for growth in leaders at all levels, is a philosophy that has not been endorsed in academic medicine. Unfortunately, the lack of succession planning or a leadership pipeline is commonplace within the majority of Canadian and US medical faculties recruiting into senior roles (Rayburn et al. 2009). Whereas in the business model, much of the work to replace senior individuals occurs before the announcement of a departure, this is not true in academic medicine (Charan et al. 2001). Our story indicates at least two deficiencies inherent in thinking about leadership within academic institutions – inattention to leadership transitions and a lack of attention to leadership skills development (Charan et al. 2001). For example, we found minimal attention being paid to leadership succession in the strategic plans of Canadian medical faculties and could not find any explicit initiatives for the development of individual leadership skills in these faculties in 2009. The greater focus has been to develop mentorship/career development sections. We also found minimal medical literature assessing the competency of leadership in medical departments (Black et al. 2010; Charan et al. 2001; Duda 2004; Rayburn et al. 2009).

In the fall of 2009, we at the University of Calgary, in Alberta, were challenged to consider the impact of losing many senior leaders all at once. System-wide changes had left individuals with unclear expectations of leadership and frustration about the future. The executive of the department determined that it was critical to demonstrate to our current leaders that we continued to be confident about the future, and to address the potential gap that might be created by a loss of leaders. We also sought to retain high-potential individuals who were at flight risk. Our contention was the following:

• Formalizing a succession plan for division heads would send a message that we were planning for success in the future. It would also send a message to division heads that they were valued.
• Engaging with emerging leaders within the organization would connect them to our goals and enable them to cascade positive values to other colleagues. It would also provide an opportunity to infuse a sense of purpose for the future and prepare them for leadership roles.

In considering how to engage with emerging leaders, we reviewed successful business leadership development approaches that have generally not been used in academic medicine. We were especially interested in a cohort exercise methodology; we hypothesized that by using this we could connect with a larger group of emerging leaders at one time. Our one concern for this approach initially was that there was scepticism from mature medical leaders, who thought this would not be suited to us given its roots in the "for profit" sector.

We also knew that the success of this initiative was dependent on developing an assessment questionnaire that allowed us to evaluate leadership skills and to make this attractive to academic faculty. Given that there were no questionnaires that had been developed for the assessment of leaders in our arena of academic medicine, we determined to use our first cohort group to both engage with them and use their input to develop an assessment grid and the criteria for these skills. Finally, we worked with the Faculty of Medicine administration to ensure that this activity could be credited to individuals within their annual assessment form.

Methods

The department executive described a project in late 2009, calling this Leadership SPAN (Succession Planning and Needs Assessment). This began with the development of a succession plan, using a modified Georgia method (Brooks and Henderson 2005). The plan used elements such as communication of the plan, identification of leadership characteristics, assessment of the current situation and bench strength, identification of talent, development of talent and the evaluation of succession planning. This was our approach:

1. The concept of a succession plan and the key leadership characteristics were communicated to division heads in early 2010 (communication and identification). Over a three-month period, each division chief met with the department head to outline the succession plan for that division. The objective was for the academic department head to present the dean with a clear succession plan by mid-2010 (bench strength).
2. A second objective of meetings with division chiefs was to identify high-potential individuals who could be the focus of our first cohort group involving skills development (identify talent).

An expert coach worked with the executive to put together a comprehensive plan of how to develop leadership skills within the department. This, together with a comprehensive succession plan, was presented to the division heads for their input and endorsement in June 2010. A budget was approved, and the group of high-potential individuals was invited to a discussion group with the coach in late June 2010. Fifteen early to mid-career individuals attended the first meeting, together with two division head observers, the department head, the deputy head and an expert coach.

A presentation to this group by the department head and coach included a discussion around the elements to be examined at the half-day meetings proposed for September and late October. Elements of these half-days included the following:

• Brainstorming around departmental vision, purpose and the reasons why leadership talent development was so important.
• Development of a manual that could provide information to individuals. Objectives for this aspect were to (1) develop an assessment grid for evaluating leaders at different stages; (2) develop an understanding of the traits needed (so-called leadership radar screen) for someone to be considered an emerging leader; and (3) describe the road map from an assessment of potential through to successful skill development in the department.
• Performance of a thinking style profile questionnaire. We had a choice of assessment tools to use as part of an exercise to heighten the awareness of our emerging leaders about their individual talents. We chose to use the InQ Thinking Styles (InQ Your Thinking Profile, InQ Educational Materials, Inc., Oakland, California) because this particular tool emphasizes how a leader's thinking style affects communication with other people, both individually and in groups.

Results

Succession Planning

Between February and April 2010, the academic department head met with each division head (11 divisions) to develop and refine the succession plan of each division. The request to the division heads was to each identify a person who could operate as the interim division head if called upon and to provide qualitative reasons why they felt this person was the most appropriate individual to do the job. At these meetings, the division heads also identified talented individuals whom they felt were future leaders.

We reviewed the divisional plans on several occasions with the division heads' council between April and May 2010. This was communicated to the dean and to the rest of the department members in June 2010. It has since been used by the faculty administration office and division heads to interact with faculty and to discuss the health of each division. We believe it has stabilized leadership to the extent that division leaders are strongly engaged with discussions around strategic plans for the future.

Development and Endorsement of a Leadership Development Manual

All three objectives for the manual development were achieved (i.e., the leadership radar screen, grid assessment of skills and road map of how to get there). Two half-day sessions plus two other one-hour sessions were required to bring this work to maturity. Of the 15 emerging leaders who committed to attend these sessions, all attended at least one meeting, 12 attended two sessions and nine attended all four sessions. The majority of individuals provided feedback to the final document through attendance at sessions or by electronic means. The manual was developed by the executive coach after feedback from the first three meetings (one half-day retreat and two one-hour meetings). It was then reviewed and endorsed by the group at the final half-day retreat, with some final electronic input from members of the group unable to attend the last half-day.

Content of the Manual

The content of the manual can be viewed in detail in the Continuing Medical Education section of the Department of Oncology's website. The assessment grid can be seen in the table on pages 6–8 of the manual (https://departmentofoncology.com/docs/tbccleadershipsummary1_Oct_29_Cohort_Meeting_handout.pdf); this table defines the skills considered necessary for effective leadership: communication, management, delegation/collaboration, motivation/professionalism, vision and error management. These skills are organized according to the criteria for the three leadership levels being considered, namely, potential leader, developing leader and mature leader. The manual also provides a list of the traits that identify individuals as being on the leadership radar screen: risk taking, initiative, integrity and trustworthiness, passion, insight, creativity, character, decisiveness, calm and humour. It was felt that for individuals to be considered for development, they should possess more than 50% of these traits. These traits are used as signposts to identify emerging leaders to division heads.

The manual also illustrates a road map of how to progress individuals through the assessment phase toward discussions with their division head and then the development of skills; this is presented in the figure on page 4 of the manual (https://departmentofoncology.com/docs/tbccleadershipsummary1_Oct_29_Cohort_Meeting_handout.pdf). We recognized that cultural change toward leadership development such as that described needs strong support from division heads and the provision of opportunities to develop leadership skills.

The results of the cohort group discussions were presented to the division heads' council for their approval. This received unanimous endorsement, with a commitment to using the assessment grid, list of traits and road map. Division heads also endorsed a budget for a single resource person within the department to drive accountability for this activity, and for a resource library with leadership materials and a list of seminars and formal courses.

Conclusion

Strong leaders are a key factor for success within academic health facilities in Canada; however, it is important that such a message be cascaded downwards as far as possible within academic departments in order to impact the culture of organizations. It is hoped that projects such as ours will enable departments to realize their vision of an academic future and to engage with faculty members as to how to develop individual leaders.

Internal discussions around leadership often are unfocused. We have used the following philosophies to frame discussions with early-career medical academics:

• Leaders lay the tracks; managers make sure the trains run on time.
• Leaders are the spiritual compass of the organization.
• Leaders understand that activity and accomplishment are different things.
• Leadership is the ability to organize a group of people to achieve a common goal.

Our contention is that connecting emerging leaders with our vision of the future gives them a sense of purpose and encourages them to inspire others to make positive change. Of interest are the skills that these emerging leaders identified as critical elements for successful leadership. Some of them are quite different from the ones we proposed, for example, error management. Of further interest is the general harmony between these skills and the CanMEDS core competencies that are recognized by the Royal College of Physicians and Surgeons of Canada as driving specialists' maintenance of competence and postgraduate training elements.

The qualitative benefits of leadership within academic institutions have not been well described. Although it is well understood that good leadership should result in quantitative benefits such as better recruitment, stronger research and effective health education programs, there is little recognition of the "softer" benefits these leaders can bring. Business and not-for-profit sectors often demonstrate the added values of increasing a sense of purpose, a feeling of belonging, security, trust, passion and results. In general, these are talked about in academic medicine but are not set as priorities (Bacon 2007, personal communication October 25; Maxwell 2001). As a result many medical professionals perceive leadership from a jaundiced viewpoint and see it as merely "administration."

We have demonstrated here that academic professionals operating within academically based cancer centres are both interested in and willing to enter into leadership training. It seems from the skills and traits recognized by this group that the softer aspects of leadership are highly regarded and are among the keys to these professionals feeling involved. In an age where we struggle to find ways of connecting people to their passion and purpose, this approach has been very effective at engaging with academics. It seems that when emerging leaders are recognized for their leadership talents, the majority of them respond with a positive outlook and a genuine interest to contribute. Two other spinoffs for these emerging leaders from such an initiative could include an improved ability to make decisions about their future and a better balance in their personal lives. We contend that the benefits of developing a matrix of strong leaders in academic medicine will far outweigh the challenges to coordinate such an initiative.

Is there evidence that this project will result in department-wide benefits? It has been heartening to see that within an academic department of approximately 150 members, inertia has turned around and members are holding onto an academic future again. Almost certainly this is not related purely to this initiative, but we think it has contributed to a positive mood and retention of high-potential faculty members. Another improvement seen in the past six months is higher attendance at group meetings, which are now well attended by division heads, by emerging leaders and others. We have also been able to come through significant instability in medical leadership without major resignations.

Our previous approach to developing leaders in this department was disjointed and tenuous. We also contend that few academic medical departments have used systematic ways of recognizing potential leaders and developing them. One of the associated problems is that traditional leadership development is expensive. Courses through executive leadership programs such as those offered by Physician Management Institute, Harvard Business School, Banff Centre Leadership Development and others allow the benefit of a concentrated leadership development focus but can only be afforded by a small number. We believe the cohort approach may allow for several people to come together and benefit from the synchronicity that occurs when identifying issues as a group. This will allow for individuals from these cohorts to be selected for attendance at focused courses.

One general attitude in academic medicine that has been counterproductive to developing emerging leaders is related to the identification of talent. The funnel approach – inviting only those who attain excellence in research, educational or clinical arenas into a "club" of higher-level department heads and institute directors – has been only partly effective and pays little attention to succession planning. The development of internal talent at multiple levels is more targeted, and the adoption of succession planning models such as the Georgia method assists departments to develop talent where needed.

What have we learned from this? Firstly, it is encouraging to see that both senior and emerging leaders are interested in making a difference to their divisional groups by doing succession planning and leadership development. Secondly, we have defined a framework that would work for many other academic medical departments, and we offer it as a tool for others to discuss and use. Thirdly, it is likely that if the cycle of evaluation and development is properly used, we will see far more benefits to the department in the long run, including the engagement of leaders and the implementation of initiatives that drive culture change. We have received approval to go ahead and use tools that identify emerging leaders, to provide them and their division heads with an assessment tool and for a coordinator function that will allow individuals to be able to access resources and permit other people to develop them maximally.

The future will tell whether or not we reach success. Recognition of success will depend upon (1) the continued commitment of our current mature leaders and role models, (2) our ability to track and monitor what has worked well and to share that information widely and (3) providing ongoing development support, however modest, to those who are on our leadership radar screen.

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