Recruiting Leaders to Academic Medical Centers

This resource was prepared by the Academic Advisory Committee to Merritt Hawkins.
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Seeking a Leader Begins with Clarity About Institutional Profile, Including its Vision and Goals for the Future

While there are some shared features that help define an academic medical center, including its component medical school and teaching hospital(s), each also has its own unique vision, mission and goals; different models of organization and governance; and variations in resources and accompanying strengths, weaknesses and challenges. Accordingly, senior leadership positions vary widely and the attributes of the potential candidates will depend on a host of factors that should be well defined and delineated before the search gets underway. It is imperative that the search committee, selecting institutional leader (e.g., president, dean, chancellor, hospital CEO) has clear and aligned understanding of the institutional profile and the characteristics of leadership position that is being sought. These characteristics will vary enormously on the medical center and the university even though these are often inextricably interrelated.

For example, the characteristics of leadership candidates for medical school or medical center that is primarily clinical in its mission will be different from those that are more research focused. Whether the institution is public or private, urban or more rural, or whether it is considered to be in the top tier of national and international institutions can have a considerable impact on the search process and potential candidates. This is further impacted by the size and scope of the school and university and whether it is medical or surgical or whether it is hospital based. The nature of the healthcare system and its funding where the search is being conducted has enormous importance, as does the funding and support for the missions in clinical care, research and education.

The organization and governance of the medical school, medical center and university will also influence the leadership skills for the leader who is being recruited. For example, will the reporting relationships within the medical school and university as well as the affiliated teaching hospitals. As research in leadership shows, the success of leaders depends largely on the level of matching leadership behavior with the team’s expectations.

It is also important to define the expectations of the leader being sought beyond administrative leadership responsibilities. For example, will the leader be expected to have clinical care responsibilities or continue in research, and if so, what percentage of her or his time should be allocated to those duties. While the traditional skills of many leaders in academic medicine include expertise in clinical care, education and research,  detailed knowledge and skills in financial management and administration are of equal or more importance for a number of leadership roles. Of particular important are skills as a communicator and an individual who is respected for accessibility as well as the ability resolve inevitable conflicts and overall human resource management that arise all too frequently. While it is unlikely that any individual will possess deep skills in every domain and dimension, it is imperative that the skills needed for a particular position be carefully assessed and matched to attributes of the candidates. The world of academic medicine has changed enormously over the past years and the requirement for leadership transcend the traditional roles that most academic faculty have acquired. Being a great researcher, or an outstanding clinician or a superb educator does not in itself assure that an individual will be successful While knowledge in the academic enterprise is a perquisite for leadership, success requires a high level of emotional as well as cognitive intelligence along with knowledge and skills that transcend the traditional academic pathway. If a search committee or selecting official chooses a candidate on past academic performance without also critically assessing leadership skills and abilities, the likelihood for failure is high.

Defining the institutional resources and culture

Given the issues noted above, it is important that prior to the initiation of a search for a leader of an academic medical center efforts be made to fully delineate the current and anticipated institutional resources. These should be compiled in a detailed assessment of all the relevant metrics candidates will want to know about. This includes the history of the medical center (and where relevant the department), the number of faculty, staff and students and how they are appointed, promoted and supported. Details of the available physical resources (clinical, wet and dry laboratory, office and administrative space) is important to delineate, including how that space is funded and paid for along with how much discretion the chair has over their assignment and allocation. The financial resources of the school (and where relevant department), and parent institution are critical components of an institutional portfolio, including sources of revenue (from clinical care, research and education), their uses and allocations and an accurate assessment of financial performance and the metrics used to assess it. Ideally, the resource materials prepared for review by potential candidates will include multiyear financial projections together with a clear delineation of the resources that the leader will have to manage – including funds for recruitment, retention, initiation of new projects, etc. It is also imperative that the institutional portfolio delineates the administrative organization of the medical center (including departments, divisions, sections, centers, institutes and teaching hospitals) and how they are governed and relate to other schools as well as the medical center and university. Depending on the “state of health” of the medical center (and its units), an institutional evaluation and assessment, ideally performed on non-institutional leaders, can be extremely helpful and important in defining the desired attributes of a new chair and the key goals she or he is expected to achieve over the first several years of incumbency. For example, if the medical center (and its departments) is well resourced and mature in its state of functions, it could seek a different leader than one facing serious challenges. For example, if the center is strong in its research mission and accomplishments but facing challenges in clinical performance, the skill set of the department chair will need to be considered accordingly. That said, it is imperative that a clear sense of institutional “culture” be assessed so that it is made clear to institutional leaders as well as potential candidates the kind of institutional environment and culture they could be entering. Put another way, if her or his colleagues do not respect the new leader, success could be hindered or seriously compromised.

Delineation of the skills and knowledge required successfully meeting and fulfilling the position description

Based on the institutional assessment and generation of a comprehensive resource report that can be shared with selected candidates, a detailed job description and set of expectations can be developed and shared with candidates. While there are common features of various institutional leaders, there are major differences in expectations based on some of the institutional and programmatic issues defined above. Capturing as many of these as possible in a written job description is helpful for the search committee, institutional leaders and potential candidates. Obviously it is also important to recognize that some components and features of a leadership position and appointment cannot be put into written format and thus it is imperative that the in-between-the-lines issues and expectations of the position be transparently shared with chair candidates. This is important for the institution as well as future leaders. Most fundamentally, the appropriate approach to balancing leadership (requirements related to flexibility, innovation, and change) and management (requirements related to stability, order, and efficiency) in view of the various contingencies needs to be defined. The job requirements should then be specified further based on specific leadership functions and personal skills and abilities needed to fulfill these functions.

Initiating the Search Process

In tandem with the institutional and (where appropriate department) assessment of challenges and opportunities, and the generation of the report on institutional resources and the attributes of the prospective leader that form the basis for the position description, it is imperative to clearly define the process that is planned. Whoever is assigned to select the leader should fully delineate her or his expectations and desires for the kind of individual being sought and why. Simply saying that we want the “best academic leader” is fraught with hazards unless accompanied by a clearer delineation of the skill set being sought or the putative measures of success that the leader will be evaluated on. It is important to make clear that the search is open and competitive and that an off-line or informal process has not already selected a potential candidate. This is particularly true when there may be internal candidates or if it is known and forecast that the selecting official has a particular individual or agenda in hand that is not being shared. Nothing will contaminate a search more quickly than failures of transparency and communication, especially from institutional leaders. All the way through the search process, group dynamics in the search committee and in interaction with other involved parties need to be carefully monitored and counteracted if needed.

It is important for the selecting individuals to delineate their expectations on the “deliverables” from the search committee. For many this should be an unranked list of 3-5 finalists. In doing so, it is important for the selecting individual to also make clear points of expectation, including the need for diversity in gender and minority balance in the candidate list and the need for confidentiality. It should be underscored that names being considered by a search committee must remain confidential and that calls by search committee members to the candidates’ home institution that have not been approved by the search committee and institutional leaders is forbidden. While gathering intelligence about the performance of candidates is enormously important, it is essential that the process is well orchestrated and fair to candidates and the institutions involved. All information considered should be cross-validated and ethically correct behavior in seeking and using this information needs to be assured. To that regard, it is critical for the roles and responsibilities of the chair of the search committee and the selecting individual (e.g., dean, trustees) to be clear to all. This is true regardless of whether the search is conducted by an internal search committee, an external search firm or some hybrid between them. Clarity of process and expectations is preeminent along with a clear appreciation of the attributes and skills of the candidate being sought.

Assessing Potential Candidates – Generation of the Long List

Making the institutional profile, goals, challenges and opportunities of the department and the key attributes of the potential leader as clear and specific as possible will help enormously once the actual search process begins. This is particularly true as the search committee, executive search firm or institutional leaders reach out to colleagues and leaders in the field for potential names for consideration. The traditional process benefits from direct telephonic or personal discussion with trusted colleagues at different institutions about a potential candidate. This process is obviously enhanced when several consultant reviewers provide the same potential candidates, especially when the defining attributes being sought are clearly delineated and shared with reviewers in a consistent manner. As noted, it is important to describe as clearly as possible the type of leader being sought and evidence that such an individual has already performed in such a manner as to give confidence of future success. Depending on the size and complexity of the institution that will host the new leader, evidence of prior administrative leadership can be inferred from the nature of antecedent leadership positions. This should include evidence within the institution but also in national and international professional organizations and societies. Where possible, direct evidence of how the potential candidate has solved challenging issues is important. In contrast, given that academic medicine is also a small world and that most candidates have a history known to others, gathering data about how the candidate is seen by colleagues in her or his current institution, whether she or he is the go to person or someone that others would prefer not to interact with is invaluable.

It is relatively easy to assess individuals on research performance, positions held, etc., especially given the availability of so many public data bases, but it is much more important (albeit difficult) to assess the candidates’ emotional intelligence and personal strengths and limitations. Importantly, these can often define future success with one important caveat. Performance in one institution does not necessarily forecast success or failure in a new and different one. That is why assessing institutional culture is so important.

As the search committee gathers names of potential candidates (or solicits them through an executive search firm) it is often helpful to gather input from all search committee members on all proposed candidates based on the preliminary information that is gathered. This approach still lacks considerable needed detail but it can help to reduce a list of 50-100 names down to a shorter list of 10-20 that can then be subject to more detailed assessment from trusted advisors and institutional leaders.

Regarding the candidates to be considered in the search, the searching institution has a legitimate interest in handling only serious applications. While most candidates will only apply for a position if they are able and willing to take the position if offered, some may abuse the process in order to re-bargain their conditions at their home university. This should be considered a lack of integrity and should be avoided.

Assessing Candidates – Initial Visit of Top 10-12 Candidates

When the candidate list has been pared to the 10-12 who will be invited to campus for interviews (or who may participate in an antecedent “airport” interview) it is important for the search committee, selecting institutional leader, and candidates to fully understand the process that will be utilized. By the time of the actual visit, candidates should have received and reviewed the institutional portfolio and have reviewed the position description. Candidates should attend the interview with the goal of demonstrating why she or he is the best suited for the position – but also with the goal of determining what additional information is needed to make the process more conclusive and successful.

Usually, candidates will be asked to give a vision-based presentation to an interested audience in the hiring institution. While this is a good start into an evaluation process, interviews are a key feature of the internal assessment process and should be constructed in a manner that exposes the candidate to a wide number of individual perspectives and data sources while at the same time placing candidates in different settings and scenarios that allow the committee to see them and their skills as broadly and deeply as possible. To do so, it is important for candidates to be seen and evaluated in one-on-one meetings, in group sessions with the committee, in a bidirectional information conveying session with non-committee institutional constituencies, in settings that assess the candidates problem solving around administrative and human resources issues and challenges, and in social settings. Using a multifaceted approach to the interview process helps to provide a triangulation that can elucidate key aspects of the candidate’s leadership style as well as her or his professional and personal dimensions. Examples of different interviews that, when combined provide a more comprehensive assessment include:

Meetings with the chair of the search committee: The chair of the search committee often plays a critical role that transcends convening and coordinating the committee. Because the chair of the search committee is likely to be the first person to contact potential candidates, describe the opportunity and solicit interest, it is common for a bond to form between the search committee chair and the candidate(s). This affords an opportunity for the chair to get to know the candidate more deeply – through introductory meetings, resource gathering and the simple back and forth that takes place during the search process. In turn, candidates look to the search committee chair as a point of institutional contact and often someone who he or she is eager to share a panoply of views and perspectives that, when used properly, can help provide insights into how the candidate interacts with various individuals and reacts to new and sometimes stressful experiences. While it is important for the chair to sustain a confidential relationship with candidates, the insights gained from their interactions can shed light on skills that include communication, attention to detail, follow-though, etc.

Meeting with the selecting institutional leader: Although the point in the process when the candidate(s) will interact directly with the selecting institutional leader (e.g., trustee, president, dean, and vice chancellor) varies by institution and the nature of the search, this too can be a very important source for assessing a candidate. It is often ideal when such a meeting takes place during the initial visit of the candidate to campus as this helps forge a relationship that can be carried forth through the search process. It allows the selecting institutional leader to calibrate the comments and feedback about the candidate against her or his own evaluation. It also permits the institutional leader the opportunity to address specifically the challenges and issues she or he believes are pre-eminent and to evaluate the candidate’s response to them. This also helps candidates understand the expectations of the institution and the “chemistry” that is necessary to create a successful working relationship.

Individual meetings with members of the search committee members: Candidates often have a greater comfort level with 1:1 meetings and during a visit can become proficient in the information they share and exchange. At the same time, if the search committee is broad and diverse, individual members will be able to gather different insights and perspectives about each candidate. Sharing this information with the committee is important and this is best accomplished by having each interview respond to a set of key questions about candidate interviews but also allowing for individual and more subjective assessments to be gathered and shared.

Candidate presentation to the search committee as a whole: It is important to have the candidate appear before the search committee as a whole and to begin the meeting with her or his analysis of the opportunity and their vision and goals they are formulating to respond to the challenges. This is most effective when candidates have received information about the department and institutional challenges prior to their visit, as note above. It is not infrequent for some candidates to perform differently in a group meeting when they are asked to share a vision with a larger group and to respond to questions emanating from different perspectives. How a candidate handles a group interview session can be quite informative. While some advocate for “standard questions” to be addressed to each of the candidates, it is often more successful if these group interviews follow a more flexible and spontaneous format. They can shed considerable light on how a candidate might lead a group and respond to probing queries. Just as with individual interviews, committee members should be queried after the meeting to respond to objective and subjective questions about their evaluation of the candidate’s performance.

Scenario review with the search committee to evaluate leadership and emotional intelligence skills: Separate from the committee meeting that reviews the candidate’s vision and plans for the institution (or department), it is also helpful to have a meeting with the candidate and search committee members that engages the candidate in responding to different and challenging scenarios. Ideally these would be around problems the candidate face as a department chair, including conflict resolution, difficult human resource issues, financial challenges, and ethical issues. A set of scenarios relevant to the search  (and institution or department) should be constructed and these same scenarios should be presented to each candidate during their visit. Candidates should be advised in advance that the meeting will be assessing their response to a series of hypothetical but real life scenarios and that this is being done to help the committee understand how he or she would approach some of the complex issues faced as a department chair. Ideally these questions should be developed with a specialist in organizational or behavioral management. All of the candidates in a search would be give the same questions to respond during their visit. As with other encounters, committee members would be asked to provide their assessment about how the candidate performed in this meeting at the conclusion of the session.

Assessment of the candidate during social functions: Having group meetings around breakfast, lunch, dinner or other receptions is another important facet of the evaluation process. While these meetings are sometimes viewed as just a social event, they can provide another perspective on prospective candidates. Social settings such as group dinners allow committee members to witness other features of the candidate’s persona and to get a sense of how they will handle the many impromptus or planned social events that must be part of the chair’s repertoire. Assessing candidates in mixed company outside of the more familiar professional setting can provide additional clarity on the candidate’s communication skills as well as respectability and even integrity. As with other encounters, gathering feedback from the committee members who attend a social event is an important part of the search process.

Based on the individual and committee meetings and interviews with candidates, a comparative quantitative and qualitative assessment is feasible and, with additional deliberation by the search committee, should result in constructing the finalists who should ideally number 3-5 individuals. These should be assembled with all the supporting documents and conveyed to the selecting individual (e.g., chair of the trustees, president, dean) as an unranked list for the next phase of the search process. It is important that the list not be ranked so as to provide the selecting official some flexibility in determining who she or he believes is the best candidate for the position.

Assessing the Finalists – Generally 3-5 Candidates

Once the selecting official (e.g., trustees, dean, president or chancellor, CEO) has received the list of unranked finalists from the search committee, that individual should then assume responsibility for the rest of the search process. While the search committee can remain engaged, it is important that the candidates understand that the selecting official will be the lead person for the final phase of the search. This includes assessment of the candidate’s professional and academic stature as well has her or his leadership and management skills.

Return visit and detailed reference checking and vetting of the finalists by the selecting institutional leaders. Once the finalist list is assembled, the selecting official should contact the finalists and inform them that they are in the final group. Obviously this is the time to make sure that they wish to remain engaged, especially since the next phase will include reference checking among other things. The candidates should be informed that the selecting official will do the reference checking and candidates should be asked to provide a list of potential references. The institution should feel free to add others but when doing so should check the candidate to make sure that a call about their candidacy is permissible.  Having an institutional leader directly calling references provides an opportunity to probe more deeply about the candidate’s performance in the various dimensions and domains.

Presentation by the candidate at a town hall meeting, focusing on vision and goals. One way of getting broad institutional involvement and engagement is having finalists speak at a “town hall meeting” during a finalist visit to campus. This permits faculty and others to become engaged and offer an opinion about the final candidates. For example, the candidate can be instructed to provide a vision for the department presentation lasting around 15 minutes and then host a Q&A with faculty from the department for about 45 minutes. The selecting official can introduce the candidate and then observe the dynamics of the presentation and also how the candidate handles the Q&A. Following this town hall, attendees can be queried electronically about how the assess the candidate and thus provide another data source regarding the leadership skills of the finalists.

Reverse site visit. Depending on the search, a reverse site visit by the selecting institutional leader to the candidate’s home institution can also be a valuable source of data. A visit to the candidate’s home institution is an important signal to candidates about the importance of the search and the chair candidates. It also provides an opportunity for the selecting official to interview individuals in person who might offer additional insights about the candidate’s leadership and accomplishments. At a different level, simply observing how the candidate navigates her or his home turf and how the community responds to him or her can be enormously valuable.

Once all the data has been gathered and collated, the selecting official can ascertain which of the finalists should move to the next step of the process. In general it is best to move forward with this process expeditiously given the risk for losing one or more of the other short list candidates once a negotiation with one of the finalists has commenced.  Once the negotiation has been completed, it is important for the selecting official to notify directly all the other short list candidates so that they also believe that their engagement in the process has been valued and respected.

Positioning the Selected Candidate for Success

The success of a new leader begins with his or her selection but requires considerable ongoing support to optimize institutional leadership. A significant component of this involves developing a recruitment package that clearly delineates the resources that will be available to the new chair. Coupled with this are explicitly defining expectations and the metrics for assessing them. These need to be spelled out clearly and completely.

Newly appointed leaders also benefit from at least two additional resources. One is an institutional leader who can provide ongoing institutional knowledge and support. This is particularly helpful for individuals who are coming from outside the institution. Together with this institutional advisor, it is important to assign new chairs an executive coach who is skilled in leadership and organizational management. This is generally an individual from outside the institution who can provide ongoing critical feedback on everything from communication style, decision-making, conflict resolution, strategic planning, etc. An executive coach should be an expectation for new leaders and not reserved for individuals who encountering difficulties with the position.

Serving as a leader in an academic medical center is an extremely challenging position that requires a wide range of knowledge and skills. Few individuals possess all the skills necessary but their future success begins by identifying and appointing individuals whose abilities, background match the opportunities and needs of the institution at the time of appointment. These needs will change over time and the requisite skill set of a chair at any institution will also change over time.

Concluding remarks

There is no single formula for conducting a search that optimizes the selection for skills in leadership, organization and management. But there are many ways of gathering the data that enables the appointment of individuals who best fit the position and the opportunity. The menu of activities that can be used to accomplish this are delineated above and represent a starting point for an effective search. It is also hoped that this position paper will serve as a template for discussion and debate that fosters opportunities for critical research about how to optimize the chair selection process at academic medical centers.