FROM ADFM: KNOWLEDGE, ATTITUDES, AND SKILLS FOR FAMILY MEDICINE LEADERS: COMPETENCIES FOR SUCCESS

Jeff Borkan; Peter Catinella; Myra Muramoto

doi:10.1370/afm.2805

The ADFM Leader Development Committee undertook a major revision of its leadership competencies^1,2 with an expanded focus on the knowledge, attitudes, and skills needed to achieve success in the evolving health care and academic environment. Although there will be significant variations depending on personal needs, departmental or organizational needs, and local conditions as reflected in the current open chair position descriptions, we believe it is important for every new (and established) leader to pay attention to leadership, administration/management, professional and personal development, as well as scholarship and academic engagement. These changes also mean the competencies are now also more broadly applicable to other senior leadership positions beyond that of the chair role.

These competencies may be attained individually by a leader or along with their leadership team. They are intended to be used for self-evaluation, professional and personal development, and to help in role and team growth, rather than for external evaluation. These are leadership competencies in a generic sense; leaders will need to be aware of the context in which these skills need to be called upon (within your department, institution, community, etc). Since leadership and managerial competence is as much a journey as a destination, these competencies are also intended to be a stimulus for lifelong learning and professional development in the art and science of leadership.

1. Leadership

Be aware of your leadership style(s) and have the ability to use different types of leadership styles when needed
Create, sustain, and periodically reassess mission, vision, and values
Assess, understand, monitor, and shape departmental structure, culture, and context
Utilize iterative tools for strategic planning
Select and utilize frameworks for leading and managing change, including system change
Lead and manage different crises before, during, and after they arise
Understand, embrace, and promote diversity, equity, and inclusion
Develop and manage internal relationships:
1. Build, develop, and sustain a leadership team
  1. Identify the capabilities of your leadership team members and develop a plan to promote growth and development
  2. Determine missing or weak capabilities as well as strengths among your team and develop strategies to address and maximize team effectiveness
2. Respect and support all faculty and promote their development. Recognize that there are likely faculty with more experience and success than you. Accessing and utilizing their abilities can accelerate department growth and success.
3. Develop and advance other leaders within your department
Develop and manage external relationships:
1. Understand overlapping and different needs of medical school and hospital/health systems and where the department fits in institutional culture(s)
2. Analyze, understand, and effectively utilize different types of power and political dynamics within your setting
3. Develop and foster awareness of the larger landscape of the health care industry and health policy
4. Network with others in your institution
5. Partner/negotiate with other departments/units for mutual gain
6. Communicate the value of the department to the institution, and the institution to the department
7. Maintain credibility and understanding regarding teaching, patient care, scholarly work, grants, and grant funding
8. Lead and manage departmental image in the institution
9. Manage your relationship with your Dean/President/CEO
10. Identify and manage relationships (personalities, cultures, etc) with other external individuals and entities, including:
  1. Payers—insurers, employers, government
  2. Teaching partners—eg, preceptors, FQHCs, other external organizations
  3. Partners in patient care—community agencies, nursing homes, affiliated practice groups
  4. Research sponsors
  5. Other department chairs/unit leaders at your institution
  6. Health systems leaders
  7. Pillars of community engagement (above and beyond patient care)

2. Administration/Management

Understand departmental finances, including:
1. Sources of income
2. Matching revenues and expenditures
3. Budget development
4. Budget growth and budget cuts
Understand human resources issues, including:
1. Federal/state employment law
2. Local institutional policies
3. Leadership structure for faculty/staff
4. Assessment of departmental resources
5. Talent development and management, including:
  1. Position development, recruitment, hiring
  2. Matching talent with departmental needs
  3. Matching effort with resources
  4. Mentoring, coaching, and sponsoring talent
  5. Performance evaluation and management
  6. Promotion and career development
  7. Talent retention
Build endowments and philanthropy
Plan for succession in all leadership positions
Manage departmental communications
Negotiate effectively across the departmental and organizational spectrum
Facilitate difficult conversations and manage conflicts
Foster wellness and resiliency

3. Professional and Personal Development

Sustain ongoing awareness and evolution of one’s leadership knowledge, attitudes, skills and style(s)
1. Adhere to lifelong learning^*
2. Cultivate self-awareness and reflection; know your strengths, weaknesses, values, and personal boundaries
3. Seek out coaching and mentoring to promote continued growth and development
4. Acquire and utilize advocacy skills
5. Develop and expand effective interpersonal communication skills
6. Expand your sources of information and learning to be more broadly aware of the issues and trends in the health care industry as well as leadership practice
Manage your time, calendar, communications, administrative support
Develop an awareness of unconscious bias and how to mitigate it within your work
Continually reassess and rebalance your departmental chair roles, priorities, and relationships as part of managing in a complex adaptive system with changing goals and communications
Evaluate and choose external leadership roles, when appropriate
Develop resiliency and self-care routines
Define and develop your role within the practice plan/clinical system
Develop relationships with family medicine organizations locally and nationally
Manage transitions in leadership and roles
Be open to changes that require new or reinforced knowledge, attitudes, and skills

4. Scholarship and Academic Engagement

Leadership position often require academic skills including:
1. Understanding ACGME, LCME/COCA and other acreditation requirements as they relate to your area(s) of oversight
2. Developing and nurturing collaborative relationships with the academic leadership and peer leaders in other disciplines
3. Actively managing and developing your own scholarly activity with output (publications, lectures, committee work) as a model for others in your Department
4. Developing and enhancing grant-writing skills leading to extramural and founding funding
5. Ensuring academic achievement on track to meet minimal qualifications for the role

ADFM offers opportunities for members and other leaders to grow in these competency areas and encourages those who are interested in senior leadership roles to learn more about our Leadership Education for Academic Development and Success (LEADS) fellowship (https://adfm.org/programs/leads-fellowship/), whose curriculum is structured around these areas.

Footnotes

↵* Additional material related to lifelong learning suggested by ADFM membership (specifically the ADFM Leadership Resources and Executive Coaching lists)

References

1.↵
1. Davis A,
2. Zweig S,
3. Franko J,
4. Weidner A.
Evolving competencies for chairs of departments of family medicine. Ann Fam Med. 2015; 13(3): 284–285. doi:10.1370/afm.1794
OpenUrl FREE Full Text
2.↵
1. Mallon WT,
2. Grigsby RK
Association of Departments of Family Medicine: competencies for family medicine department chairs. In: Mallon WT, Grigsby RK, eds. Leading: Top Skills, Attributes and Behaviors Critical to Success. Association of American Medical Colleges; 2016: Appendix E.