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SharethisWhat qualities and skill sets should we look for when choosing leaders in cardiothoracic surgery? A review of recent US job postings in our field finds the following. “The successful applicant will be accomplished in the area of…” or “The ideal candidate will have a strong background with an interest in…” This is usually followed by a listing of every possible area of cardiac surgery. A background in research also appears to be a favorite, “The candidate must have an established research record and demonstrated ability to contribute to designing research studies.” Unfortunately, few job postings ever mention requirements for team building capabilities, mentoring, organizing ability or strategy creation, which are a few of the attributes of a good leader. Furthermore, bearing in mind that even a small department will have finances that run into the millions of dollars, I am yet to find one that lists an understanding of financial metrics as a requirement.
So what are the prerequisites for a leader in our field? We argue that the skills needed today are very different from those in the past; particularly in light of the financial pressures that many hospitals currently face. The skills sets required can be broadly categorized into “hard” skills that are learnt through training and courses, and “soft” skills that in part can be learnt and in part are inherent in all of us.
Clinical excellence as the basis for expert power is clearly first and foremost on the “hard” skill set list. However, in our opinion, the other key skills needed today include an understanding of the fundamentals of strategy, marketing, operations management and importantly finance. One may question why we have listed these last four areas. We counter with the recommendation that clinical departments today need to act as separate business units, the same way they would if they were part of a larger non-medical company. Therefore, they must think beyond the usual provision of clinical care, teaching and undertaking research. They must have a deep understanding of their core competencies, actual and potential customers and the potential threats to them. These are key elements that once understood can lead to creation of a great strategy. Knowledge of marketing, operations management and finance provide the tools that not only help in formulation of the strategy but also its proper implementation and follow-up. At our own institution, we used basic principles of operations management to achieve significant cost savings by having our surgeons agree to standardize the equipment used across all cardiac cases. In addition to cost savings, there were efficiencies achieved in our supply chain by having less stock keeping units to re-order, keep track of and find storage space for.
Should we attach importance to research standing when choosing leaders in our field today? The rationale is understandable: clinicians with outstanding research backgrounds should be able to attract government and/or corporate funding and perhaps elevate the academic standing of the institution. Although, in no way do we minimize the significance of medical research, we submit that in today’s competitive healthcare market, formal business skill should be foremost sought after as a quality in leadership candidates.
There are many other attributes that make up a good leader which could be categorized as soft-skills. Although clearly not exhaustive, we attach importance to the following: integrity, vision, communication skills, relationship and team building, adaptability, mentoring, and decisiveness. It is these soft-skills that ultimately facilitate translation of the hard-skill set into practice. For a lucky few these attributes come naturally, but for most of us they can be learned—it is now well accepted that few good leaders are born and that most are made.
The business world has long realized the importance of growing leaders from within and leadership succession. Companies which follow this strategy tend to have greater stability and better long-term financial returns1. It appears that modern medicine has fallen behind in this regard. It is therefore essential that future leaders in cardiothoracic surgery be appropriately selected and groomed, i.e. be taught the necessary business skills that will enable them to navigate their departments in a direction that is mutually beneficial for them and the institution as a whole. Today, many universities around the world offer excellent executive education courses that can be taken either part-time or over the course of a few days or weeks. Participation in these courses should be encouraged for both current and potential future leaders in our specialty. However, along with this, supporting mechanisms such as allowing time for course participation, partial or full fee reimbursement and professional recognition for advancement also need to be in place. Certain districts within the United Kingdom’s National Health Service have recognized this need and now provide leadership 101 type courses for consultants.
Cardiothoracic surgeons have generally tended to be recognized as leaders within the field of medicine. With the ever changing complexities of modern healthcare delivery we should capitalize on this fact by appropriately grooming future leaders. This will not only serve to further our own specialty and medicine in general, but will also serve as a model to other specialties.
