Chairs and Their Faculty: Reducing “Top” Stress; Enhancing “Middle” Leadership

Thestatement “if youhaveseenonemedicalschool,you have seen one medical school,” applies to Departments of Pediatrics as well. They vary in myriad ways, including size, priorities, and resources. The principles of organizational psychology provide a frameworkfor understanding an organization in order to improve functioning. One framework that many in academic medicine have found helpful (eg, has been taught in the Executive Leadership for Academic Medicine program) is the systems work by Oshry et al. 1-5 This framework focuses on the predictable behaviors of individuals based on their position (top, middle, bottom) within the organization. Tops are those who have overall responsibility for shaping the system, bottoms are “doing the work” with little control over resources, and middles are caught in “the middle” between these groups. Typical behavior is for tops to “suck up” responsibility and feel burdened, for middles to become alienated and competitive, and for bottoms to blame others. Chairs are clearly “shapers,” and they also are middles caught between the dean (and hospital Chief Executive Officer) and their faculty, and sometimes feel it is challenging to negotiate for adequate resources. Within their leadership positions, faculty may feel like middles— feeling torn between groups. At other times, faculty may feel like bottoms, having little sense that they can control their work world. It does not have to be this way. As Oshry notes, tops can create responsibility in others and bottoms can take responsibility. Middles can integrate (ie, share information, solve common problems, and support one another) rather than remain alienated and torn between tops and bottoms. Within our faculty development program, we sought to support the Chair to create responsibility, encourage bottom responsibility, and foster middle integration by creating meetings with the Chair and the faculty development leader. We have conducted versions of these gatherings at two dramatically different institutions, University of Texas Medical Branch (UTMB) and Columbia University. We have now held over 35 meetings of various groups across the two institutions. We have conducted evaluations of individual sessions and tracked outcomes. For purposes of this report, we will focus on lessons learned about program structure and examples of outcomes.