Reflections on Leadership in Academic General Pediatrics: Some “First” Impressions Lewis R. First, M.D. University of Vermont College of Medicine Vermont Children’s Hospital February 28, 2007

Objectives: L—earn what leadership in academic general pediatrics is and is not E—valuate what attributes are needed and what are not A—cquire some principles and practices to enable you to lead D—o it!

L—earn What Leadership Is… Can the Internet help? Multiple search engines used to determine what is out there on leadership in pediatrics (which we need to understand before we apply what is out there to academic general pediatrics) Results follow…

Top 10 List of Internet Sites Devoted to Leadership in Pediatrics

Site 10:Nurse Practitioners ( PNPs

Site 9:Dentists (

Site 8:Critical Care Nurses (

Site 7: Pediatric Surgery (surgery.osu.edu)

Site 6: Occupational Therapy (

Site 5:Geriatric?/Pediatric RNs (

Site 4: EMS (

Site 3: Psychology (

Site 2: Research (

Site 1: Parents! (

Leadership by Academic General Pediatricians: What It Is-- Leadership is hard… to find on the internet for pediatricians, let alone academic general pediatricians and perhaps that implies it is hard in general to change into a leader in academic general pediatrics. We’ll have to see…

Becoming a Leader is a Hard Change to Make…An Example Cross your arms as you would to take a defiant stand Do you like this type of leadership style? Would you like to change it?

Now cross your arms but reverse the position of each so that the one that is on top becomes the one that is on the bottom and vice versa. How did it go? Easy? Hard? Fast? Slow? Comfortable? Uncomfortable?

What Becoming a Leader Is… Something that is not easily accepted by you, let alone others Something you cannot easily change into so you are more comfortable being a leader Another survey follows…

Top 10 List of Why I Cannot Become a Leader in Pediatrics: The Academic General Pediatric Perspective

10. I have no time to lead.

9. I have no training to know how to lead.

8. I have no time and no training.

7. I was never any good at even playing follow the leader let alone being one!

6. I can barely supervise my office staff let alone anyone else.

5. I was never a leader in med school, residency, or even fellowship—that’s for someone else to do.

4. Every leader I know goes to jail.

3. You need to subspecialize to lead in pediatrics and I do general pediatrics.

2. Academic general pediatrics never seems to win the battle for academic resources no matter who leads us into battle.

1. Give me 10 ways to lead as an academic general pediatrician and I’m willing to give them a try.

E—valuate What Is Needed True or False: With the appropriate resources, leadership can happen.

Personal Anecdote #1: The Parental Makeover

Personal Anecdote #1 Conclusion: Resources alone cannot make a successful leader.

So What Is Needed? True or False: If you martyr yourself— you’ll become a great leader.

Personal Anecdote #2: The IV Story

Personal Anecdote #2: Conclusion Martyring yourself will not make you a leader.

So What Is Needed? True or False: Looking the part makes you a leader.

Personal Anecdote #3 The Biker Rally

The Bottom Line: Resources, martyring, and “stylish” clothing are not what is needed to make you a leader!

A—cquire Some Principles To Make It Happen: The A-B-C’s of Leadership Made Simple (adapted from Kouzes and Posner’s The Leadership Challenge: How to Get Extraordinary Things Done in Organizations)

“Model the Process” A—stablish your credibility and visibility by being yourself— not someone you think others want you to be!

Examples What has not changed since I became a academic general pediatric department chair— My tie collection My sense of humor (may have gotten me my job) My passion for taking care of children and families on a national, regional, and individualized basis

Bottom Line for This Step If you are in a position where you cannot be yourself and cannot role- model the values inside of you that you believe are important and worth sharing with others—you may want to rethink whether you should be in that position!

“Inspire a Shared Vision” B—sure you communicate often and well with your team if you want them to be and stay on “your bus”!

“Who’s On Your Bus?” (with thanks to Jim Collins) People who already fit with your core values when you hire them People who do not need to be tightly managed People who understand they do not have a “job” but do have responsibilities People who 100% of the time will do what they say will do. People who are passionate about their cause!

“Who’s On Your Bus?”(con’t) (with thanks to Jim Collins) People who demonstrate the “mirror and window” effect—they will give credit to others for good things (look outward) and take credit for things that go wrong (in the mirror)

Note About Mission, Vision, and Values as a Division Chief If you find your mission, vision, and values differ from those of the leadership you report to, hopefully you have discovered this before accepting the position since alignment with the overall organizational mission is critical. If there are differences between you and your chair, dean, etc., and you need to reeducate such people about the import of what you are trying to do—use the tools at this conference to get you and your bus back on the road.

Communication Tool #1: The Importance of “Day One” Critical for Imparting Your Division’s Mission, Vision, and Values Critical for Setting Up Your Operating Systems and Implementing Change

Communication Tool #2: The Humility Factor Tell stories that point out strengths of others and weaknesses that say you are human– Personal anecdote #4 --the salt-water nose drops story

Communication Tool #3: The Media Factor Importance of working with the media— a great way to share vision and earn the community’s buy-in such that your community wants to become a part of your “team”

“Challenge the Process” C—that it is ok to take some risks to get to where you want to be or want to see happen as a leader.

“Encourage the Heart” D—fine your leadership culture with passion and creativity for achieving your goals and with caring and compassion for those on your team!

“Enable Others to Act” E—valuate your effectiveness and see if you or your division have “tipped” and are on the road going from “good to great”

Ways to Do This: Measure outcomes relative to your mission, vision, goals, etc Have a “to do” but also a “not to do” list to maintain your focus Will others tell your “stories” and in so doing recognize the role you play as a leader/player- coach they respect in a division they respect? The golf analogy for evaluating your leadership effectiveness: Long game versus short game Develop a sustainability plan in your faculty so they can carry the ball forward even if you are not calling the play

F—you think you can’t be a leader with these simple steps— think again!

The A-B-C’s of Leadership: A—stablish credibility with visibility B—sure you communicate often C—that risk-taking is acceptable D—fine a culture that allows passion, creativity, caring, and compassion E—valuate your effectiveness

Kouzes and Posner’s ABCs A.Model the process B.Inspire a shared vision C.Challenge the process D.Encourage the heart E.Enable others to act

D—o It! Do it nationally! Do it for your community! Do it for your institutions! Do it for your training programs! Do it for your patients! Just do it!

Objectives: L—earn what leadership is and is not E—valuate what attributes are needed and what are not A—cquire principles and practices starting in residency and continuing onward to enable you to lead D—o it!

Summary: L—earning to lead the way as a academic general pediatrician to E—mpower others to A—dvance clinical care, research, education and advocacy for children, D—efines a healthier future for our generation and those to follow!