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an online version of the magazine Spring/Summer 2007

Heads with Many Hats

For today’s departmental leaders, the needed skill set is daunting.


By Dean/CEO Edward D. Miller, M.D.

asking for money... with reluctance

Through a convergence of circumstances, I’ve had the opportunity in my 11 years in this job to select almost every department and institute director at Johns Hopkins Medicine.

The qualities I look for in these key institutional leaders have shifted dramatically during that time due to the whirlwind of change in health care and academic medicine. What skills will future department directors need to keep Hopkins on an upward trajectory? Here’s my take.

The No. 1 requisite is outstanding “people skills.”

We used to pick department directors because of their preeminence as scientists. That’s no longer the main driver. Yes, our directors still must be tops in their fields but increasingly what’s paramount is the ability to deal effectively with others inside and outside Hopkins.

Departments can’t remain isolation booths of scientific inquiry. Interdependence is what counts—shared resources and working across departments, schools, or even universities. We’ve found it takes a broad array of medical insights and technologies to attack complex diseases.

Financial management skills are increasingly important.

Department directors must become masters of budgeting to achieve their goals.

There was a time when a department leader could simply request $1 million by saying, “I need new equipment.” It doesn’t work that way anymore. For basic science the questions are more along the lines of: How will this instrument or core resource leverage your strategic vision for the department?

This is how I look at it: Smart directors get the most out of their budget allocations because they know that wasting finite resources penalizes everyone in the department.

Leaders of departments must get the most out of their faculty.

How do you coax or encourage an increasingly diverse group of researchers, educators, and clinicians to work as a team? That’s the challenge.

Good directors have a knack for molding their faculty into a united group focused on bettering the department and leaving their egos, hopefully, at the door. Interaction with your faculty is essential. Becoming a good listener is important. So is sharing responsibility. The days of the department directors as a benevolent dictator who makes all decisions are gone.

Successful chairs delegate responsibility, use colleagues as sounding boards, and expect trusted faculty to work through a problem before it reaches their desk. They establish clear lines of authority. They seek solutions, not scapegoats.

Directors must be accountable for faculty performance.

This means making tough decisions. Unproductive faculty members hold back the rest of a department’s achievers.

The best Hopkins chairs regularly evaluate their faculty. When I ran Anesthesiology, I had each faculty member fill out a one-page self-evaluation sheet. Then we’d talk about it and I’d give some constructive criticism. After a while it became clear who wasn’t progressing. Difficult as it was, I took action.

Today, I do this sort of self-evaluation with my vice deans and direct reports. It keeps everyone on their toes and fully informed about what’s required of them.

Future Hopkins leaders must be exceptionally nimble.

They’ll have to find new revenue sources and squeeze the most out of every dollar because the news from Washington isn’t good.

We’re again faced this year with flat funding from the National Institutes of Health. Essentially, we’re being asked to do more with less. Meanwhile Medicare and Medicaid reimbursements are under attack. Private insurers continue squeezing provider payments. This will test our directors’ financial and management acumen.

Creative solutions will be needed. Directors must “sell” the vast potential of medical breakthroughs to foundations and philanthropists. They must accelerate technology transfer. They must find national and international markets for Hopkins programs and management expertise. They must explore alternative avenues of government funding—from the state, from homeland security grants, and from military research.

Hopkins leaders must be open to new ways of running their departments.

In a few years, many of our patients may never set foot in Hopkins Hospital. We’re decentralizing the delivery of health care at ancillary sites like White Marsh and Green Spring Station. Department directors must leverage these promising opportunities to expand clinical care, research, and education. Those who don’t keep an open mind will be left behind.

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 Learning Curve
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© The Johns Hopkins University 2008