EP55 HOOK VIDEO
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[00:00:00] Hello, and welcome back to the Academic Medicine Strategy Podcast. Today, we are gonna be talking about divisional leadership change. And the reason for that is I had this amazing opportunity to work with a group who was doing all the hard work around how you deal with transitions. And we're gonna talk a little bit about a structured framework for sustainable change.
Now, the reason I'm gonna talk about this is this group was rightly confronted with a leader who was leaving with fairly short notice and in very real-time. Literally the day it was announced, the informal leaders in that group and some of the formal leaders leaned in and said, "What do we need in order to move forward?"
And that's a beautiful way to address what is a lot of instability in real-time. And they reached out and they said, "We need somebody external to help us through this transition," and that's how they ended up coming to me. And understanding what does this [00:01:00] transition mean? It is not just a change in personnel, although obviously that's a huge issue.
Oftentimes, when there's somebody who's been your leader and your friend and your colleague, it's really important because there are fantastic opportunities on, the flip side of how things change, but also some normal grieving and sadness and, anxiety around what's gonna be a new situation and new stability.
So there's some critical inflection points where you can either consolidate your identity and your mission as a division or as a department, or you end up being in a more reactive mode that allows you to drift and really causes more instability. And so the first 90 days of a new leadership set the trajectory for that culture.
They help you figure out the priorities. It's really critical for retention. This is an easy time for you to lose faculty and really can have implications for the next three to five years. So without some intentional work upfront, you are more than likely going to lose some people And so most [00:02:00] divisions celebrate the outgoing leader, and that is healthy.
It helps pull people together. It shows them where their common purpose was. But when they announce the incoming one, sometimes there's instability, and especially if there's a long period between when one leaves and one comes. But no matter which set of that stage you're in, there is a long neutral zone in between of the endings and the new beginnings that oftentimes people try and skip over, and it is not useful, not healthy.
In fact, one of the best things is to lean into that period and see what you can do with it. And what you wanna be able to do is figure out, what do we actually believe? Where are we headed, or do we want to be headed? And who are our real partners? And the cost of that ambiguity is high. So faculty uncertainty, especially about the values and the direction, really correlates directly with early career attrition and disengagement, and that disengagement frequently turns into a desire to leave.
And I can tell you in the division I was working with, we did some [00:03:00] pre-survey work to try and understand where people were and where the pain points were and there were several people who were looking already at some outside ins- opportunities, and then a large group of people in the middle who said they were neutral, which really means they hadn't said, "Yes, I'm committed to staying."
They said, "I would consider looking." And that is a huge issue when more than half of the people in your division or your department are saying, "Gosh, this might be something I'm gonna consider walking out the door during because I don't know what's coming next. I'm not sure if I fit. I'm not sure if it reflects my values.
I don't know if I wanna spend my time here." And so it brought me to a conversation I had with them Which is about a model of change or transition by William Bridges and Susan Bridges, and it's about three phases and one critical gap. And it's to distinguish between the change or what happened externally, "Hey, we're getting a new division director," and the transition, which is both an internal psychological and organizational process.
And so the [00:04:00] three phases that I talked about, and what I want everybody to understand is like the very most normal thing in this is uncertainty. You're supposed to feel that way. It is normal. If you're thinking, "I'm not sure if this is right, I'm not sure if I belong," normal. All of that is right. So there's an ending or a letting go stage, and that is when the old leader departs, and that old structure is acknowledged and celebrated oftentimes.
And there's gonna be honestly people who are sad that it's ending and some people who are happy, some people who weren't feeling like they fit into the old regime or with the old leader. And so it's also understandable to understand that there's a dichotomy of emotions, and some people will feel both at the same time.
"Hey, I see the positives, but I also see the negatives." And so once that phase is visible and ritualized, celebrations, farewell, there's this period called the neutral zone. And it's after that ending, but before there's really a big new vision. You don't know what's coming next. There's a lot of uncertainty.
People don't understand the expectations. They may not understand [00:05:00] the values of the group anymore or the new leadership, and priorities are definitely uncertain, especially as that all just churns, and it's uncomfortable and destabilizing. People do not like sitting in this. It is hard to say, "I don't know what's coming next, and I just have to sit here and wait in this discomfort until it's learned what's next."
And so these new beginnings that happen oftentimes get forced, and I don't mean this in a bad way necessarily. It's great if you can make quick decisions. We can find the right next new leader. But oftentimes a new leader will walk in articulating a vision that's probably been vetted with senior leadership and the people that hired them.
But while they have met, might have spent a lot of time thinking about this vision and this next step, the people who have been waiting in that division or that department waiting for the next step aren't on board yet. This is brand-new information. They haven't had time to assimilate it. They haven't had time to assess it, and they're not gonna jump right in.
As much as a leader we're like, "I've spent all this time, I've figured it out, I'm gonna let everybody know," oh, why isn't everybody on [00:06:00] board? They're not on board because it's brand new to them. They haven't had time to process it, and quite honestly, you may not have thought of everything that they're gonna think of about how it impacts their day-to-day life or their future.
And so oftentimes this new leader will articulate a direction, values, and a vision, and the faculty understand what's expected, and they may feel aligned, but some may not feel aligned. And what's important here is they also may not feel like they've had an opportunity to give input.
And so What often happens, and I'm not recommending this, is that we experience this neutral zone passively and we lose people during it because we are not actively engaging them in the process. We're telling them, "Here's what's happening. Here's what's coming. I hope you're on board." And that old leadership voice is gone for good or for bad, but the new leadership voice Oftentimes it's not either been defined or it doesn't have the credibility that it needs to have.
And so faculty begin to operate from assumptions, there's rumors, there's all kinds of talking. There's a lot of segmenting of small groups instead of people talking as a whole or [00:07:00] having a single vision. And so without some express facilitation, oftentimes externally to bring everybody together, that neutral zone stretches out.
And clarity doesn't happen organically. It requires that structured, facilitated work. Oftentimes it includes a full faculty voice. Those who are happy, those who are unhappy, those who are all in on the new vision, those who aren't quite sure, those who hated the old regime, those who loved the old regime.
And you need all of that, not just the leadership voices, in order for everybody to move forward. And the longer that neutral zone persists, the more faculty assume that the values don't align with their values, that the division's moving in a place that maybe isn't their direction, and that early career faculty especially are vulnerable to exiting during this period.
Now, what does intentional transition work look like? And this is what I'm gonna say. I had the opportunity to work with a group at Cedars-Sinai, and they did a beautiful job of saying, " We are gonna have that ritual. We're gonna celebrate what's ending and our leadership and our [00:08:00] accomplishments and our group and our clarity."
And they had a beautiful sense of family and community. And it is that ending phrase, they did a really nice job and gave permission for change. And then what happened next is they said, "What do we need? What can we do? How can we come together?" And we did a values clarification exercise with the full department.
We looked at something that had been created about nine years ago by a smaller subset of the faculty, some of whom were there, but some of whom were not. And we convened the faculty and the mid-level providers and got some of the input from some of the other folks as they talked to their outside audiology folks and some other people, and they didn't decide the values from scratch.
But what we did do is say, "What does everybody believe?" And we took everybody's opinion. We looked at it together. We understood where it all came from. It literally was on the board. And then we aligned and surfaced a whole bunch of different beliefs and values, and that is how we move from this is what the new leader wants to this is what we [00:09:00] collectively want.
And it was powerful. People all congealed around five or six themes. And sure, were there are a couple things here and there where people were like, "I really feel this is important," and it didn't make it to the communal values exercise. But people heard the conversation and were like, "How can we fold this in somewhere else?"
And then you go from there to some stakeholder mapping, looking at some internal partners, look at some external collaborators. That's part that they're still working on. But then we've drafted a vision and a mission statement, and this isn't the final, but it is a starting place to say, "Here's our values."
What's our vision and mission? What do we believe we need to be about? And what's our vision? Where are we going with this? What is it gonna look like? And so we articulated where the division what they were about, what do we care about, how do we integrate that together? And it was different than the communal cause that they'd had several years ago because they've changed.
They've added a residency. They've done some really big things since that time. And then where are we going? How do we decide where our yeses and no's are for this group, so that we know [00:10:00] how we're gonna get to where we wanna go? And then some explicit role clarity. How do these individual roles connect to the division's mission?
What closes that gap between I know what we're doing and I know how I fit into it, and that is the work that's happening now. And that's what's exciting about it, is they're being extremely intentional. And why that external facilitation matters is there's some neutrality. There's no stake in the game.
They don't understand or necessarily need to be living in those political outcomes. They can really look at here's what matters is the vision, here's what matters in the values, how do we pull all that together? And faculty and partners and mental providers could speak more openly. We also had components that allowed you to give anonymous feedback.
We had, the QR code where you can throw things in the parking lot, you can answer the survey anonymously. But there was a pre-work where everybody answered things anonymously. And the new leader, isn't there to defend themselves, they're there to learn, but they're learning in this alongside everybody else, and you give permission to service tensions.
In addition, you give permission [00:11:00] for everybody to understand that differences in opinion was what we were looking for. We wanna hear the whole spectrum. We wanna understand the different views. Were you happy with where we were? Were you not happy with where we are? Do we all think we're going the same direction?
If we do, great, but if not, let's figure out where all those pieces fit, so nobody feels like they've been disenfranchised from the start. And are we still a more clinical place? Are we looking more at academic work? How do we honor our history and move forward at the same time? And then there's a structured process.
So leadership often tries to do this work informally, and many of them are very good at it. Sometimes there's great institutional resources to do it, but many places there's not. And so it's an opportunity to produce some formal outcomes so that not single or a couple voices dominate and others stay silent.
It actually brings all of that to the surface, and that structured facilitation allows full participation and documented clarity as we kept track of all of it. And then hopefully what it does is it compresses that neutral zone, so that clarity emerges in a much more timely manner [00:12:00] instead of waiting for the months or years that can sometimes happen without facilitation.
And you allow that intentional work to collapse those months of ambiguity into a shorter timeframe. So this reduces the window where people are most vulnerable to leaving Now, there is evidence for this transition design. If you look at the work by William and Susan Bridges they've got a great book which I have sitting around here but is not in front of me right now about making the most of change, managing transitions.
And this seminal work talked about the distinction between a change, which is an external event, and transition, which is the internal psychological and organizational process. And I love that differentiation of understanding there's a change that happens. I probably was not the one that made it happen, but the transition to going to the new system, to the new process is something I do have an input in, and I get to decide if I'm part of it and how I can be part of it.
And that framework shows that managing that psychological and cultural dimensions of the change is as critical as managing the structural change. [00:13:00] There's also things like humble inquiry. We're talking about shifting the dialogue and being much better listeners and not a top-down version, as well as building a values-driven organization.
I'm not gonna get into all of it, but there is really great literature out there if you're interested. Happy to send you references. Please let me know. But what we do know in the academic medicine context is that early career faculty attrition runs forty-six percent at the four-year and half year mark without a transition in leadership.
So that misalignment of values and direction accounts for a significant part of that voluntary departures. So preventing that misalignment is critical, and truncating that timeline with external facilitation can really help do that. So what does this mean for your division? If you are in the middle of a transition, it might be a huge issue, and it's really important to know that the cost of losing one faculty member is estimated to be one and a half to two times their salary, which is a huge amount of loss.
And that does not even necessarily include all the [00:14:00] lost productivity and the decrease in morale that results when people leave. In addition, intentional work during the first ninety days of new leadership in terms of infrastructure work has been shown to improve that and reduce the amount of attrition.
And that's particularly urgent if your division has grown or changed mission or focus, or has brought in some new things like a new residency program or a new scholarship or a new research focus. So for faculty in transitioning divisions, if your division's in transition and you have the opportunity to shape what comes next, structured facilitation can be really useful.
Values clarification is really critical, making sure everybody in the room has an opportunity to feel like they have a voice, which again, is easier if you have some neutral parties helping you with this. These may be in your leadership office or they may be external facilitation like we do for my group.
But the faster that happens, the faster you plan your own career with confidence. And then consider advocating with your leadership for external facilitation if transition feels [00:15:00] ambiguous because it's a sign that your neutral zone may need more structure Now, if we can help you at all, we do have a faculty excellence and retention initiative, which you can find at our website at www.amedsg.com.
That's Academic Medicine Strategy Group, or amedsg.com. Otherwise, if this was useful for you, please share this with your colleagues, with other chairs and deans and department chairs and faculty who are going through transitions because that is the fact of life these days. And if there's anything we can do to help you, please raise out.
Otherwise, share this with people who will learn, and feel free to join our newsletter because we would love to hear from you. In the meantime, I look forward to talking to you next week. Thank you so much and for joining us with the Academic Medicine Strategy Group
