SAVANNAH, Ga.—Chairs of surgery play a critical role in the success of any academic institution, and their responsibilities have shifted and changed over time, reflecting the larger changes in the culture of surgery and medicine as a whole. What sort of challenges do today’s new chairs face, and how do they deal with them in ways that will help not only their department, but the entire institution, thrive?
At the 2023 Southeastern Surgical Congress, Caprice C. Greenberg, MD, MPH, the chair of the Department of Surgery at the University of North Carolina at Chapel Hill, and Valentine Nfonsam, MD, MS, the chair of surgery at Louisiana State University, in New Orleans, fielded questions posed by Don Nakayama, MD, the senior associate dean at Mercer University School of Medicine, in Columbus, Ga., and William Richards, MD, the chair of surgery at the University of South Alabama College of Medicine, in Mobile.
Dr. Nakayama: We all agree that it’s important to establish a culture that’s collegial yet productive. How did you go about achieving that?
Dr. Greenberg: I think culture is the most important thing to think about when you’re taking on a new role as a leader. It’s important to understand the history of the organization that you’re joining, and to make sure the values are honored and continued. But you also want to align your own values with the culture that you’re trying to promote. You want to be sure the organization you’re joining prioritizes the same things that you do.
Dr. Nfonsam: Recognizing the culture of any institution is very important, especially if you are an outsider trying to implement change. An institution’s culture is formed by a series of events in the past. You need to understand why things are the way they are and make incremental changes, while clearly articulating your vision. Making change is much easier if you have allies because if there is a significant amount of resistance, no matter how good the intentions, making change will be challenging. Having said that, accepting an uninspiring status quo just to keep everyone happy is not helpful for anyone.
Dr. Richards: Every department has its problems. How did you go about identifying problems and prioritizing solutions to those problems?
Dr. Nfonsam: [When I started as chair at LSU] I met with every faculty member and all the stakeholders to identify what they perceive as the problems and bottlenecks. I also asked everyone what they think is working well for the department. Those conversations gave me an insight into the main problems facing the department. I categorized the problems into two: those I have some control over and those I had no control over, then prioritized and focused more on the problems I have control over. I spend my time looking for solutions to the things I can change and try to move that process forward.
Dr. Greenberg: I agree. The most important thing you can do in the first six months is listen. Try to get as many perspectives as you can because those problems arose from a history you weren’t there to witness. I inherited a couple of burning platforms that I needed to make changes to quickly after I arrived. I do think you need to have a couple of quick wins as a new chair, problems that everybody identifies that you can move the needle on.
Dr. Nakayama: Every department has its problem people as well. Which type of people are the most difficult to manage, how did you identify them and how did you manage working with them?
Dr. Greenberg: The most obvious group of challenging people are those who don’t think you were the right person for the job. They might undermine your initiatives, your priorities and the culture you’re trying to build. These are the people you need to spend the most time with to help them understand your vision and see if you can get them on board.
Dr. Nfonsam: To me, the most challenging people are those who just can’t get past the negative. Whatever solution you come up with, they’ll find ways to poke holes through it. They never come up with solutions themselves. But I think most people have good intentions, and with a lot of patience and good will, will come around; they just need to be talked to. A leader can never over-communicate, especially the vision.
Dr. Richards: One of the most heartbreaking things for a chair is losing good people. How do you identify those people, win them over onto your team and keep them from leaving?
Dr. Nfonsam: When I was appointed as chair, I asked all the division chiefs to write—in addition to a SWOT [strengths, weaknesses, opportunities, threats] analysis of their divisions—a succession plan. The goal for that exercise was to see those who have a plan for developing younger faculty. That plays a tremendous role in retention and keeping talent within an institution. If someone is leaving for a greater opportunity, we should encourage, support and help them along the way. But if we can keep someone in the fold by offering them something that would elevate their career, I think that’s the best thing to do.
Dr. Greenberg: One of the biggest challenges as a department chair is to find what motivates each individual and to make them feel valued for the contributions they’re making to the department. I really try to understand everyone’s goals. Sometimes within surgery, we take a very hierarchical approach to our leadership. I’m trying to have a more collaborative approach.
Dr. Nakayama: How do you go about implanting your own agenda so that it thrives in your institution’s environment?
Dr. Greenberg: You need to identify areas that are opportunities for growth. Once you’ve established your vision, it’s really about being able to articulate those priorities. The next thing is to make sure the infrastructure aligns with what you’re trying to accomplish. Some components may need to be rebuilt, and that can certainly take time.
Dr. Nfonsam: Success depends on strategy. You have to be persistent in selling your vision and getting the right people on the bus. I call it “retail leadership”: selling your vision one-on-one, even to the skeptics, over and over. Eventually people will see where you’re going, and if you help them understand that it’s truly not about you, but about them, our patients, learners and the system, then you will eventually get people along.
Dr. Richards: A surgeon’s reputation begins and ends with the OR. How do you approach the leadership position in the OR? Also, how much do you operate?
Dr. Nfonsam: When my position was approved by the dean, I insisted that I be part of the leadership in the hospital. One of the biggest frustrations of the surgeons are the challenges they face in the OR, how it functions and its efficiency, so it was important that I was part of all that process. I think every chair needs to be operating.
Dr. Greenberg: As a breast cancer surgeon, I do nearly all my surgeries at our ambulatory surgery center, so it’s really hard to be present in the main OR. I have to find ways to be purposeful and present there. In Augusta, the first thing we did was to redesign the block time. It was a burning platform and had to be done. It allowed me to build rapport with the other surgical chairs.
Dr. Nakayama: There’s another side to being a chair, and that’s the relationship with the community and the region. How are you negotiating that?
Dr. Greenberg: I think that as the chair of an academic institution, especially a state institution, one of your priorities should be to organize surgeons throughout your state, providing the infrastructure and the opportunities for people to get together and share data and learn from each other. This will help to not only improve the care at the population level, but also to build referrals and trust, to help to build those clinical programs.
Dr. Nfonsam: We see a lot of gunshot wounds and deaths in New Orleans, so our trauma division has been engaging the community. We have faculty involved in reentry for incarcerated people who are released back into the community, by creating temporary housing and healthcare for them. Engaging with the community is really important. That gives not only the department, but the institution, a lot of credence and support. As surgeons, we cannot ignore social issues that impact our society and our patients’ overall health.
This article is from the November 2023 print issue.
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