ASSIGNMENT 3.1

Faculty Members' Self-Awareness, Leadership Confidence, and Leadership Skills Improve after an Evidence-Based Leadership

Training Program Jamilah Hackworth, EdD, Scott Steel, MA, MEd, Erika Cooksey, MSW, Mallory DePalma, MEd, and Jessica A. Kahn, MD, MPH

P reparing academic faculty for leadership roles hasbecome increasingly important given the challengescreated by new healthcare delivery systems and payment structures, a deeper focus on quality and patient safety, higher standards for medical education, and greater compe- tition for research funding.1,2 However, many faculty leaders have not had the opportunity to develop the confidence or skills they need to lead others through the challenges facing aca- demic medical centers today. A limited number of studies have been published evaluating programs designed to address the specific leadership development needs of academic faculty.3

These programs are often regional or national and may be costly; are cost-prohibitive for training cohorts of faculty leaders in one institution; are not necessarily tailored to the institu- tion’s vision, mission, and culture; and do not foster network- ing across an institution.

To address this gap, the Office of Academic Affairs and Career Development (OAACD), in collaboration with our hospital’s Department of Learning and Development, developed the Core Leadership Program (CLP). The overarching goals of this program were to develop a cadre of outstanding faculty leaders across the career continuum, foster peer mentorship and coach- ing among participants, and encourage faculty leaders to create a culture of service, appreciation, inclusion, teamwork, and collaboration.

Program Development The impetus for program development was a needs assess- ment conducted by the OAACD that identified an urgent need for faculty leadership development, as well as the institu- tional strategic plan that identified a need to invest in struc- tured leadership development at all levels. Our approach was to design a program based on best practices nationally, iden- tified through a literature review,4-12 that drew on the staff’s previous experience in developing leadership programs. The program was also designed to address both core leadership skills and organizational priorities. In addition, several leadership development theories provided a framework for program design, especially those focused on authentic leadership and increasing self-awareness.13-20 The primary objective of this com- ponent of the curriculum was to facilitate an increase in par- ticipants’ self-awareness of strengths, limitations, motivations, and behaviors, to foster transformative leadership skills.

The premise of the program was that improvement in faculty members’ leadership self-awareness, confidence, and skills would be facilitated by participation in programs that blend theory

with practice. The program was designed to (1) provide op- portunities for self-reflection, peer support, and practice over an extended period; (2) use multiple learning formats, includ- ing onsite and offsite learning settings, 360° feedback, small groups, experiential learning, and guest speakers, to main- tain energy and excitement; (3) initially focus on helping par- ticipants discover their personal strengths, limitations, and values before focusing on leadership competencies and core skills; (4) connect to participants’ experiences with leader- ship at work as well as in their homes and communities; and (5) help participants acknowledge how personal view- points can positively or negatively impact their leadership influence.

The structure of the program included 68 hours of learn- ing activities occurring over a 10-month time frame: (1) two 1-day onsite seminars with experiential activities, presenta- tions, videos, case studies, small group cohort discussions (ex- ploration teams), learning triads, and 360° feedback on emotional intelligence; (2) a 2-day offsite session with expe- riential activities (eg, high ropes course), team-building ac- tivities to practice new leadership behaviors, “life stories” sharing, and personal strengths feedback; (3) 7 monthly 4-hour meetings with presentations on core skills by senior faculty lead- ership team members and exploration team breakout ses- sions to discuss leadership foundational skills and lessons learned from assigned readings and practice; (4) reading as- signments based on Discover Your True North20 and How Full is Your Bucket?21; and (5) a half-day for “leadership profile” pre- sentations by each participant.

Program Participants Participants were faculty members with supervisory or team leader responsibility who were identified by their division di- rectors as having high leadership potential. The participants were multidisciplinary, including physicians, psychologists, bio- statisticians, basic scientists, and others, and represented all de- partments and almost all divisions within the medical center. A total of 99 faculty leaders participated in the first 4 cohorts of the program.

From the Cincinnati Children’s Hospital Medical Center, Cincinnati, OH

The authors declare no conflicts of interest.

0022-3476/$ - see front matter. © 2018 Elsevier Inc. All rights reserved.

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Program Evaluation The mixed-methods program evaluation was designed to align closely with program objectives. Participants and their division directors completed surveys at planned timed inter- vals over the course of the program to assess program content, experience, and impact. Four cohorts of program partici- pants received a preprogram survey on the first day of class, postsession surveys following each classroom session, and a postprogram survey immediately after program completion. Participants’ division directors (cohorts 1, 2, and 3) also re- ceived a preprogram survey at the beginning of the program and a postprogram survey on completion of the program. Pre- program and postprogram surveys assessed leadership confi- dence, leadership self-awareness, and strategic, operational, and leadership skills. Postsession surveys measured program sat- isfaction, application, and impact. Quantitative survey items were measured using a 7-point Likert-type scale (from 1, strongly disagree to 7, strongly agree). Qualitative items were open-ended. The comparison of differences in mean scores from preprogram to postprogram was analyzed using the Mann-Whitney U test. Qualitative data were analyzed using content analysis, organizing responses into representative themes.

Results

Participant preprogram and postprogram surveys that as- sessed perceptions of leadership confidence, leadership self- awareness, and attainment of strategic, operational and leadership skills demonstrated statistically significant improvement in all 26 comparisons (Table I; available at www.jpeds.com). Likewise, manager preprogram and postprogram surveys that assessed observations of leader- ship confidence, leadership self-awareness, and strategic, op- erational, and leadership skills demonstrated improvement in all 16 comparisons (Table II; available at www.jpeds.com). These changes were statistically significant (P < .05) for 10 of the 16 comparisons and marginally statistically significant (P < .10) for an additional 4 of the 16 comparisons.

Participant surveys assessing program experience, impact, and application after each session and at the end of the program were highly rated. The mean scores for all 4 cohorts com- bined for the items assessed were as follows: “Overall, I was satisfied with the quality of this educational program,” 6.5; “This training program will significantly enhance leadership and/ or management capabilities at my organization,” 6.6; “I will be able to apply the knowledge and skills learned from this training to my job,” 6.5; “I learned new knowledge and skills from this training,” 6.5; and “This training was a worthwhile investment for my career development,” 6.7. When asked if they would recommend the program to others, 94% responded yes, 6% not sure, and 0% no.

Analysis of qualitative survey data provided by CLP par- ticipants indicated that they found the experience satisfying and had successfully applied skills acquired through the program. Participants reported that the most valued oppor- tunities included developing relationships with their peers and

networking with colleagues, sharing stories with others and learning from those shared by others, focusing on personal de- velopment that fostered the development of leadership skills over the course of the program, and gaining exposure to senior hospital leaders, which offered opportunities to learn from lead- ership role models, strengthen their connections to the medical center, and enable them to learn first-hand how the medical center operates. Participants also reported that the program increased their awareness of the impact of their leadership be- haviors on others, increasing their utilization of positive lead- ership styles and behaviors; increased their ability to engage and empower members of their clinical/research teams; in- creased self-confidence in their leadership skills and better pre- pared them for future leadership roles; enhanced their emotional intelligence (eg, self-awareness and self-regulation); and increased their awareness of the importance of directly ac- knowledging others’ accomplishments and contributions. Analysis of qualitative survey data provided by division di- rectors indicated that on completion of the CLP, participants demonstrated improvements in leadership ability, confi- dence as a leader, listening skills, conflict management skills, and cross-disciplinary collaboration.

Discussion

Participation in the CLP led to increases in faculty members’ leadership confidence and self-awareness; enhanced strate- gic, operational, and relational skills; and successful develop- ment of supportive peer networks. In a systematic review of articles on physician leadership development programs, Frisch et al demonstrated that most programs exclusively enrolled phy- sicians and focused on implementing and evaluating skills train- ing and technical knowledge (vs personal growth and self- awareness), and that evaluations were largely limited to measurement of participant satisfaction and self-assessed changes in knowledge and behaviors.3 In contrast, the CLP was designed for all faculty, including research faculty as well as physicians, psychologists, and other clinicians. Moreover, the program addressed the fundamental principles of outstand- ing leadership and core skills, and the program’s impact was evaluated comprehensively by participants and their division directors.

CLP participants demonstrated significantly increased con- fidence in their leadership skills. These increases in self- confidence and self-efficacy experienced by participants are critical because these leader cognitions are vital underpin- nings of leadership success.22,23 Participants also reported an increase in their ability to articulate the values and principles that guide their leadership, as well as awareness of the skills required for the next level of leadership. Furthermore, par- ticipants reported improvement in skills related to emo- tional intelligence, including self-awareness, self-management, social awareness, and relationship management.24 This was fa- cilitated by a 360° assessment, which has been implemented in other physician leadership programs.10,25 The authors of a recent systematic review of the literature on emotional intel- ligence and physician leadership development concluded that

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evidence supports the benefits of emotional intelligence train- ing in physician leadership programs, and that these strate- gies are especially important in the current academic healthcare environment, which requires interdisciplinary collaboration.26

Along with improved self-confidence and self-awareness, par- ticipation in the program led to improvements in strategic, op- erational, and relational skills. These included leading large system changes, performing strategic planning, managing budgets, using cost reduction strategies, building a personal support team, and leading across age, sex, racial, and other di- versity dimensions. Strategic and operational skills are vitally important for successful leadership in academic health centers, but are rarely included as components of professional educa- tion for physicians or researchers. Relational skills are par- ticularly important in employee engagement and retention, which in turn leads to improved patient safety and an en- hanced care experience.27 Improvements in all of these core skills ultimately contribute to improved overall organiza- tional effectiveness.28

Qualitative data analysis demonstrated the positive impact of the CLP on the development of social networks, improved communication, and engagement. Specifically, participants cited successful development of supportive peer networks, as well as the opportunity to learn from senior leaders in the orga- nization, strengthen their connections to the medical center, and gain first-hand knowledge of how the medical center func- tions from an operational perspective. The development of stronger peer and institutional networks facilitates greater col- laboration across divisions and departments, and also en- hances team science efforts. The CLP also increased participants’ ability to engage and empower all members of the clinical and research teams, and increased awareness of the importance of

directly acknowledging others’ contributions. Leadership quali- ties, including demonstrating greater appreciation for team members and supporting the development of new relational connections between colleagues, has a number of positive ben- efits, including improved morale; increased retention, pro- ductivity, and innovation; and possibly even burnout prevention.28-31 We have also developed “booster sessions” for former program participants so that they can continue to learn together and network, and several exploration teams have con- tinued to meet independently after the program ended and provide one another with peer coaching.

Conclusion

The leadership program evaluated in this study significantly improved participants’ confidence, self-awareness, and stra- tegic, operational, and relational skills. Individuals at other in- stitutions wishing to implement a similar program to prepare faculty leaders to lead in an ever-changing academic health center environment should ensure that sufficient financial and other resources are available for these programs; provide release time, support, and encouragement for faculty leaders to fully participate in the program; and adopt the idea that invest- ment in faculty members’ leadership development today will provide very valuable returns in the future. ■

Reprint requests: Jamilah Hackworth, EdD, Office of Academic Affairs and Career Development, MLC 4000, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229. E-mail: jamilah.hackworth@ cchmc.org

References available at www.jpeds.com

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Table I. Comparison of participant evaluations preprogram and postprogram, assessing perceptions of leadership con- fidence, leadership self-awareness, and strategic, operational and leadership skills

Survey items*

Preprogram Postprogram Change preprogram to postprogram P value†n Mean n Mean

I am aware of behaviors I exhibit that may negatively impact team performance. 98 5.03 75 6.27 1.24 <.0001 I am aware of challenges to overcome when effectively leading large system change (institution-wide). 98 4.01 75 5.87 1.86 <.0001 I am aware of specific actions leaders can take to create an engaging culture. 98 4.44 75 6.19 1.75 <.0001 I am aware of the methods that can be used to create an effective strategic plan to launch a new program. 98 4.09 75 5.65 1.56 <.0001 I am aware of ways in which my leadership style impacts others. 97 4.76 75 6.24 1.48 <.0001 I am aware of what motivates me as a leader. 96 5.11 75 6.35 1.24 <.0001 I am confident in my leadership abilities. 97 4.80 74 5.92 1.12 <.0001 I am knowledgeable about CCHMC strategies to decrease cost and increase value. 97 4.40 73 5.71 1.31 <.0001 I believe emotional intelligence and self-awareness are essential to successful leadership. 97 6.34 74 6.76 0.42 <.0001 I can articulate my leadership limitations. 97 5.07 75 6.32 1.25 <.0001 I can articulate my leadership strengths. 97 4.68 75 6.20 1.52 <.0001 I can articulate the values and principles that guide me as I lead others. 96 5.15 74 6.46 1.31 <.0001 I effectively support the career success of my direct reports. 25 5.6 75 6.12 0.52 .026 I have a network of people who support me as I grow as a leader. 97 5.08 75 5.79 0.70 <.0001 I know how to balance my personal and professional lives. 97 4.18 74 5.45 1.27 <.0001 I know how to build a personal support team. 97 4.28 73 6.12 1.84 <.0001 I know how to develop and effectively manage a program budget. 97 3.69 74 4.88 1.19 <.0001 I know how to effectively build relationships with mentors and others that may aid in my career success. 97 5.05 74 6.01 0.96 <.0001 I know how to effectively decrease cost and increase value in my area. 97 4.02 73 5.45 1.43 <.0001 I know how to lead across age, gender, racial and other differences. 96 4.90 75 6.05 1.16 <.0001 I know what skills are required for the next level of leadership. 98 4.00 75 6.07 2.07 <.0001 I seek ways to maximize use of my leadership strengths. 98 4.97 75 6.16 1.19 <.0001 I seek ways to minimize my leadership limitations. 98 4.69 75 6.07 1.38 <.0001 With confidence, I can build relationships with mentors and others that may aid in my career success. 97 5.02 74 5.93 0.91 <.0001 With confidence, I can lead across age, gender, racial and other differences. 96 4.68 74 5.92 1.24 <.0001 With confidence, I can overcome challenges and effectively lead large system change. 97 4.02 74 5.49 1.47 <.0001

*Survey items assessed with a Likert-type scale; responses ranged from 1 (strongly disagree) to 7 (strongly agree). †Differences in mean scores preprogram to postprogram assessed using the Wilcoxon rank-sum test.

Table II. Comparison of manager evaluations preprogram and postprogram, assessing observations of leadership con- fidence, leadership self-awareness,; and strategic, operational and leadership skills

Survey items*

Preprogram Postprogram Change preprogram

to postprogram P value†n Mean n Mean

Based on my interactions with and observations of the participant, he/she: Creates an engaging culture 61 5.44 50 5.84 0.40 .098 Delivers difficult messages and manages conflict in the context of an evaluation 56 5.07 43 5.42 0.35 .096 Effectively leads across age, gender, racial, and other difference 62 5.84 49 6.08 0.24 .175 Effectively models how to achieve balance between personal and professional lives 62 5.47 50 6.02 0.55 .014 Expresses self clearly 64 5.80 50 6.28 0.48 .004 Regularly highlights team or organizational goals 64 5.42 48 5.92 0.50 .006 Respects others' viewpoints 64 5.92 50 6.24 0.32 .036 Effectively manages own emotion when communicating with others 63 5.51 50 5.88 0.37 .059 Can articulate his/her leadership limitations 61 4.95 46 5.48 0.53 .023 Can articulate his/her leadership strengths 62 5.32 47 6.17 0.85 <.0001

Based on my interactions with and observations of the participant, he/she: Effectively builds relationships with mentors/others that may aid in her/his success 64 5.83 48 6.17 0.34 .039 Effectively develops and manages a program budget 37 5.27 27 5.52 0.25 .074 Effectively supports others' career success 63 5.71 49 6.04 0.33 .119 Effectively uses annual faculty evaluation tool for her/his own career development 51 5.49 40 6.10 0.61 .004 Is aware of ways in which her/his leadership style impacts others 61 4.98 49 5.65 0.67 .005 Is confident in his/her leadership skills 64 5.41 50 6.04 0.63 .002

*Survey items assessed with a Likert-type scale; responses ranged from 1 (strongly disagree) to 7 (strongly agree). †Differences in mean scores preprogram to postprogram assessed using the Wilcoxon rank-sum test.

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