Institutional leaders in academic medicine are frustrated by what they perceive to be a short list of limited assets that can be used to guide or encourage individual and group behavior: faculty rank and/or institutional titles, compensation and budgetary authority, and space.
Even though the organization’s work takes place at the bottom, done largely by self-directed professionals, an academic medical center’s professional intellect is rarely recognized as an asset, let alone as the binding force that enables transformation of the other assets into academic medicine’s principal products: education, research, and patient care. Professional intellect is not limited in quantity or quality. It can be cultivated, stimulated, and maximized, all to the benefit of the institution and the individual, as well as stifled, stymied, under-supported, and unappreciated, all to the detriment of the institution and often to the individual as well.
James Brian Quinn defined professional intellect by describing its operation on four levels in order of increasing value to the organization:
- Cognitive knowledge (know-what)—the basic mastery of a discipline gained through extensive training and certification
- Advanced skills (know-how)—the ability to translate what has been learned into effective execution in any relevant setting
- Systems understanding (know-why)—deep knowledge of the web of interrelationships, not just cause and effect, that enables professionals to move beyond task execution to seeing the processes of change required to be understood in order to solve larger and more complex problems. Quinn elaborates, “The ultimate expression of systems understanding is highly trained intuition—for example, the insight of a seasoned research director who knows instinctively which projects to fund and exactly when to do so.” In our contexts, substitute “educator” or “clinician” or “administrative leader” for “research director” and modify the final clause appropriately.
- Self-motivated creativity (care-why)—the will, motivation, and adaptability for success both individually and organizationally. Complacency is the enemy for these professionals. They are always aware of the next set of challenges and opportunities at the leading edge of their fields of interest and of the constant efforts of competitors to take their and their institution’s places. Complacent institutional administrators (I don’t like to call them “leaders”) often see these individuals as “boat rockers” who don’t remember the bad old days and can’t leave well enough alone. Consciously or not, “care-why” professionals live by Andrew Grove’s admonition: “Success breeds complacency. Complacency breeds failure. Only the (non-delusional) paranoid survive” (parenthesis added).
Because professional intellect is the medium that academic medical centers have to offer society in exchange for its recognition and support, institutions must aim to maximize the value and quantity of their product through the use of culture, policies and practices, and structural mechanisms.
Cultures can be built from scratch and grow in strength over the years. Two of the strongest, in my opinion, are Johns Hopkins and the University of California San Francisco. Both are among the top few academic medical centers, no matter what measures are used, and have been for many years. Hopkins is private and became a model for medical education in the post-Flexnerian era beginning in 1910. UCSF is public and was founded in 1946, one of four schools begun in the immediate post-WWII years. The UCSF website includes an open access manual on how to succeed as a faculty member at the school. UCSF also grows and grooms its faculty (its professional intellect) through weekly progress meetings in every laboratory at every level. The mechanisms at Hopkins are not as familiar to me, but I suspect they are similar. In both cases, the institutions have been extraordinarily successful for decades and their success shows no signs of slowing down.
Policies and practices that support and encourage the development of intellectual capital are essential. Recruit strategically and hire the best faculty you can. Make sure they understand why they were recruited and help them to achieve the institution’s, and their, expectations for success. Remove limits to growth. Align missions, goals, strategies, and tactics and keep them in sync with advances and changes in the larger world.
Structural mechanisms to assist the development of professional intellect are often unrecognized and overlooked. Administrators and administrative structures should emphasize support, not control. Their overriding purpose must be to assist faculty, residents, and students who have been recruited at great effort and expense to accomplish what they were recruited to do. At least three ways administrative staff can assist faculty include:
- Environmental monitoring (“horizon scans”), both internal and external
- Provision and maintenance of supportive environments for research, teaching, and clinical activity
- Assistance with developing applications, proposals, and requests for external (and internal) support
When managed effectively, “centers” and “clinical trials support units” can relieve faculty of all extraneous responsibilities except those required by law and ethics. Focusing professional intellect in this way has been shown to generate returns far beyond expected levels with no diminution of professional interaction, rewards, or recognition.
Professional intellect is the single most important asset in academic medicine, yet it is the least understood and managed. As the numbers of allopathic and osteopathic medical schools continue their growth, institutional leaders must grasp the fact that they are all competing for the professional intellect that, while inadequately understood and managed, is central to everything these institutions hope to accomplish for themselves and for society. Something has to change.
James E. Lewis is an independent consultant to departments and schools of medicine, and teaching hospitals. He blogs at Wing of Zock.
