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  • Memento Mori—Remember, Thou Art Mortal

    Executive Coaching for Department Chairs:  The Five Stages of Chair Tenure

    Authors: Harry van Loveren, MD and Fayyadh Yusuf, PhD


    Neurosurgeons distinguish themselves as exceptional even prior to entering their seven-year training program.1 In the recruiting process, we look for stronger than average work ethic, intellectual prowess, ability to delay gratification, and remarkable tolerance for emotional and physical suffering. Upon completion of residency, we hope these character traits continue to facilitate career advancement, whether in the private sector or academic medicine. In the former, a senior partner position that equates to substantial financial holdings is the pinnacle. For those of us in the latter, ascension to chairmanship can be the culminating recognition of excellence in teaching, science and surgical skills; however, it is also the beginning of a new journey with its own share of challenges, victories, and self-discovery.

    In my first decade of chairmanship, I recall feeling as if I was doing a pretty good job—my faculty were happy, our book of business was booming, and we were academically productive. In short, I was at the top of my game and profession. Like many of you reading this article, I didn’t think I would benefit from coaching whatsoever, didn’t need it, didn’t want it.2 Nevertheless, four years ago, I agreed to a pilot study. The coach is still here today, albeit with a new title and responsibilities. Now he is the focal point of a reimagined division within our school of health and offers services to all levels of leadership, including the C-suite at our partner hospital. As the first faculty member to embrace executive coaching and now the one who helps grow the platform, I hold a unique perspective on its benefits—when implemented correctly. We have witnessed great successes for the coaching program and some disappointing failures. Through our own coaching M&M, we have realized two key components for successful coaching interventions: 1) determining whether a leader is coachable; and 2) identifying those who are on the leadership continuum. In this perspective paper, we share some of the lessons learned thus far in hopes that you can maximize the benefits coaching provides. 

    Harry van Loveren meets with his executive coach, Fayyadh Yusuf, at USF.

    Indications for Coaching

    Executive coaching started to gain notoriety about 30 years ago, and has since grown into a multi-billion dollar industry with a multitude of coaching qualifications, processes, and (outcome) quality.3 The scope of practice for coaching arrangements rangeS from interpersonal skills to strategic thinking.4 Our slice of this giant pie is comparatively insignificant. Housed under Clinical Affairs, we are a division of 1.5 FTE (a third of which is purely administrative); the hospital supports part of our funding budget thus reducing the University’s burden; and although we boast a high success rate, complications do exist.

    In our model, we considered any chair or Division Chief a candidate for coaching but those new to their leadership role received invitations to meet informally. The assumption that all chairs would embrace our services over-estimated our perceived value. As demonstrated in sport, coaches prefer players who are coachable, knowing that even the most talented athlete can improve further from guided instruction.5-7 Similarly, chairs need to demonstrate the desire for honest, direct feedback. Subsequently, they must demonstrate the effort to practice their coach’s recommended strategies.

    The Five Stages of Chairmanship

    Reflecting on chairmanships around the country, we identified five stages that leaders, if fortunate enough to last, will eventually experience. In Stage I, new chairs refine basic leadership skills while attaining insights on the history and politics of their institutions. In Stage II, junior chairs transition their primary focus from personal ambitions to development and promotion of their faculty. In Stage III, chairs conduct a robust self-evaluation and program assessment to determine growth opportunities. In Stage IV, senior chairs begin designing a succession plan that meets the needs of the faculty, university and themselves. Finally, in Stage V, chairs emeriti adjust to a new normal in which they are either sage advisors or an after-thought.

    Regardless of the Stage, chairs can benefit from the third-person perspective that a coach provides. We see the relationship as similar to anyone who plays a sport, takes up a hobby or pursues a passion—an unfiltered, objective voice pointing out obstacles or praising your abilities is an invaluable resource. Rules of engagement are encouraged because the structure adds accountability to both parties. 

    Stage 1: On-boarding

    You never get a second chance to make a first impression.

    This adage goes for both the institution and the new chair. Imagine flying into a new country with no prior knowledge of the language, customs or history…with the expectation of the locals that you are there to make their lives better. Having a guide to facilitate the transition—from colleague introductions to time-honored traditions—will help you avoid basic mistakes. While most errors are easily overcome, too many of them will cost time and even reputation. After an exhaustive search and substantial financial investment, senior administrators only hurt themselves by failing to support new chairs with a coach for the immediate transition.

    From a chair’s perspective, access to a coach who understands the “lay of the land” is priceless. The coach can facilitate early wins by paving a path toward acceptable changes (think less resistance), potential adversaries (resistors who wanted another chair), and influential power brokers. Coaches who are invited to the numerous meetings chairs host in their first six months should provide rapid feedback regarding messaging (e.g. communication style, habits, clarity, etc.). As a dedicated resource, chairs also appreciate the accessibility and confidentiality that coaches provide.8 Previous mentors may not have the time needed to counsel the new chair; and admitting weaknesses or errors to unknown colleagues who at first appear friendly, is not always prudent.

    Case in Point…

    A highly lauded, internationally renowned professor arrived to our university with great expectations. His enthusiasm and energy were unbounded as reported by the faculty, administrators and other constituents. At the all chair meetings (held monthly with his counterparts from other departments), the new chair asserted himself confidently and explained how poorly certain parts of the ambulatory service were run, especially in comparison to his previous place of employment. At the first meeting, the other chairs nodded in agreement; at the second, they ignored him; but after the third consecutive outburst, they dressed him down: “We all know the problems that exist here. You aren’t telling us anything new or revealing. You were hired to improve things, so do your job and make it better.”

    The coach (who does not participate in the all chairs meetings) received feedback on the incident and quickly met with the new chair. Posited in a positive, non-threatening manner, this point of consternation became a teachable moment (if not humbling one). First, you never compare your old institution as more favorable than the new—it is a bad idea in all relationships, be it former spouses or employers. Second, building credibility is like creating wealth: positive commentary is putting money in the bank while criticisms are negative cash flow. Save up for that rainy day.

    Stage 2: One-Eye Blind

    Junior chairs, typically in mid-career themselves, often have one eye on their own career and the other on everything else. That makes them “one-eye-blind” to the goals, ambitions, and development of the numerous colleagues who are attempting to build reputations or earn promotion. The coach must be that other eye, constantly meeting with faculty and trainees alike to present to the chair a clear picture of the department’s mood and temperament. When faculty feel stalled or trainees hindered in their own development, corrections are required in real-time before they fester into something malignant.

    One successful approach to coaching junior chairs is making them define, in writing, their department’s culture. We call that document our playbook and require it for both residents and faculty. All non-technical or clinical aspects of daily operations are legitimate subjects for the playbook. We include our mission, values, academic expectations, and even accountabilities for non-compliance. Good chairs have some iteration of a playbook at all stages of their tenure; great chairs constantly revise it to reflect the needs and expectations of the department members.

    Case in Point…

    We met with a new chair who had built a career at another institution only to return “home” as the new leader. The selection committee believed that a former trainee was best to lead this strong-willed, exclusive group. Unfortunately, the previous chair held the confederate of surgeons together through charisma and a little intimidation, which was not a transferable trait. When asked about creating a unified group, we explained that he was better off establishing a culture that was acceptable to the majority of the partners. It was a large group and potentially lethal if they formed a majority coalition against his agenda. Creating a new culture that placated the dissenters was more achievable than attempting to rebuild the program through firings.

    Stage 3: Memento Mori…Remember, Thou Art Mortal

    Several years into your chairmanship, things typically become routine and comfortable: there are no major obstacles with which to contend; calls from the Dean do not elicit fears of the unimagined; even home life feels balanced. The moment this sense of calm is consistently apparent, is the time you call your coach. Together, you determine the relationship between your department and “fine”. As adjective, fine reflects a higher standard (think dining, wine, art, etc.); as an adverb, it is the gateway to mediocrity (think dinner, drink, museum tour, etc.).

    In professional sports, there are players, coaches and owners who are content with just being in the league. Getting to the play-offs is a bonus—typically, a financial one—but regardless of final records, the organization lacks any sense of urgency to win. For fans, this complacency manifests as poor recruiting, not investing in facilities, or perpetual cycles of “rebuilding.” Such a mentality corrupts the program from the inside out and requires inordinate effort to correct. Our message to chairs is simple: when you think things are fine, consider yourself in trouble. Then, work with the coach to assess your leadership style, the department culture and future goals as part of an honest SWOT report.9,10 The revelations from this exercise can help drive your new strategic plan.

    Case in Point…

    Early on in my “coached career,” I gave the Annual State of the Department Address to the faculty. Just minutes later the coach came to my office, closed the door and asked me how I thought it went. Pretty well I thought. So, he asked, “What do you think you told them?” So, I laid it out. Then the coach asked, “Do you want to know what they actually heard? You said compensation going forward would reflect academic as well as clinical performance. They heard pay cuts were coming. You said metrics would be developed to more accurately track clinical productivity. They heard you don’t think they’re working hard enough. That little talk you gave was very negatively received.” So, in my defense I asked, “then why didn’t anyone speak up?” “Something else we should talk about” he said. After he described everyone’s sense of my intimidating persona, I said, “that’s ridiculous, I’m like the nicest guy in the world.” He agreed but said it doesn’t matter because your role of chair supersedes everything else.

    In my decades as a faculty member, I recall only a few people comfortable enough to have that discussion with me. Coaches must possess the confidence to speak their opinions; chairs must welcome such unfiltered feedback. In ancient times, certain military commanders on triumphant parade in ancient Rome would have an Auriga, a slave with gladiator status, in their chariot hold a laurel crown over their head while continuously whispering in his ears “Memento Mori,” remember you are mortal. The coach is my Auriga, constantly reminding me that neither I, nor the program, is perfect. We are constantly checking the pulse of the department culture and temperament to minimize catastrophic damage.

    Stage 4: Chaos is a Ladder

    Fans of HBO’s Game of Thrones may recall Littlefinger’s allusion to chaos as a ladder when discussing the competition for the Kingdom’s crown. At the senior stage of chairmanship, believe us that even if you are not thinking about succession, others around you certainly have it on their minds. Some are worried because a new leader may disrupt their careers in a negative manner. For others, they are yearning (if not vying) to succeed you.

    Chairs should consider two aspects of succession. First, related to Stage II, it is part of the chairs’ mandate to develop their faculty. In this instance, administrative leadership (e.g. divisional directors, running committees, etc.) is the principle focus. Athletics shares its own equivalency: assistant coaches hired as coordinators or head coaches for another program. You are spreading your legacy across the sport by helping others reach a higher level. Putting people in positions of growth and then nurturing their maturation through mentorship or coaching is one of the rewards of chairmanship.

    The second aspect of succession is a bit more sobering. Many of us enter into the job believing we will stay at the helm for a specified time, make positive changes, step down while “still at the top of my game,” and humbly return to our original status, “member of the faculty.” We loathe repeating the failures of our predecessors who stayed too long. Progressively, however, some chairs falsely conflate their leadership with the survival of the program. If this were true, it would demonstrate a complete failure of organizational development and succession planning.

    The role of a coach is to challenge the chair with three important questions: 1. If you died suddenly tomorrow, who have you prepared to lead? 2. When you do step down, who have you groomed to be a viable internal candidate? 3. Have you constructed a department that will attract high-level candidates in a national search? Even with positive responses to all three questions, there are chairs who cling to their corner office, reserved parking spots and other privileges beyond the desired stay.

    Regular reflection of these three questions enables a coach to discuss, in a safe environment, the chair’s timeline for transition—and visions for life after chairmanship. Programs across the country approach this question for all levels of faculty differently. Some base it on age—regardless of physical or mental acuity. Others have no set parameters leaving it up to the individual. Regardless of your institutional policy, have a plan. One productive exercise is to conduct a 360 evaluation of the chair that includes senior leadership (specifically, the Dean or CEO) and certainly senior members of the faculty. A coach can use their feedback to determine whether the timed exit involves a gentle guide or more abrupt shove. Both are delicate matters, but the latter gets messy fast.

    Stage 5: Chair Emeritus

    In full disclosure, I have not experienced this phase so I cannot comment intelligently upon it. Dr. Robert Ojemann, previous chair at Harvard, once wrote an open letter advising chairs of departments to not overlook the best job you could have, chair emeritus. The ability to spend time in the direct care of patients, educating and inspiring medical students, training residents, and acting as “wise counselor” to the new chair with great authority but no responsibility. It will undoubtedly require a humility that is difficult to achieve but will be inflicted upon you eventually regardless of what choices you make. I’m confident that the coach will guide my ego to suppress the id. I’ll let you know how that works out and leave you with the following, “Don’t gripe about growing older, it’s a privilege denied to many.”


    As with any new initiative, hobby or activity, smart enthusiasts hire coaches to establish good fundamentals and habits. Academic chairs are especially primed to benefit from skilled guidance throughout their tenures as departmental leaders. Most chairs dedicated their professional lives to mastering technical skills and advancing science; leadership is another ability unto itself. Simply taking accomplished academics and giving them a title is insufficient for success. The guidance and messaging that coaches can provide is especially valuable because the success of the organization guides their perspective. There are no ulterior motives when having the uncomfortable discussions or delivering difficult news. Rather, they serve the chairs individually, thus benefiting the entirety of the organization.

    It is incumbent on any chair who accepts coaching to do so unconditionally. Un-coachable chairs exist; they have all the answers; nothing is their fault; or they are too important and busy to work on themselves. Certainly, the chair can help set the agenda (depending on phase of tenure), but accepting the direction of the coach is imperative to success. When a trusting relationship exists between the chair and coach, institutions can enjoy the benefits that good leadership provides.



    1. Zuckerman, S.L., et al., Predicting resident performance from preresidency factors: a systematic review and applicability to neurosurgical training. World Neurosurgery, 2018. 110: p. 475-484. e10.
    2. van Loveren, H., F. Yusuf, and C. Paidas. The Benefits of coaching in the Ultimate Contact Sport: Neurosurgery. in Congress Quarterly. 2018.
    3. Athanasopoulou, A. and S. Dopson, A systematic review of executive coaching outcomes: Is it the journey or the destination that matters the most? The Leadership Quarterly, 2018. 29(1): p. 70-88.
    4. Bono, J.E., et al., A survey of executive coaching practices. Personnel Psychology, 2009. 62(2): p. 361-404.
    5. Giacobbi Jr, P.R., et al., College coaches’ Views About the Development of Successful Athletes: A Descriptive Exploratory Investigation. Journal of Sport Behavior, 2002. 25(2).
    6. Piedmont, R.L., D.C. Hill, and S. Blanco, Predicting athletic performance using the five-factormodel of personality. Personality and Individual Differences, 1999. 27(4): p. 769-777.
    7. Favor, J.K., The relationship between personality traits and coachability in NCAA divisions I and II female softball athletes. International Journal of Sports Science & coaching, 2011. 6(2): p. 301-314.
    8. Silver, M., et al., Supporting new school leaders: findings from a university‐based leadership coaching program for new administrators. Mentoring & Tutoring: Partnership in Learning, 2009. 17(3): p. 215-232.
    9. Hill, T. and R. Westbrook, SWOT analysis: it’s time for a product recall. Long range planning, 1997. 30(1): p. 46-52.
    10. Helms, M.M. and J. Nixon, Exploring SWOT analysis–where are we now? Journal of strategy and management, 2010.

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