Difficult times are when leaders need to rise up. There is no more important or impactful time for you to demonstrate your character and mettle, no time your group needs you more. Leaders cannot shrink from this responsibility, or they should be replaced. It does not take tremendous intelligence to strive in a crisis, but it does require character, fortitude, and courage. This chapter outlines some principles that may be of use in the event of a crisis. It begins with understanding the scope of the problem and how it will affect your group. It goes into how to stay ahead of the curve, predicting the potential outcomes and implications of the crisis before they occur. It talks about the importance of clear, concise, and effective communication to your group. It goes into the importance of aligning your actions with not only your group but the groups above you, such as the hospital and medical school. It covers the concepts of surveying your constituents, learning from them, and adapting your responses based on their needs. We talk about the importance of addressing mental health issues that develop in response to a crisis, not only for your group but also for yourself. It concludes with how to come out on the other side of the crisis as a strong and functional group.

Culture can mean several things when referring to a group: identity, values, goals, principles. Culture can be defined from the inside or outside – how is your group viewed by others, either at your institution or outside? Is your group viewed as “functional,” in which the members get along with each other, work as a team, and accomplish important goals? Or does it carry a reputation of being a “difficult place to work”? Usually a culture is a mix, some elements hardworking and driven, some supportive and nurturing. This chapter talks directly about how to develop a positive culture for your group, and how to be explicit in the process. It starts with recognizing and acknowledging the elements of your core identity as a group – what are your guiding values and behaviors? It dives into the difference between acceptable behaviors that can stimulate the group and be positively provocative, versus those that can be negative, destructive, and unacceptable, and how to deal with them when they occur. It describes the principle of accountability and how all group members are responsible for the overall health of the group. It discusses how to handle difficult interpersonal interactions once they’ve taken place, and how to reset the team after a negative culture event. It reminds the reader of the importance of embracing diversity, that differing opinions are necessary and important, but negativity and destructive behavior is never helpful.

One of your biggest challenges as a leader is having difficult conversations with members of your group. These conversations may be necessary for a variety of reasons: (1) they might be underperforming or out of compliance with documentation or billing; (2) they might have conduct that is detrimental to the team; or (3) they seem to be struggling with the team concept and the overall goals of the group. Your success as a leader will be determined primarily by how well you conduct one-on-one meetings, working with “problematic” group members to help them be successful or to find a different path for them, sometime even “managing them out.” This chapter discusses how to have these difficult conversations, using case examples to illustrate different techniques. It goes into how to set up the meeting in advance, setting clear expectations and the right mindsets. It discusses how to plan in advance for how you’d like the meeting to go, as well as having a plan B and plan C for when things don’t go as intended. It discusses how to conduct the meeting, including who should be in the room when it happens. It also describes necessary documentation and follow-up from these meetings, as well as setting expectations and next steps. It concludes with the particularly difficult situation of removing someone from a leadership position.

All too often, we see the leadership above us as obstructionist, miserly, or otherwise misguided or misaligned. This is usually not the case, but there are often communication issues up and down that create that impression and sometimes lead to an adversarial relationship. Both groups benefit by aligning their goals, and the earlier they do so, the better. This chapter will speak mostly to aligning your goals with that of your hospital, with some time at the end devoted to the medical school. They have many similarities, but some important differences. Understanding their priorities will help you to align yours. We discuss the paramount importance of understanding the finances both of your group and the group above you, hospital or medical school. There are ways to maximize your productivity to a mutually beneficial end, and being overt with leadership about this is always welcome. You should gain an understanding of what a “return on investment” or ROI means to the leadership above you, as this is a central concept to their willingness to invest in you and your group. You will gain an understanding of the downstream effect of your group’s efforts, particularly financial. It emphasizes the importance of understanding the key individuals you communicate with and how to approach situations where you are having communication issues. It concludes with how to align goals with the leadership above your group.

Most meetings are not run efficiently or effectively, and very few leaders put the time and energy into running a meeting well, not only wasting the time of their audience but their own as well. Without question, some meetings, or at least portions of meetings, are necessarily informative and perfunctory, such as updates on the financial situation of a department or the medical center or school. But not all meetings have to be like that, and nor do all portions of a given meeting. This chapter gives some tips for running an effective meeting, getting the most out of your group in the process, and having the group feel not only updated but engaged, respected, and perhaps even inspired. We talk about how to get people engaged from the get-go and the importance of setting the tone and expectations for meetings at the very start. We discuss the importance of setting the agenda and giving people prework so that they come prepared and ready for discussion. We get into the importance of establishing trust in meetings, so that people can speak freely and without fear of recrimination or attack. We talk about how to foster a constructive dialogue, allowing people to spread their wings and explore their creative sides, but also how to deal with a negative team member who makes others uncomfortable. And we talk about how to wrap up a meeting, discuss next steps, and have the group leave excited for the next meeting. We conclude with how to conduct a retreat for your group.

In medicine, the goals are different based on the individual group; thus, establishing the vision and goals for your group is essential, so that they know the scope, steps, and potential obstacles. All too often, teams are left to make assumptions as to what the goals are; this leads to uncertainty, questioning, and a lack of faith or trust in you as a leader. Setting the goals, and reminding people of them periodically, will help keep your group oriented and focused. This chapter focuses on how to assemble a well-running team, whether you need to get to know who is on it already or if you’re assembling it from scratch. It dives into how to gain a better understanding of your team members, what motivates them, and their potential strengths and weaknesses. It also goes into how to identify the personality traits that may make them a more or less effective team member. We describe the great importance of diversity for your team, as it is a key source for innovation, creativity, and perspective. It discusses the importance of midlevel leadership and when it is necessary. Mentorship is discussed in detail, as a key component to the development of your group members. Principles of recruiting and retaining good group members are reviewed, as well as operating principles for your team.