Guiding the Smart, the Opinionated and the Hard to Please

By Sarah Klein

Oct. 4, 2007

The leader: Joe Garcia, hospital boss

The challenge: Persuading hundreds of independent-minded colleagues to support common goals.

The techniques: Identifying individual motivations, rewarding collaborators and starving non-cooperators of resources.

At its worst, academic medicine is akin to politics, with dueling egos jockeying for position and space. If left unchecked, petty disagreements can become longstanding feuds that impede recruitment of junior faculty and derail efforts to secure federal grants.

Getting a group of physicians to support a single vision for a program takes a special person.

“You need to have a nurturing style,” says Edward Benz Jr., president of the Dana Farber Cancer Institute in Boston. “There’s a lot of insecurity,” despite the tremendous accomplishment of such faculties.

At the same time, the leader can’t be so soft that divisive personalities are allowed to run roughshod over others.

Joe Garcia, physician and chair of the University of Chicago’s Department of Medicine, has that unique combination, says Benz, who recruited him from Indiana University in the late 1990s to turn around Johns Hopkins University’s troubled pulmonology division. “They didn’t quite realize who they had,” he says.

Indeed, Garcia, a lung disease specialist who ranks in the top 3 percent of all National Institutes of Health grant holders nationwide, made quick work of the assignment at the Baltimore university. He restructured to eliminate or minimize the role of faculty members who were destructive to morale.

“An overarching way to deal with these folks is to basically starve them of key resources, including money, people and titles,” Garcia says. With more collaboration in the department, he was able to secure NIH grants worth more than $30 million. He also doubled the faculty to 60.

Soon after, the University of Chicago came calling. “If you are a success at Hopkins, you’re on everyone’s dance card,” he says.

When Garcia, 52, took over U of C’s Department of Medicine in 2005, he first articulated a vision for the department, which has a faculty of 400 physicians and a budget of roughly $200 million, five times the size of the one he oversaw at his previous post.

“It doesn’t have to be complex. It doesn’t have to be dramatic. It has to be clear,” he says.

He wants U of C to lead the way in translating scientific discoveries into clinical practice and to train the next generation of academic leaders. That goal includes everyone in the department, where some specialize in research, some in training and others in treating patients.

Garcia doesn’t deny some members of his faculty are more important than others. He values those who can build bridges between departments and institutions to enhance research and medicine, such as a faculty member who brings scientists, statisticians and physicians together to identify the genetic basis of a disease.

“You can have an accomplished scientist who runs a really good lab but has not built a program around that to make other people around him better,” he says. “Someone who does that is invaluable.”

He feeds resources to those people, including bigger budgets, higher salaries, titles and space. Such physicians are often targets of the competition, so he offers them leadership roles or creates a center around their work to retain them.

“It hits the ‘I feel valued by the institution’ button very effectively,” Garcia says.

He also considers himself a quick study of people. He can figure out what will motivate someone in their first meeting, he says. “One of the things I have learned in leadership positions is that for some individuals—a very small percentage of individuals—it is about physical or monetary things you do for them,” he says. “You give them more space. You give them more money. You give them titles. But I am always impressed by how meaningful it is for a leader to demonstrate value through simple things—a phone call, a meeting, a pat on the back, a handwritten note.”

Demonstrating value is essential, he says. As their leader, he has no trouble praising his faculty and staff.

“In any accomplished group you find egocentric folks constantly needing the feelings of being valued,” he says. “These things are easy for me to do because I feel them. I admire these people.”

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