308
MAINTENANCE OF COLLEGIALITY* MURRAY GOLDSTEIN, D.O., M.P.H. Director National Institute of Neurological Disorders and Stroke Bethesda, Maryland
T o PLACE THE MAINTENANCE OF COLLEGIALITY in an instutional perspec-
tive, it is important to recall what the institutional administrative setting is in the usual American academic health center. The property and fiscal resources of the center are generally, "owned" by a board of trustees, the members of which are appointed by a yet higher authority. The board consists primarily of distinguished people from the community, but people who are rarely members of the academic health center-people not members of the academic health center collegium. The board generally appoints a chief executive officer (e.g., vice president for health affairs, executive dean) responsible to the board for the conduct of the affairs of the center; the executive officer may or may not be a member of the collegium. In turn, the executive officer appoints department and division chairmen to assist him in meeting the academic goals of the institution and to assist him in its governance. These administrative officers-chairmen-serve at the pleasure of the executive officer; these chairmen are usually members of the collegium. Other members of the faculty with academic tenure are not necessarily involved directly in the governance of the institution but are core members of the collegium and responsible for the internal management of the institution's affairs. The point to be made is that all members of the academic health center at all levels are appointed to it directly or indirectly by an executive officer responsible to a board of trustees. Having established this, we can now focus on the ground rules for the maintenance of constructive inter-relationships of the professional members of the academic health center-the collegium in meeting the professional goals of the academic health center: developing new knowledge, teaching and information transfer, and related health care services-goals endorsed by the board of trustees, the responsibility of the executive officer and shared by him with members of the collegium. For the * Presented as part of a Symposium on Academic Collegiality in American Medicine held by the Foundation for Neurosurgical Research at Camp Trowbridge, NY, September 7-9, 1990. Address for reprint requests: Building 31, Room 8A52, NINDS, Bethesda, MD 20892
Bull. N.Y. Acad. Med.
MAINTENANCE
-~~A
N
EN
N
E
0
309
purposes ofthis paper, collegiality is defined as the method by which members of the collegium-the faculty and its staff-interact with each other and with the executive officer to achieve the professional goals of the academic health center. I start with these propositions: collegiality is useful; internal governance of the affairs of the collegium is desirable; and that collegiality is important in fostering institutional status, in maintaining academic freedom, in prompting individual pride, and as a method for regular information exchange. My charge is to address how to maintain that collegiality or, conversely, how to prevent its disruption; put another way, how to strengthen and maintain internal relationships so that the members of the collegium-the facultyhave a critically important role in sharing responsibility with each other for addressing the professional goals of the institution. Machiavelli in his advice to the Prince provided him with principles to constrain and disrupt collegiality. He advocated that maintaining the authority of the sovereign depended upon keeping the peerage distrustful of each other, each one's position secure only in believing he had a special and individual relationship with the Prince. Thus loyalty was acceptable only if it was loyalty to the Prince, and loyalty to the Prince was to be fostered by maintaining a climate of mutual distrust among his vassals. The objective was maintaining the authority (power) of the autocrat; the method was destruction of collegiality. I suspect that we would agree that a chairman, a dean, or even an academic vice-president is not a prince, and that methods proposed by Machiavelli generally are neither useful nor acceptable as the basis for the conduct of affairs of American academic institutions or the achievement of their goals. However, his focused attention on disrupting collegiality and the techniques he advocated tell us a great deal about the role collegiality can play in organizational decision making and the forces that can disrupt it. Thus, unlike the promotion of disruption and mutual distrust, the maintenance of a collegial environment requires the fostering of opportunities for constructive interactions on a continuing basis between individuals, within committees, and between committees and executives. A posture of interrelationships based principally on reacting only to crises-whether major or minor-actually helps to undermine constructive working relationships between peers and keeps the process of collegiality under tension. To the contrary, group interaction both to plan for the future of the institution and to address both immediate and future issues of its activities is a key to the maintenance of collegiality. I propose that collegiality depends upon group Vol. 68, No. 2, March-April
310 310
GOLDSTEIN M. GOLDSTEIN
participation in the planning and operational process at each level of the institution. It requires fostering of the attitude "we are in this together." It does not mean that all decisions require group approval; however, at a minimum, the approach to the solution of many problems should include group discussion. Accepting the premise that continuing interaction and group participation are keys to collegiality, I suggest that the ground rules for maintaining collegiality include: Each member of the group must agree to the sharing of responsibility, of having general knowledge about, and being sensitive to the professional and organizational needs of every other member of the group. Group action, including recommendations to the group leader, must be based on information and sensitivity, not on peripheral issues ("other agendas") or on matters of organizational or professional turf. This does not mean that every member of the collegium always gets what he wants or even what he feels is needed. It means that decisions or recommendations are made by the group based upon a recognition of their impact on individuals, on the group, and on the institution. In response, decisions of the leadership on recommendations must be promptly transmitted and explained so that the collegium knows what has happened and why. Prolonged wondering by the staff of what might happen hardly supports sharing of responsibility. Within this framework of personal and group interactions, it is also important to remember that "no" for an answer to an individual's request or the group's recommendation, is better than no answer. The former-a decline sets the stage for whatever the next step, if any, should be; hopefully, it will lead to the development of an acceptable alternative. Failure to respond is frustrating, too often perceived as lack of interest or of fear to act and can lead to intemperate reaction. Sensitivity also includes avoiding surprises. What would one like to know if in the other person's role? As an administrative executive, I recognize fully the importance of delegation of responsibility and of the authority needed to meet that responsibility. However, people to whom responsibilities are delegated must keep me informed of accomplishments, failures, and potential trouble spots-for my information. The faculty needs to recognize that "everyone has a boss;" me too. I must be informed and prepared to alert my boss to problems, potential problems, and successes. Because a responsibility has been delegated, it does not mean that the chief is not concerned or interested in it. Surprises to each other, to the chief, or from the chief, are administrative pitfalls and must be conscientiously avoided-surprises are the fuel of confrontation, not collegiality. Bull. N.Y. Acad. Med.
MAINTENANCE MAINTENANCE
311
A clear definition of authority. Who makes what decision must be clearly understood by all members of the collegium. It also defines who is responsible for making decisions and keeps issues from "falling between the cracks." In addition, the decision making process has to be understood-chain of command, the role of committees, delegated authorities, etc. Who is the "they" whom we are too often told said yes or no-or is responsible for saying yes or no; also who is responsible for initiating discussion of an issue. "Who is responsible" should never be an unanswered question. Responsibility for decision making must be unambiguous and clearly understood by all members of the collegium. The operation of an academic health center is so broad that "town meeting" methodologies are rarely effective for collegial discussion. Thus, committees are organized to represent the knowledge, needs, and wisdom ofthe collegium. Definition of role is particularly important in committee activity-the operational locus of institutional collegiality. A committee can easily end up in conflict with the executive because the committee perceives its role as other than its actual charge. Committees can be action committees in which the decision of the committee is the final word. Although final authority is true for juries in the American judicial system, it is rarely true for committees in medical or educational institutions. More often, committees are advisorypresenting recommendations. If the committee is advisory, everyone needs to understand that role. There are situations in which the executive cannot or should not accept a committee's recommendation. However, a wise executive does not ask an advisory committee for an opinion unless he is prepared to accept it. If he does not accept it, the advisory committee certainly deserves an explanation. Finally, a committee can be a discussion group not charged with consensus development. An issue is presented for discussion by the individuals in the group. Members are there to learn from each other and to make certain that each member understands the several aspects of the issue. A committee recommendation is not part of the agenda. Again, the key to maintaining collegiality between members of a committee and between the committee and the institution requires that each member of the committee and the executive understand the role of the committeedecision making, advisory, or a selected forum for discussion.
The mechanism for the adjudication of conflict tests the system. Most academic health centers have a formal appeal mechanism. By the time this mechanism is initiated, collegial relationships have generally broken down. Thus, the informal appeal mechanism is an important initial step in preserving collegial relationships. Assuming an important difference of opinion on some Vol. 68, No. 2, March-April
312
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M. GOLDSTEIN
matter-between two colleagues, between a person and his chief, or between two units of the collegium-each needs to understand that it is acceptable and desirable for both to agree to seek a joint audience with the next level of authority. A shortage of a resource (space, personnel, funds) leading to a perception of inequitable distribution is often the reason for an informal appeal; another example is a chiefs decision not to support a tenure or a promotion request. Of great concern, the suspicion of behavior unacceptable to the collegium can test the fiber of the group. The fact that prior to resorting to the institutional grievance mechanism a collegial appeal mechanism is available in itself can often serve to resolve the problem.
Organizational loyalty-loyalty by the faculty to each other, and of the group to the institution. By loyalty I do not mean blind allegiance; I mean loyalty as an expression of pride in the organization and in each member's association with it. The reputation and image of the individual and of the unit are closely linked to and often depend upon the reputation and status of the organization. In the hurly-burly of everyday problems and internal competition, people under stress too often forget Spinoza's admonition that each man is an important part of the whole. The issue is to promote and to maintain organizational identification and pride, pride in being identified as a member of the collegium. It requires taking the time at every level to provide for staff participation and for information transfer to members of the staff. Regular meetings of appropriate staff at each level and between levels are absolutely essential for the sharing of information, presentation of issues, discussion of common problems, making recommendations, etc. It reinforces the identity of the organization, the important role of the individual in the group, and the importance of the group per se; it supports the maintenance
of collegiality. Respected leadership. Staff at every level want to be proud of their leaders and peers. There certainly can be disagreement with the leader or with a colleague on matters, but being associated with people whom each member of the collegium respects is critical. A respected and loyal opposition is not a bad thing. Understanding that everyone has a right to disagree-to disagree constructively-and not become an enemy, helps to maintain collegiality. A difference of opinion should not be personalized. There is an old saying that today's enemy is tomorrow's friend. Likewise, today's opponent can also be tomorrow's colleague. I need to respect him, understand his posture-even if I do not agree with his position. Cordiality begets cordiality; the sum of cordialities is collegiality. Bull. N.Y. Acad. Med.
MAINTENANCE
MAINTENANCE
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Now to address the disincentives for collegiality. These include an executive who fails to recognize the existence of problems important to the activities or morale of the collegium; does not request input from the members of the collegium on matters of concern to it; gives the appearance of working primarily with only a selected few members of the collegium; hesitates to delegate responsibility to members of the collegium and denies authority to those delegated to meet assigned responsibilities; or provides inadequately for regular communication with and within the collegium. A collegium can be a disincentive if it communicates poorly with the executive or within itself; fails to agree that it is unacceptable to pursue a course that may be good for one segment of the collegium but can be destructive to the institution or to another segment of the collegium; does not honor its members for distinguished performance or chastise its members for unacceptable performance; fails to share resources with other members of the collegium (e.g., financial assets, expensive equipment, space); the syndrome of "what is mine, is mine; what is yours is negotiable," hesitates to address sensitive issues or to participate in developing solutions to them; or pursues goals in conflict with the primary goals of the academic health center: development of new knowledge, teaching and information transfer, related health care services. In summary, maintenance ofcollegiality requires continuing effort by every member of the collegium; it does not just happen. It depends on leadership, recognition of responsibility, sensitivity, definition of roles, the right to disagree, and creating opportunities for constructive interaction. Maintaining collegiality depends upon pride in each other and in the organization. It means that each member of the group must recognize the importance of collegiality for the maintenance and health of the group and the consequences of its failure. Each member of the staff must work actively to maintain collegiality or it will disappear and be replaced by authoritarianism and/or confrontation. Maintenance ofcollegiality is not a process characterized either by avoiding the consideration of problems or the winning of internal battles; it is characterized by active participation in institutional activities by all members of the faculty-each participant concerned with the welfare of the group and institution as well as with his own needs. The operating principle is: We are in this together to meet the professional goals of the collegiumgoals to which we have all agreed, both leadership and faculty.
Vol. 68, No. 2, March-April
MAINTENANCE OF COLLEGIALITY* MURRAY GOLDSTEIN, D.O., M.P.H. Director National Institute of Neurological Disorders and Stroke Bethesda, Maryland
T o PLACE THE MAINTENANCE OF COLLEGIALITY in an instutional perspec-
tive, it is important to recall what the institutional administrative setting is in the usual American academic health center. The property and fiscal resources of the center are generally, "owned" by a board of trustees, the members of which are appointed by a yet higher authority. The board consists primarily of distinguished people from the community, but people who are rarely members of the academic health center-people not members of the academic health center collegium. The board generally appoints a chief executive officer (e.g., vice president for health affairs, executive dean) responsible to the board for the conduct of the affairs of the center; the executive officer may or may not be a member of the collegium. In turn, the executive officer appoints department and division chairmen to assist him in meeting the academic goals of the institution and to assist him in its governance. These administrative officers-chairmen-serve at the pleasure of the executive officer; these chairmen are usually members of the collegium. Other members of the faculty with academic tenure are not necessarily involved directly in the governance of the institution but are core members of the collegium and responsible for the internal management of the institution's affairs. The point to be made is that all members of the academic health center at all levels are appointed to it directly or indirectly by an executive officer responsible to a board of trustees. Having established this, we can now focus on the ground rules for the maintenance of constructive inter-relationships of the professional members of the academic health center-the collegium in meeting the professional goals of the academic health center: developing new knowledge, teaching and information transfer, and related health care services-goals endorsed by the board of trustees, the responsibility of the executive officer and shared by him with members of the collegium. For the * Presented as part of a Symposium on Academic Collegiality in American Medicine held by the Foundation for Neurosurgical Research at Camp Trowbridge, NY, September 7-9, 1990. Address for reprint requests: Building 31, Room 8A52, NINDS, Bethesda, MD 20892
Bull. N.Y. Acad. Med.
MAINTENANCE
-~~A
N
EN
N
E
0
309
purposes ofthis paper, collegiality is defined as the method by which members of the collegium-the faculty and its staff-interact with each other and with the executive officer to achieve the professional goals of the academic health center. I start with these propositions: collegiality is useful; internal governance of the affairs of the collegium is desirable; and that collegiality is important in fostering institutional status, in maintaining academic freedom, in prompting individual pride, and as a method for regular information exchange. My charge is to address how to maintain that collegiality or, conversely, how to prevent its disruption; put another way, how to strengthen and maintain internal relationships so that the members of the collegium-the facultyhave a critically important role in sharing responsibility with each other for addressing the professional goals of the institution. Machiavelli in his advice to the Prince provided him with principles to constrain and disrupt collegiality. He advocated that maintaining the authority of the sovereign depended upon keeping the peerage distrustful of each other, each one's position secure only in believing he had a special and individual relationship with the Prince. Thus loyalty was acceptable only if it was loyalty to the Prince, and loyalty to the Prince was to be fostered by maintaining a climate of mutual distrust among his vassals. The objective was maintaining the authority (power) of the autocrat; the method was destruction of collegiality. I suspect that we would agree that a chairman, a dean, or even an academic vice-president is not a prince, and that methods proposed by Machiavelli generally are neither useful nor acceptable as the basis for the conduct of affairs of American academic institutions or the achievement of their goals. However, his focused attention on disrupting collegiality and the techniques he advocated tell us a great deal about the role collegiality can play in organizational decision making and the forces that can disrupt it. Thus, unlike the promotion of disruption and mutual distrust, the maintenance of a collegial environment requires the fostering of opportunities for constructive interactions on a continuing basis between individuals, within committees, and between committees and executives. A posture of interrelationships based principally on reacting only to crises-whether major or minor-actually helps to undermine constructive working relationships between peers and keeps the process of collegiality under tension. To the contrary, group interaction both to plan for the future of the institution and to address both immediate and future issues of its activities is a key to the maintenance of collegiality. I propose that collegiality depends upon group Vol. 68, No. 2, March-April
310 310
GOLDSTEIN M. GOLDSTEIN
participation in the planning and operational process at each level of the institution. It requires fostering of the attitude "we are in this together." It does not mean that all decisions require group approval; however, at a minimum, the approach to the solution of many problems should include group discussion. Accepting the premise that continuing interaction and group participation are keys to collegiality, I suggest that the ground rules for maintaining collegiality include: Each member of the group must agree to the sharing of responsibility, of having general knowledge about, and being sensitive to the professional and organizational needs of every other member of the group. Group action, including recommendations to the group leader, must be based on information and sensitivity, not on peripheral issues ("other agendas") or on matters of organizational or professional turf. This does not mean that every member of the collegium always gets what he wants or even what he feels is needed. It means that decisions or recommendations are made by the group based upon a recognition of their impact on individuals, on the group, and on the institution. In response, decisions of the leadership on recommendations must be promptly transmitted and explained so that the collegium knows what has happened and why. Prolonged wondering by the staff of what might happen hardly supports sharing of responsibility. Within this framework of personal and group interactions, it is also important to remember that "no" for an answer to an individual's request or the group's recommendation, is better than no answer. The former-a decline sets the stage for whatever the next step, if any, should be; hopefully, it will lead to the development of an acceptable alternative. Failure to respond is frustrating, too often perceived as lack of interest or of fear to act and can lead to intemperate reaction. Sensitivity also includes avoiding surprises. What would one like to know if in the other person's role? As an administrative executive, I recognize fully the importance of delegation of responsibility and of the authority needed to meet that responsibility. However, people to whom responsibilities are delegated must keep me informed of accomplishments, failures, and potential trouble spots-for my information. The faculty needs to recognize that "everyone has a boss;" me too. I must be informed and prepared to alert my boss to problems, potential problems, and successes. Because a responsibility has been delegated, it does not mean that the chief is not concerned or interested in it. Surprises to each other, to the chief, or from the chief, are administrative pitfalls and must be conscientiously avoided-surprises are the fuel of confrontation, not collegiality. Bull. N.Y. Acad. Med.
MAINTENANCE MAINTENANCE
311
A clear definition of authority. Who makes what decision must be clearly understood by all members of the collegium. It also defines who is responsible for making decisions and keeps issues from "falling between the cracks." In addition, the decision making process has to be understood-chain of command, the role of committees, delegated authorities, etc. Who is the "they" whom we are too often told said yes or no-or is responsible for saying yes or no; also who is responsible for initiating discussion of an issue. "Who is responsible" should never be an unanswered question. Responsibility for decision making must be unambiguous and clearly understood by all members of the collegium. The operation of an academic health center is so broad that "town meeting" methodologies are rarely effective for collegial discussion. Thus, committees are organized to represent the knowledge, needs, and wisdom ofthe collegium. Definition of role is particularly important in committee activity-the operational locus of institutional collegiality. A committee can easily end up in conflict with the executive because the committee perceives its role as other than its actual charge. Committees can be action committees in which the decision of the committee is the final word. Although final authority is true for juries in the American judicial system, it is rarely true for committees in medical or educational institutions. More often, committees are advisorypresenting recommendations. If the committee is advisory, everyone needs to understand that role. There are situations in which the executive cannot or should not accept a committee's recommendation. However, a wise executive does not ask an advisory committee for an opinion unless he is prepared to accept it. If he does not accept it, the advisory committee certainly deserves an explanation. Finally, a committee can be a discussion group not charged with consensus development. An issue is presented for discussion by the individuals in the group. Members are there to learn from each other and to make certain that each member understands the several aspects of the issue. A committee recommendation is not part of the agenda. Again, the key to maintaining collegiality between members of a committee and between the committee and the institution requires that each member of the committee and the executive understand the role of the committeedecision making, advisory, or a selected forum for discussion.
The mechanism for the adjudication of conflict tests the system. Most academic health centers have a formal appeal mechanism. By the time this mechanism is initiated, collegial relationships have generally broken down. Thus, the informal appeal mechanism is an important initial step in preserving collegial relationships. Assuming an important difference of opinion on some Vol. 68, No. 2, March-April
312
312
M. GOLDSTEIN
matter-between two colleagues, between a person and his chief, or between two units of the collegium-each needs to understand that it is acceptable and desirable for both to agree to seek a joint audience with the next level of authority. A shortage of a resource (space, personnel, funds) leading to a perception of inequitable distribution is often the reason for an informal appeal; another example is a chiefs decision not to support a tenure or a promotion request. Of great concern, the suspicion of behavior unacceptable to the collegium can test the fiber of the group. The fact that prior to resorting to the institutional grievance mechanism a collegial appeal mechanism is available in itself can often serve to resolve the problem.
Organizational loyalty-loyalty by the faculty to each other, and of the group to the institution. By loyalty I do not mean blind allegiance; I mean loyalty as an expression of pride in the organization and in each member's association with it. The reputation and image of the individual and of the unit are closely linked to and often depend upon the reputation and status of the organization. In the hurly-burly of everyday problems and internal competition, people under stress too often forget Spinoza's admonition that each man is an important part of the whole. The issue is to promote and to maintain organizational identification and pride, pride in being identified as a member of the collegium. It requires taking the time at every level to provide for staff participation and for information transfer to members of the staff. Regular meetings of appropriate staff at each level and between levels are absolutely essential for the sharing of information, presentation of issues, discussion of common problems, making recommendations, etc. It reinforces the identity of the organization, the important role of the individual in the group, and the importance of the group per se; it supports the maintenance
of collegiality. Respected leadership. Staff at every level want to be proud of their leaders and peers. There certainly can be disagreement with the leader or with a colleague on matters, but being associated with people whom each member of the collegium respects is critical. A respected and loyal opposition is not a bad thing. Understanding that everyone has a right to disagree-to disagree constructively-and not become an enemy, helps to maintain collegiality. A difference of opinion should not be personalized. There is an old saying that today's enemy is tomorrow's friend. Likewise, today's opponent can also be tomorrow's colleague. I need to respect him, understand his posture-even if I do not agree with his position. Cordiality begets cordiality; the sum of cordialities is collegiality. Bull. N.Y. Acad. Med.
MAINTENANCE
MAINTENANCE
313
Now to address the disincentives for collegiality. These include an executive who fails to recognize the existence of problems important to the activities or morale of the collegium; does not request input from the members of the collegium on matters of concern to it; gives the appearance of working primarily with only a selected few members of the collegium; hesitates to delegate responsibility to members of the collegium and denies authority to those delegated to meet assigned responsibilities; or provides inadequately for regular communication with and within the collegium. A collegium can be a disincentive if it communicates poorly with the executive or within itself; fails to agree that it is unacceptable to pursue a course that may be good for one segment of the collegium but can be destructive to the institution or to another segment of the collegium; does not honor its members for distinguished performance or chastise its members for unacceptable performance; fails to share resources with other members of the collegium (e.g., financial assets, expensive equipment, space); the syndrome of "what is mine, is mine; what is yours is negotiable," hesitates to address sensitive issues or to participate in developing solutions to them; or pursues goals in conflict with the primary goals of the academic health center: development of new knowledge, teaching and information transfer, related health care services. In summary, maintenance ofcollegiality requires continuing effort by every member of the collegium; it does not just happen. It depends on leadership, recognition of responsibility, sensitivity, definition of roles, the right to disagree, and creating opportunities for constructive interaction. Maintaining collegiality depends upon pride in each other and in the organization. It means that each member of the group must recognize the importance of collegiality for the maintenance and health of the group and the consequences of its failure. Each member of the staff must work actively to maintain collegiality or it will disappear and be replaced by authoritarianism and/or confrontation. Maintenance ofcollegiality is not a process characterized either by avoiding the consideration of problems or the winning of internal battles; it is characterized by active participation in institutional activities by all members of the faculty-each participant concerned with the welfare of the group and institution as well as with his own needs. The operating principle is: We are in this together to meet the professional goals of the collegiumgoals to which we have all agreed, both leadership and faculty.
Vol. 68, No. 2, March-April
