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Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.

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Surgical Chairs Playbook Offers Proven Strategies for High-Performance Leadership

Tony Peregrin

February 8, 2023

Surgical Chairs Playbook Offers Proven Strategies for High-Performance Leadership

Transitioning into the role of the surgical chair can be a gratifying and challenging experience.

To help current and future surgeon leaders feel more confident and have an easier time navigating the process, the ACS and the Society of Surgical Chairs (SSC), through support from the ACS Foundation, have released a Surgical Chairs Playbook that features innovative leadership strategies, evidence-based practices, personal experiences, and advice.

“More than 80 extraordinary leaders in academia have contributed to the chapters, so—taken together—this book is a comprehensive reflection on the skills and characteristics a surgeon can learn to be an effective leader or chair. There also are elements that are meaningful for those who have moved into a dean’s role, the hospital C-suite, or who desire those positions,” said ACS Executive Director and CEO Patricia L. Turner, MD, MBA, FACS.

Developed from a conversation at an SSC meeting, the Playbook has been a passion project for its four surgeon editors—Robert S. D. Higgins, MD, MSHA, FACS, president of Brigham and Women’s Hospital and executive vice-president of Mass General Brigham in Boston, MA; Jeffrey B. Matthews, MD, FACS, Dallas B. Phemister Professor of Surgery and chair of the Department of Surgery at UChicago Medicine in IL; Todd K. Rosengart, MD, FACS, professor and DeBakey-Bard Chair of the Michael E. DeBakey Department of Surgery at Baylor College of Medicine in Houston, TX; and Sandra L. Wong, MD, MS, FACS, William N. and Bessie Allyn Professor of Surgery and chair of the Department of Surgery at Dartmouth Hitchcock Medical Center and the Geisel School of Medicine in Lebanon, NH.

Drs. Robert Higgins, Jeffrey Matthews, Todd Rosengart, and Sandra Wong
Drs. Robert Higgins, Jeffrey Matthews, Todd Rosengart, and Sandra Wong

“It’s clear that the role of the department chair is evolving in many ways given the complicated nature of healthcare in the current environment,” said Dr. Higgins. “The Playbook offers valuable perspectives and lessons learned that could really make a difference for our colleagues.”

Dr. Matthews added that the book is a must-read for leaders in today’s surgical department: “The chair leads a complex enterprise engaged in multiple missions across a matrixed organization. The practical advice and guidance are invaluable.”

The Playbook is organized into four sections: Managing Missions, Managing Oneself, Managing People, and Managing Business. Within each section, the content is structured in a question-and-answer format, providing readers the opportunity to quickly identify topics that may be of particular interest. Topics include:

  • Common leadership styles
  • Evaluating your leadership performance
  • Effective strategies for developing curriculum and faculty
  • Role of the chair in handling student and resident misconduct
  • Best practices for recruitment and building a diverse team
  • Best practices for tracking research productivity

“The guidance on these topics from experienced surgical chairs is paramount,” said Dr. Rosengart. “We want to make it easier for current and future chairs to function more effectively and avoid pitfalls.”

Dr. Wong agreed, saying that the Playbook will serve an unmet need in the surgical community, “A few great leadership books are available, but this one is written by surgeon leaders for surgeon leaders.”

Many of the leadership principles outlined throughout the book are tethered to specific competencies, including the ability to conduct rigorous and measurable self-assessment; developing consistent and intentional communication strategies; engaging in effective delegation of tasks and responsibilities; and the ability to recruit, develop, and oversee a diverse surgical department, among other competencies.

Leadership Skills Development

The “born leader” perspective is generally understood to be an out-of-date concept; today, leadership skills are known to be the result of “experience, insights, and techniques that enable individuals to lead others,” according to Playbook authors. “Some people may have more aptitude, interest, or experience in the leadership role, but everyone can acquire the associated skills and improve with practice.”

They note that the “acquisition of surgeon leadership skills begins in surgical residency training and is a part of the competency required to provide team-based clinical care. Early career opportunities to lead committees or teams offer real-world scenarios to try out different styles of leadership in low-stakes situations. However, these ‘leadership classrooms’ require self-direction and deliberate consideration.”

The development of these competencies can continue throughout the career of any practicing surgeon, as they engage in opportunities to apply these skills in their current environment. For those who aspire to, or are selected for, department leadership roles, it often is helpful to obtain additional formal training.

Table 1. Leadership vs. Management





Impact through influence

Impact through direct reports
Provide vision
Implementation supporting vision
Chart or change course
Follow the path
Assessed based on ideas
Assessed based on execution
Selected for capability fitting the moment
Selected for technical skills

Leadership vs. Management

According to the Playbook, a key component of transformational leadership, at every level and setting, is the ability to determine the differences between leadership and management—both of which serve a key role in guiding a department or team.

“As a general rule, leadership involves setting the tone, driving the desired culture, and providing the vision for an organization,” note Playbook contributors. “Management is much more technical in nature and often involves elements that can be measured more directly as outcomes. Management tends to be more driven by the reporting structure of the organization, while leadership at its best, transcends the organizational chart.” (See Table 1).

The Surgical Chair’s Leadership Role in Education

Leading a surgical educational program is another key facet of the surgical chair role. Developing and maintaining a productive education program starts with communicating clear expectations for faculty. According to the Playbook, failure to establish such expectations “often leads to a small cohort of highly motivated faculty carrying a disproportionate share of the teaching burden. Outlining clear expectations also significantly enhances accountability during the annual performance review.”

Expectations of faculty could include permitting learner participation in operative procedures according to ability; providing constructive, direct, and ongoing feedback to residents regarding progress; and completing learner evaluations with 14 days of the end of the rotation.

“Faculty members can differ in their educational expertise: some are engaging and enthusiastic in the classroom presenting core curricular topics, while others are at their best conducting bedside teaching rounds with a small group of students,” the authors advised. Surgical chairs and other educational leaders should work to align faculty skills and interests with appropriate instructor roles and functions.

Available Electronically or in Print

The ACS is committed to providing career-enhancing opportunities and resources for surgeons in all specialties in all practice settings and all locations.

“We recognize the pivotal role that surgical chairs play in the lives of their faculty, trainees, and team members throughout their departments,” said Dr. Turner. “This book is indispensable to those who are sitting chairs, those who aspire to be chairs, those who aspire to leadership at other levels—all who perceive themselves as surgical leaders.”

A PDF copy of the Surgical Chairs Playbook is available for purchase and download at facs.org/playbook. A hardcopy version also is available via the same website.

Tony Peregrin is Managing Editor, Special Projects, in the ACS Division of Integrated Communications in Chicago, IL.