How to handle an old department head who was replaced because of malfunctioning but is still around

A department head was replaced because of malfunctioning. A new head of the department has started and created a new momentum while the old head was on sabbatical leave for half a year. However, the previous head of the department will be back in a few months. Which measures should/could we take to prevent a collapse of the momentum and improvement created by the new head given that we have to live with the fact that old head will be around?

Prof. AB is a well renowned specialist, head of her department at our academic hospital for over 12 years. She has an excellent research reputation world-wide and brings in most of the research grants for her department. The research in her department rests completely on her shoulders and reputation.

In the past 8 years various audits (clinical audits, quality audits, training audits) have pointed out that communication of the management team, which was chaired by AB, was below par, staff and resident’s voices were not heard, and collaboration between the management team and people on the floor was poor. Several actions have been taken during those years. These resulted in short-lasting improvements, but did not address the core of the problem; and complaints kept returning.

In January 2015 during a regular training-audit by the Dutch association of specialists in her field, the residents in training reported that they collectively felt unsafe and not at ease during training at this department. At that point we (board of the division) decided to ask a well-renowned external party to examine this department extensively. The resulting report was crisp and clear: the management and communication and management style of the head of the department and at least one other management team member was at the root of the problem. Replacing them was the only option. That was what we did: AB stepped down in February 2016 as head and an interim-head from outside was appointed. After many discussions with the board of directors, we had to keep her on board because of her research and specific clinical qualities and to prevent reputational damage. In the meanwhile we searched for a successor and found an excellent candidate which started in January 2017. AB was asked to take a sabbatical leave for half-a-year starting at the same time as the newly appointed head started to give him a head-start. Since the new head has started and AB has been away, the department as undergone a metamorphosis. People are happier and working atmosphere has much improved. AB will return in July this year.

It is probably clear that AB is a quite strong personality who needs much “room” and doesn’t keep silent if she thinks things should be organized in a different way. People, especially younger staff members and residents, are scared to contradict her or to do things she wouldn’t approve.

Which measures should/could we take to prevent a collapse of the momentum and improvement created by the new head given that we have to live with the fact that she will be around?


Physician Handovers


Post-Acute Stroke Care

Participant comments on How to handle an old department head who was replaced because of malfunctioning but is still around

  1. Challenging situation of disruptive behaviour in a senior established member of a department which can be an impediment to or even a threat to quality of patient care. Soon after AB’s return, a conversation should occur between the new Head and AB outlining expectations of behaviour in the “new” department, why that is important and what the potential consequences for transgression would be under the new leadership. Appropriate ongoing monitoring and step-wise feedback will be required. If there is no change in behaviour, in the end the Board may well have to decide which is more important – the presence of AB, or a high functioning department delivering high quality patient care. No one person is indispensable.

  2. Hi Ivo
    It was proven that the relationship with the immediate manager is a key factor if not the most important factor in staff satisfaction on their workplace and in reducing burnout, apparently the previous manager is greatly talented and skillful in aspects rather than people management, that made your organization keen to retain her even with her negative influence on her peer and subordinates.
    In cases like this which we encountered in our organization, we sat the below steps to manage talents and potentials as wisely as possible:
    • Create a succession planning for each department head up to executive managers and leaders
    • Equip succession planning candidates with the tools to help them in the new leadership era through a one year leadership program that include both written and practicum aspects with coaching methodology of education.
    • Allocate the staff to an area of the best of their capabilities such as: writing Policies and procedures, running equipment and processing inventories, Units rounds and accreditation readiness, Computer and software engineering, etc…
    • The leader of that area usually set a performance management plan, that will be discussed with the staff member and agreed upon with her on the objectives and the area of influence ( this conversation may not sound easy, however emphasizing on the strong points of AB will support the discussion which should end with mutual agreement that AB will not be back to the area and will focus her energy somewhere else)

    The golden rule here, is that each staff member is talented somehow, and the key is to dig deeper and find where they could shine more and provide them with the best tools and support to give the best of themselves for the benefit of the patients and the organization at the end.
    Wish this could help you.

  3. I think this is an ideal opportunity to develop a “Speak Up” policy directed towards behavior (vs. the classical use of direct patient safety). Coaching junior staff on how to directly, immediately address negative behavior, and making sure leaders are on board and will fully support this, will have a powerful impact. She needs to see and feel the culture has changed. She needs to see the junior staff have been empowered to “Speak Up”, and that leadership will support them through that. It often takes only one or two events backed by leadership to change behavior.

  4. This is a personality issue and will never change regardless of how hard you try. A group of people other than the new Chairman should call for a meeting with the board to lay the facts and convince the board members and seek the boards direction based on that, the board is the key in solving such difficult situations otherwise you will end up having two leaders in one place, a state pf chaos and unhappy people.

  5. very interesting former comments and ideal situation to start working on developing a ‘learning team’ (as in Amy’s book Teaming).
    To me on the one hand there is a culture problem of hierarchy and fair where the younger ones can’t deal yet with (personalities like) AB. So like amal I would agree on using this situation as a ‘mirror’ to reflect on there own behavior to prevent it in the future, or at least to deal with it in a better way. A session with the team about this, could be very good.

    But also it is a situation with the wrong skills and personality in the wrong position for the managing part of the head role. I would be very curious if AB really likes being the head of the department and if so: why she likes it. Could be that it is about status (she wants control, old school doctor seniority) or could be that she really things she is a good head. In both cases the conversation or integration process should be about really letting her get to know herself better, being straight about the effect she has on her environment and to make sure that she can focus on the things she does good (ofcourse still with respect to her colleagues and within the set ‘boundaries’ of your organisation). In the ideal situation (regardless of regulations and boundaries): let her be the ‘critical and ‘loud’ person, and let her be the senior, but make sure that she will not have to be responsible for the managementpart anymore. In my experience most of the times the person who is in the middle of the misery, is doing things he/she doesn’t like, but isn’t aware of it and needs someone to show her and learn her a more relaxed and better way of working…. But this will take time and is a very delicate process.

    Anyway: you do need to work on both issues: context/team/culture and the person herself. Challenging 😉

  6. Hi Ivo,

    Comments above are extremely interesting and that of support, quality, reflecting , team culture etc.
    You have obviously been through a lot to have to come to the board to recommend changes.
    Health delivery is a business in its own right.
    A large corporate would replace the person and walk them out of the building with a separation cheque and support services. ( further training or mentoring for them to seek another position else where) Why are we different in the health industry.
    This sounds drastic and aggressive, but really is the only way,extricate your team from the problem and move on. Do not waste precious time and resources in feel good exercises. We can feel good by providing better services.

  7. I would like to build on SN’s comment as I fully agree with his/her questions. It seems to me inhuman to burden colleagues with the presence of the former chief. Why would you do this to people?

  8. Hi Ivo,

    We face similar situations. Some HODs step-down with a huge sigh of relief as they recognise that administration isn’t their forte and are happy to return to clinical and education. However, there are some who are unable to let go. In these cases, I would agree with SN and Ulli and find someway to arrange a “lateral” promotion for such individuals. Ultimately, a healthcare facility is subject to certain goals and KPIs. Including a responsiblity to ensure a healthy team to provide best care for patients.

  9. This is often difficult and we all have to face similar personalities in our organisation. If the individual is vocal and opinionated but at least not disruptive to the department’s plan. I find the following useful in my experience

    1) The HOD should talk to AB when she returns and engage her id Dept plans and set expectations on behaviour from senior members of department
    2) Narrow her work scope to focus on areas where she is strong and will be an asset
    3) for important decision, engage the department as a whole where AB influence may be diluted by the collective and decision made by majority vote
    4) As mentioned by others, she may not be a suitable head and may be relief not to be one so the situation may not be bad
    5) If she does turn out to be disruptive and undermines the new head, then it will be a decision of the institution whether she is so valuable that she has to be kept on. Again as mention by others, no one is indispensible

    1. Wee Joo-

      I like your approach. Be up front with AB regarding expectations-and hold her accountable. Focus on the positives and offer opportunities to expand on AB’s expertise. And as Joanna said below-maybe these opportunities may be in a lab further away from the dept!

  10. It is encouraging to note that the new department head has reinvigorated the department. Building on this momentum, perhaps an idea would be to bring in a firm that can conduct a workshop (through use of facilitators) based on improving communication and relationships in a healthcare environment. As we are acutely aware, communication is the key to exceptional patient care. The goals of this type of workshop would be to improve interdisciplinary teamwork and on individual communication skills. By having such a workshop everyone in the department is engaged and AB is not being singled out. Depending on the outcome of such a workshop it could become an annual training session or a mini-department retreat.

  11. Maybe it would be wise to only give AB a consulting contract which is limited to say three days a week. In her case this would be especially appealing as she could even more focus on research and would therefore much less interfere with the new clinical setup. And you would cut your costs….

  12. Very interesting issue presented. The dynamics of needing this person’s research and influence may complicate things until the organization gets to a point where you have to consider what is the true opportunity cost at risk – losing the research dollars/influence versus the risk of morale and the betterment of the department/organization. Many times, unfortunately, organizations drag their feet in doing what they know is the right thing to do, simply because it is painful. I think the organization should truly consider separating with that individual, or move them outside of the department to an Emeritus status away from exerting any influence over the prior department.

  13. Looking back at how this situation came about, it’s the well-known scenario that just because someone is good technically (research, etc) and leads as a subject matter expert, we assume that they will be a good leader. We’ve made that mistake at my health-care system as well. In your scenario, where it is a single strong person that you cannot separate from, I favor a discussion to more deeply trigger these research interests partnered with the hospital’s need for innovation that can result from this research. Play to the ego and strengths that others do not have in this research field. You really need for her to focus on this research and need to help to make it her idea. Then find her a bigger lab space that just happens to be farther away from the core of the department. Best of luck.

  14. You position is understandable and takes us back to module 1; reasearch grants $$ vs individuals behaviour and performance. I would still see this as performance management and the person to whom Prof AB is reporting will need to take handle of the situation and manage her performance and behaviour, have a clear set of rules put to her including expected behaviour in the work place and document all discussions.

    If she fails to perform within expected guidelines then unfortunately disciplinary actions as the way to go and the Board might have to intervene and advise her that her services are no longer required.

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