Leading a Department You Didn't Build
Everything Here Belongs to Someone Else
You just became the new department leader in academic medicine, and on your first Monday you notice something strange. The meeting schedule doesn't make sense. Two faculty members clearly don't speak to each other, and everyone else seems to know why. Half the department still refers to how things were done "before."
Welcome to inheriting a leadership role as a physician leader. You didn't hire these people. You didn't create this culture. You didn't choose these problems. But they're all yours now.
Resist the Urge to Renovate
The single biggest mistake I see when a new department leader steps into academic medicine is treating the job like a renovation project. Tear out the old cabinets. Rip up the floors. Start fresh.
It's understandable. You were chosen to bring something different. But the people in that department have been living in this house for years. Some of them helped build it. When you start tearing things out on day one, you're not just changing processes. You're telling people their work didn't matter.
Marshall Goldsmith makes this point well in What Got You Here Won't Get You There. The instinct to add value to everything -- to improve every system you touch -- can be one of a leader's most destructive habits. In an inherited department, that instinct is especially dangerous.
Learn What's Load-Bearing
Before you change anything, understand what's holding the place up. Every department has structures that look arbitrary from the outside but exist for real reasons.
- That awkward meeting schedule? It might be the only time three divisions can overlap without conflicting with clinical duties.
- The informal workflow nobody documented? It might be what actually keeps referrals moving.
- The faculty member with an outsized voice? They might be the person everyone trusts when things go sideways.
Spend your first sixty days as an anthropologist, not an architect. Watch how things actually work, not just how the org chart says they should. Edgar Schein's Humble Inquiry is a great resource here -- the quality of your leadership depends on the quality of your questions.
Name What You See Without Judging What Came Before
You're going to find things that need to change. But how you frame the problem determines whether people follow you or dig in.
There's a difference between "This process is broken" and "I've noticed this creates friction -- I'd like us to look at it together." The first implies your predecessor failed. The second invites collaboration.
Think of it like a new head coach walking into a locker room mid-season. The players didn't choose you. Some loved the last coach. If you trash the old playbook, you lose the room before you've called a single play.
How a New Department Leader Builds Legitimacy
Your title gives you authority. It does not give you legitimacy. When you're inheriting a leadership role as a physician who didn't build the department, the legitimacy gap is real.
Here's what closes it:
- One-on-one meetings with every faculty member in the first month. Not to present your vision. To hear theirs.
- Follow through on small things. If someone mentions the printer has been broken for six months, get it fixed. That signals you listen and act.
- Be transparent about what you don't know. "I don't have the history on this -- help me understand" is one of the most powerful sentences a new leader can say.
Research from the Center for Creative Leadership shows that leaders who transition into new roles succeed or fail based on relationship quality, not strategic brilliance.
Decide What to Keep, What to Change, and What to Leave Alone
After you've listened and learned, you'll start to see three categories:
Things that work well. Protect them publicly. Say out loud that they work and that you're keeping them.
Things that need to change. Pick one or two. Not ten. Earn credibility before you tackle the hard stuff.
Things you don't love but aren't worth the fight. Every department has these. Let them go for now. You have a finite amount of change capital. Spend it where it matters.
The Department Doesn't Need a Founder. It Needs a Steward.
The leaders I've coached who do this well share a common trait. They stop trying to make the department theirs and start trying to make it better. They hold their predecessor's legacy with respect and their own vision with patience.
You weren't here when this department was built. But you're here now. And how you lead through this transition will define not just your tenure, but how this team thinks about leadership for years to come.
If you'd like to learn more, contact us to schedule a time to chat.
