Leadership Issues in Multi-Site Teaching and Research Hospital

The challenge
Complexities in teaching hospitals abound. Clinical services are continually evolving to meet patient needs and changing practices in environments of inevitable resource constraint.  The challenges of including meaningful front line and external stakeholder input in decision-making can be daunting.

This one-day session focused on the leadership function and structure in a major clinical service at a large multi-site teaching and research facility. The purpose of the session was to gather broad input, generate meaningful discussion and craft effective recommendations from those who would be affected, directly and indirectly, by a change in leadership structure.

Specific Forum objectives were to:

  • Clarify issues (current state), identify desired outcomes (future state) and surface ideas for a plan to achieve those outcomes;
  • Provide an opportunity for key stakeholders to assist clinical services directors in creating best solutions; and
  • Inform decision-making (as distinct from making decisions at the Forum).


The facilitator collaborated with the client to develop a background survey tool to gather relevant opinion and input prior to the session. The survey allowed meaningful, confidential input from external stakeholders, front line staff and all forum participants. It also enabled a common starting point for discussions in a tight time frame.

Survey input was assimilated into a background reading document and circulated to forum participants prior to the session. Survey results, along with a review of relevant materials provided by the client, formed the foundation of an effective facilitation strategy for this one-day issues forum.

Forum discussions and recommendations were assimilated into a proceedings document that guided the leaders’ decisions and ultimately, the restructuring of the service.


Forum participants, front line staff and external stakeholders felt engaged and respected in the generation and implementation of leadership structure solutions.

The forum informed and enriched the solutions that were assessed and ultimately implemented by this clinical service.


The facilitator created an atmosphere in which complex, challenging and potentially fraught issues could be discussed openly and thoroughly in a tight time frame. The process provided opportunity for meaningful input from front line staff and external stakeholders into decisions that ultimately affected them.

There is an art to ensuring full engagement and meaningful participation while staying on track with a challenging agenda. The facilitator was well-versed in the issues that needed to be aired and was able to manage discussions and surface points of consensus in a tight time frame. Discussions were framed within institution-wide mission, vision and values.


Client Feedback
“This meeting was a perfect platform for us, we couldn’t ask for a better forum.  The background and pre-read document were very helpful and the forum moved forward effectively throughout the day.

The facilitator’s expertise allowed our team to shine and enabled great participation from everyone. Discussions were honest, open and respectful because the facilitator created a comfortable environment. She framed questions effectively in order to bring out key points and refocus discussions when they went astray.

The session met our needs exactly”.