I recently had the opportunity to talk about spanning boundaries in the Brody School of Medicine with our Dean, Dr. Paul R.G. Cunningham, MD, FACS.

Constant learning is essential for successful leadership in any setting; however, there is a risk of “walking with kings” so frequently that the common touch is either forgotten or never learned. When that situation emerges leadership becomes only theoretical. Recently the Dean was sent a copy of “The Thin Book of Appreciative Inquiry” by a member of the local hospital board, and a few days later “Step Back from the Baggage Claim” was offered by a dean newly appointed to a school in the Northeast. Dr. Cunningham confessed that he was beginning to feel like a goose being prepared to be harvested for foie gras.

In a medical school, there is a need for continuous communication, and sometimes hopes of a common language. Academic medicine can have strong boundaries however, and efforts to speak in any one language can be like talking to deaf teenagers. In the Brody School of Medicine, it’s easy for our attention to be monopolized by our individual tribes and languages at the expense of the relationships that can span their boundaries. Our challenge is to think creatively about influencing those boundaries to be permeable enough to allow migrations and cross-pollination.

We have four individual tribes and we will describe each here in the ways we often hear them described by the other tribes. We’ll start with the Strong Teachers: the salt of the earth and our institutional raison d’être. There are the keepers of the faith, and they embody the mission. This tribe represents the purpose of the entire system and thereby “hosts” the other tribes.

The Basic Scientists wear hair shirts. They support the full spectrum of academic medicine: working with students who have incredible amounts of talent and energy, researching new methods and insights, and constantly seeking the resources that sustain them. The Clinical Scientists, caring for patients as well as learners, wear their avocation with pride and an almost “earned arrogance.” They are often the epitome of high commitment and impassioned sacrifice.

Finally, we have the Administrators: the assistant and associate deans, the directors of support functions like human resources and grants administration, and the Dean himself. Sometimes, even the department chairs are part of this tribe. Administrators can be seen as the Pharisees and the Sadducees, if not geeks. Somewhat aristocratic, they appear to be self-sufficient, middle-class businesspeople, sometimes finding it difficult to be fully accepted when visiting one of the other tribes.

One might ask: are there subsystems among these tribes    that span boundaries? Yes, and the frequency varies with the level in the formal hierarchy. At upper levels, they will coalesce, combine and maybe even conspire on a campaign basis to achieve a goal. At lower levels, where one finds junior faculty, inter-tribal subsystems are more numerous and, most remarkably, more durable. Taking a step back, one can then see that all of these tribes and subsystems are components in the larger system of healthcare in eastern North Carolina with yet more boundaries.

So there’s our territory. How do we work with the boundaries and their dynamics? What are we learning as we go along? Come back for later installments!

2 thoughts on “Boundaries and the Tribes They Contain

  1. David Musick says:

    This article is nice, but only scratches the surface of the organizational complexities associated with the structures of academic medical centers. Specifically, it puts people into four categories but fails to recognize that a given individual can fit simultaneously into 2 or more of these categories. It also resurrects a tired old stereotype of “administrators as the enemy”, which in my view does not contribute to successful collaboration.

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