Finding candidates who can expand, improve, and replicate programs

1. Core qualifications

What are the core sets of skills required for the specific program envisioned? Must the candidate have a specific degree? Did they graduate from an especially strong program? These are the most basic elements of a job posting and job description.  In some cases these are obvious; as described below, the leader of a program focused on delivering clinical services should probably be clinically trained. The strength of their graduate program may be relevant if you are looked at a junior clinician: for a more senior clinician, other experiences and qualifications will likely assume greater importance.

It is more complicated for leaders of a programs focused on training because there there is no specific degree that is typically required, and courses or certificates on being an effective trainer are relatively rare.  And there are few programs focused specifically on leadership skills.  An MD seeking to broaden their career options may seek a degree in public health, but this does not necessarily include specific coursework in training or leadership. The one year LEND programs expose prospective clinicians to some of the issues. The only exception may be a certificate or degree in educational leadership.  The upshot: you must look beyond core qualifications to assess the leadership and training experience (as described below), which will likely require a more carefully constructed and extensive interview process.

In most cases, a program designed to deliver services should seek a leader trained to deliver services

I continue to be surprised by the number of programs with a strong focus on services but that are not headed by people actually trained to deliver services. Such programs are often long on aspiration but short on actual impact.

Some exceptions are understandable for larger organizations: a hospital or school district is a business, and so a strong business leader brings other management skills, and perhaps experience crafting and delivering on a strategic plan. A strong and experienced team of supporting clinicians or educators can complement such a leader, as long as they can take their place as co-equal partners in all decisions involving services.

The virtues of this arrangement  are dubious for smaller programs.  The most common example is a clinical or educational program led by a researcher with no training in delivering services.  These seem to evolve in research settings that then aspire to experiment in delivering innovative services. Too many researchers seem to assume they just need to hire a clinician or teacher, and the researcher's ideas will be magically transformed into effective practice. More often than not, the clinician is an enterprising post-doc or recent graduate whose enthusiasm is far outstripped by their inexperience.  The clinician lacks the experience to formulate a clear approach, or is simply too eager to please a boss, with the result that no one will recognize the failure to launch.

The implicit rationale behind this choice may be that poor outcomes do not result from a lack of clinical expertise, but simply from poor management or overall conceptualization.  The leader without clinical training may simply not know what good outcomes really look like, let alone how to get there. And if they are seeking to replicate an existing program, they must rely on the judgment of the program's developers. In this case, the leader without clinical training will be unable to evaluate the true fit with their own goals, or even be sure they are not just buying a "pig in a poke".

The key here is to carefully evaluate the core mission of the program: if the goal is to design clinical research, a researcher can assume leadership IF they surround themselves with experienced clinicians who can articulate a treatment model and act as true partners in program design. If the goal is to demonstrate a new kind of service informed by research, critical implementation details risk being overlooked if the initiative is led by even the most articulate and well-published researcher.

The ambitious researcher most likely to attempt leadership of a program focused on services is especially vulnerable to misconceptions, because to admit their inexperience puts them in an unfamiliar and acutely uncomfortable position. I cannot tell you how often I have found myself, as the sole experienced clinician in a team of researchers, throwing cold water on unrealistic proposals, or clarifying fundamental misconceptions about how community-based services actually work.

2. General experience

After core qualifications, general post-graduate work experience is often the next component considered. In some cases, a glance at the candidate's resume may suffice, but specific questions about components listed later (e.g.,  areas of expertise, management experience, and so on) will be critical during the interview.  Nonetheless, some general questions about post-graduate work experience are worth asking, because the answers you seek during an interview with a potential program leader are very different from those you might seek during an interview with a potential front-line professional.

• Work experience prior to licensure is often irrelevant: If a decision to offer someone a leadership position is influenced by work or internship experience prior to the the completion of core qualifications, you better start your search anew.  Some this information may be encouraging - for example, a person who worked as an assistant will probably be a better boss to other assistants - but will play a minor role in their success as a leader. With the exception of a very specific area of expertise, relevant experience only begins accumulating once they assume the responsibilities of an independent professional.
• Have they worked full-time for at least two years in a program at all similar to the one they now seek to lead? This helps to assure basic knowledge of general day-to-day practices for that sector. For example, a person seeking to lead a hospital-based program who has only ever worked in a school or private setting will be surprised by the extent to which billing practices can drive some aspects of program design.
• Have they moved quickly from one position to another? While it is always worth asking why someone left a position, it is especially so if they tend to stay less than 2 years. There may be valid reasons, but this might also reveal difficulty establishing comfortable work relationships, or a driving ambition that views each workplace (including yours) as one more stepping stone.
• Did they hold one position in one setting for a very long time without any noticeable change in responsibilities or productivity?  Extensive experience is an invaluable asset in a front line clinician, but may signal a lack of initiative or confidence that can handicap leadership of a program launch. As always, careful questioning may reveal valid life circumstances or other reasons; otherwise, you will want to know, why now? And extensive experience only as a front-line professional is in no way a substitute with actual experience in program leadership, as described in subsequent sections.

3. Experience managing people and programs

Anyone who has recently become responsible for hiring and firing staff will tell you that personnel management is surprisingly difficult and even more frustrating.  This can be particularly true when managing professionals from different disciplines, and especially so when you are trying to implement changes in practice. Being a colleague or team leader is very different from being the "boss" who decides how people and resources will be allocated. A candidate for a leadership position but without experience managing people will face extra challenges if they are also now tasked with leading the expansion of a program, and must begin to be the boss. Managing conflict is a critical test, and is worth exploring in an interview with a potential leader.

The challenges are even greater for someone leading more innovative programs.  These kinds of transformation often depend on specialized professionals willing to be more creative and self-critical. Developing these kinds of relationships with professionals takes confidence and experience, even when there is a clear vision of the program' potential. A good leader identifies strategies to engage even the most experienced and skeptical professional in this process.

Some of the challenges of managing a program that provides services can also overwhelm an inexperienced leader.  A leader must be prepared to drop everything to address a dissatisfied consumer  or staff member, or resolve other crises, because services cannot be disrupted.  An experienced leader who has learned how to be fully accountable gains invaluable lessons from their mistakes, and can move through crises quickly. A less experienced leader who deflects or dismisses blame is doomed to repeat mistakes, stoke resentment in their clients and staff, and get bogged down.

Program management involves more than people: it also includes managing budgets, evaluating curricula, tracking progress towards goals, and so on.  Taken together, these are essential skills for evaluating which programs are replicable, because to replicate a practice or program, you must be able to consider the infrastructure of funding, staffing, populations, curriculum, and settings.

Managing a research team of students and assistants provides little preparation for managing a team of professionals. 

It is a mistake to assume that a faculty member who has managed graduate students, or a post-doc who has managed assistants in a research project, has the experience to manage the expansion of a program of services and training. Programs of services and training often depend on a front-line team of more experienced professionals who are necessarily more independent.  This is different from managing many small- to medium sized research teams, composed largely of young students and assistants eager to learn and to please (larger teams that include more professionals may offer a more comparable experience).  Research teams also tend to be more self-contained and tightly focused: they are not delivering a product daily to outside consumer, nor do they always depend on close coordination with other programs and agencies.

Off-loading day-to-day program management to an assistant director can support a less experienced leader during the transition

Good program leadership and good program management draw on somewhat different, and somewhat contradictory, skill sets. Leaders must chart a steady course towards a long-term vision that may still be emerging. Managers take care of the day-to-day details, directly answer key questions, and quickly manage crises.  In most cases, it is a lot easier to find good managers than good leaders, especially for more innovative and transformative programs.  Supporting a less experienced leader with an experienced manager can free up valuable time for the former.  And an experienced manager from within an organization can provide the institutional history and relationships that a new leader from the outside lacks. Promoting an enterprising professional into an assistant director position can also share the management burden: even if they lack extensive management, good organizational and people skills will make the an effective partner to a new leader. But even the  best management skills will never fill gaps in expertise and leadership.

4. Specific areas of expertise and related training

All efforts at program improvement, and any significant program expansion, depend on some specific and clearly demonstrated expertise that the organization does not currently posses or has yet to act upon. This expertise should include detailed knowledge of and experience with the specific service or training initiative driving the expansion.  Knowledge of competing approaches may also be key to responding to questions from stakeholders. A potential leader draws on this knowledge to draft a plan, and draws on that experience to implement it. To the extent that a new program will require training of new personnel, this knowledge and experience must include all related professional development activities needed to build the capacity for implementation.

This knowledge and experience could be acquired during an extensive post-doctoral placement in a program with an established model. In these cases, post-doctoral fellows have assumed increasing responsibility for training, day-to-day management, and leading the development of proposal for related programs, experience which provides them with the necessary content expertise.

Recognizing the limits of this experience is also, however, important. Post-doctoral expertise gathered through a research project does not guarantee the kind of program management experience needed to lead the kinds of services and training described above, that depend on a team of professionals, the positive experience of consumers,  and close coordination with other programs and agencies. When translation from the research into the applied setting requires professionals from different fields, a post-doctoral trainee may lack the experience to bridge gaps between disciplines.  And in each case, expertise may be confined to one specific area, making it different to change course or broaden the scope of a program.

Aligning expansion or improvement directly to a pipeline of  expertise generated by an established program can quickly increase capacity

One of the best lessons for assuring a program's sustainability is to create a pipeline of core professionals, and assemble the resources needed to build and sustain their expertise.  The same principle applies when seeking the leadership needed to expand or improving  a new program.  Can you identify a productive clinical-research team that has established a new model of services or training that they have begun to systematically replicate?  If so, then this team is probably beginning to graduate post-doctoral fellows eager for the next challenge.  These fellows can bring the knowledge and at least some of the experience needed to launch a modest expansion utilizing the new program of services or training.  Depending on the nature of the model and the level of expertise,you may be able to capitalize on another lesson: Build professional development around core principles that translate research into practice guidelines with clear outcomes.  Pairing a young post-doc with a more experience assistant to assist in day to day management, as described in a previous section,  can also ease the transition.

Relying exclusively on traditional consultation to provide content expertise is risky. 

How often do programs hear about a new technique, and then send staff to a workshop to learn how to do it, or invite an expert to give a workshop on site. This ineffective Train and Hope approach is one of the reasons why so many launches fizzle; a traditional workshop does not include the more extensive coaching needed for more significant program change.  But under some specific circumstances, a consultant can kick-start a modest expansion.

• A program already replicated successfully at multiple sites, and that offers a specific package of coaching during program development in addition to staff training, can be launched with the help of consultants. An established model like Project SEARCH exemplifies this approach, and also works to weed out less appropriate sites before even beginning the process.
• Engaging a consultant throughout the planning and implementation phase can help anticipate the policy and infrastructure changes that are often necessary when integrating a new treatment or training package into an existing program, but that are ignored in too many training workshops.  For example, this additional consultation proved critical to the successful integration of a new package of verbal behavior teaching strategies at a flagship preschool program: initial attempts to rely solely on traditional training sessions fizzled when teachers hit roadblocks integrating the techniques into their existing classroom and staffing schedules.

Options if you fail to find a leader for your expansion

So, you developed a proposal for expansion and improvement, and posted a position for someone to help lead your efforts, but six months later you still have no viable candidates... what do you do?

You can of course re-post, but the prospects of finding the right candidate decrease with each passing month, at the same time as the challenges of achieving a successful launch continue to increase. The most logical (albeit painful) course is to re-assess your project and re-set your timeline. Some of the options are discussed above or in the parent page to this section.

• If the candidates reviewed to date lack the desired level of management experience, you could create an assistant director position who might help with day-to-day program management.
• If the candidates reviewed to date lack the desired level of expertise in specific content area, you could re-align project goals to tap directly into a known pipeline of  expertise.
• You might have the grantee assume leadership of a new, grant-funded expansion  expansion while you hire someone else to backfill the grantee's current responsibilities.
• You may need to revisit an important lesson: Launching a complex program in phases helps to maintain focus on specific goals (beginning with the search for a leader), and to document progress for funders.

There are other options that might help to re-start the launch of an expansion, though these are probably always less effective that identifying a leader with the right experience and expertise.  One option is involves creating a leadership team that integrates some of the options already listed.  For example, some of the day-to-day program management gaps are probably easiest to backfill: who coordinates staffing schedules, who sets up stakeholder meetings, who handles finances? Perhaps some of the content expertise can be re-aligned to take better advantage of existing personnel.  Perhaps there is a staff member on staff with relevant experience in one content area but who has never developed or delivered training, but who could be paired up with another staff member experienced in training. This kind of team is necessarily unwieldy and inefficient, but could still help to meet some of the project's goals, perhaps while longer-term solutions are sought.

Another option is to make better use of consultants.  As described earlier, relying exclusively on traditional consultation to provide content expertise is risky, because consultants might not consider other approaches objectively, and might lack the level of commitment needed.  But you can not only engage a consultant to help with program planning, you might also utilize a consultant as a co-leader during a transition phase. This could also buy you time to grow expertise from within, as described earlier.  And you can always combine the use of a consultant with the creation of a leadership team, as described above.

A note of caution: these options an help to salvage a failed launch for program expansion and improvement, once the timeline is re-set, but will never substitute for the leadership required for innovation and transformation.  These more ambitious projects require a level of flexibility and creativity that a leadership team will never deliver, a level of commitment that consultants can never deliver, and a combination of specific experience and expertise that may be difficult to replicate.

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