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an online version of the magazine Spring/Summer 2005

Secrets Of The Inner Circle

Edward D. Miller, M.D.
By Edward D. Miller, M.D.

Sometimes, during the more hectic days of running this complex organization, I feel like one of those entertainers who spins plates on top of long sticks. You start with one twirling disc, slowly add more and end up racing back and forth to keep all the plates rotating at once.

For me, that sort of routine only works for a short period. One of the important lessons experience has taught me is that anyone leading an organization as complex as this can't possibly do it all. There aren't enough hours. The wise boss brings in others to handle those ever-multiplying assignments.

From my viewpoint, nothing is more important to the success of an academic health-sciences organization than strong senior management. And whenever I speak on the topic of leadership, I emphasize that step No. 1 is building a talented inner circle. In fact a top-drawer group of leaders, I believe, is even more crucial at an academic medical center. These administrators—a blend of clever faculty members and adroit businesspeople—must keep the hospital system purring 24/7, the medical school in full teaching mode and the research squads energized, at the same time they are handling myriad problems and crises that never cease. All the while, they must adhere to financial and long-term objectives.

Over the years, I've learned (sometimes the hard way), what to look for in putting together a team. Here are some of my rules:


Pick people who are smarter than you.


The universe of knowledge required to run a multifaceted enterprise like Hopkins Medicine is mind-blowing. I can't master every discipline and I don't have every answer, so I need all the brain-power around me I can find. I look for individuals with unique talents and diverse backgrounds. I sometimes make unexpected choices: Men and women with enormous upside potential. I want them at my side.


Pick people who are already busy.


These people have shown they can keep many balls in the air at once. They're used to taking on complex tasks and they have thrived on increased responsibility.


Pick people who are selfless.


Self-aggrandizers won't make the cut at Hopkins . It's not part of our culture. Our much-cherished collegial environment requires a management team that places the advancement of the institution—and its men and women—first.


Pick people who are decisive.


I want managers who will handle problems before they fester and develop into major sores. Sometimes that means making difficult, risky or unpopular calls. But top management often must act as arbiter. That's what leadership is all about.


Pick people who are good listeners.


I've found that hearing what colleagues and experts have to say is often the best way to develop an appropriate response. Everyone on my team must be an attentive listener, too.


Pick people with the courage to speak the truth.


I recruit senior managers who will give me the bad news. I would rather hear what's gone wrong and discuss it openly than have these facts hidden until the worst happens. CEOs want an early “heads-up.” Those in the inner management circle must also feel that it is safe to offer dissenting viewpoints in our discussions. Withheld communications usually get us into trouble.


Before bringing a new team member on board, I conduct my own “due diligence” background inquiry. What makes this person tick? Will he or she fit in on this level at Hopkins ? How does the individual interact with colleagues and subordinates? How does the person handle pressure?

Ultimately I have to decide if this is someone I can work with, at close quarters, day in and day out. That's important because I delegate real responsibility and authority to my inner circle. I give them the power to think and act on their own.

I won't second-guess them, either. An academic medical center is not the place for finger-pointing or the “blame game.” If things don't go as planned, if there's been a miscalculation, I'll take responsibility. It's my management group. Each person in it deserves my unstinting support.

Conversely, it's important to give team members credit for our successes. They're the ones who put in hours behind the scenes to make the institution look good.

I am proud of the senior management team we've put together. Some of these individuals, like Elias Zerhouni, who now heads the National Institutes of Health, have gone on to important new jobs. But most have stayed. We must be doing something right.

We work hard. We enjoy and respect one another. We speak candidly. We ask tough questions and seek advice and consensus before moving forward. That's what a good inner-circle management team is supposed to do. I believe we've assembled one of the best.

 Change of Heart
 Irrepressible Dr. De
 The Heat Is On
 Circling the Dome
 Medical Rounds
 Annals of Hopkins
 Learning Curve
Johns Hopkins Medicine

© The Johns Hopkins University 2005