Filling a Position versus Building a Program

In Part I of this series I noted what should be obvious: acrimonious interpersonal dynamics are detrimental to a transplant program.1 In addition, I addressed sham recruitment, inept on-line recruitment efforts, word-of-mouth referrals as an inferior option to competitive recruiting, "churning" as the signature of a suspect transplant program, the length of time it currently takes to fill a position, problems associated with "internal" recruiters, the importance of credentials, and the significance of being clear about one's visa status.

On this occasion, I would like to focus on two topics. The first is the difference between filling a position and building a program. The second, which can be related to the first, concerns the perilous situation wherein an external candidate is competing with an internal candidate for a vacant position.

Position or Program?

When people contact me they usually have a vacant position. More often than not, a colleague has accepted another position under questionable circumstances, a suspect character has been "pushed out the door" because their contributions no longer justify their membership, a formerly valued "team member" has become a royal "PITA" or, to put the matter bluntly in Facebook terms, no one "likes" someone anymore.

Although rarely mentioned, recruitment creates an opportunity for positive change, and it should be embraced accordingly. Too often people tell me "we have a position to fill," implying that transplant professionals are mere cogs in an organizational machine - the kind Karl Marx abhorred. Someone's departed, and they're being replaced, often with little thought given to how a transplant program can be enhanced with a skillful and competitive recruitment initiative.

Thus, when people engage me in relationship to their recruitment needs, I encourage them to think in broad terms about what they would like to accomplish through a carefully crafted and targeted recruitment effort. If they fail to understand what I mean, this task essentially becomes my mandate. I look at a program, critically appraise it, and then decide how I might make it better if I am successful in recruiting the best available professional given their now obvious needs. My goal is to identify the person I feel will most benefit their program, while being particularly mindful of person-environment fit.

Nonetheless, I recognize that some programs prefer "dumbing down" to "cleaning up." In other words, their goal is to recruit people who look like them (i.e., homosociality2). They prefer a low risk homogeneous proposition, and the stability it entails, which is to say they're happy treading sludge, as opposed to swimming in fresh water. Frankly, no one of any consequence wants to emulate a dubious program. Such programs are doomed by the failure they've embraced. Mediocrity is their distinction.

Then there are the people who say, it's time to "shake things up," acknowledging that they have an opportunity to do things differently, and welcoming the risk accordingly. This often produces acid in quantities that, figuratively speaking, a proton pump inhibitor can't neutralize. Yet, at the same time, looking beyond security, excessive risk taking can also generate the requisite enthusiasm it takes to make things better. With progress comes discomfort, and uncertainty.

In conclusion, whenever a position is vacated, it should be looked upon as an opportunity to build a program. By all means, avoid the temptation to merely fill a position and move on as quickly as possible.

Internal Candidates versus External Candidates

Personnel changes, whether deletions or additions, alter the interpersonal dynamics, as well as the power structure, within any organizational entity. In some cases, people are simply reassigned, given new titles, and organizational life goes on - a conservative approach to say the least. In other instances, where the goal is fundamental change yet fairness is the norm, current employees typically compete with external candidates to fill a vacant position. For example, if the medical director of a heart transplant program leaves, the question often becomes this: do we promote from within, or do we recruit from outside?

In almost every instance, there will be at least one reasonably qualified internal candidate - someone who feels they've put in their time and, thus, deserves a promotion. Yet, there are usually misgivings associated with merely handing someone a position to which they feel entitled. If the decision is to open the competition, thereby offering external candidates an opportunity to compete, the external candidates are necessarily at a disadvantage from start to finish. And, if they successfully become the incumbent, they're further handicapped in the long term. This is rarely acknowledged.

The dynamics of the situation can be characterized as follows: First, the internal candidate(s) has an established power base. They're a known entity; they've made an organizational investment, and they fully understand "how things work around here." Second, in a relatively short period of time, the external candidate(s) must convince the "voters" that they deserve to win the "selection." In doing so, they have little more than their intelligence, qualifications, experience, and reputation on which to base their claims. Otherwise, they're powerless, lacking an "inside track." Third, throughout the entire "selection process," there is little that prevents the internal candidate(s) from functioning as a saboteur. They may work hard to undermine the external candidate(s) by posing threatening vignettes. Secondhand stories will be conjured with potentially crippling consequences. Character assassination may be a last resort. Finally, the external candidate(s) is rarely privy to all the disinformation. Thus, there is little they can do to correctly represent themselves. They're essentially a victim of the circumstances they've invited by becoming a candidate.

Now, for the sake of argument, let's assume an external candidate is selected, despite the adversity I've described. Guess what? The internal candidate, who has been formally rejected, becomes the incumbent's greatest threat, making success difficult to achieve. Because bridges are rarely built where there's an emotional gulf not amenable to genuine compromise, the internal candidate continues to function as a saboteur who feels spurned by the organization to which they've been committed. Thus, in virtually every respect, the internal candidate is a threat, not only to the incumbent, but also to the organization of which they're now considered a marginal member.

Is there a solution to the dilemma I describe? Indeed, there is. First, if there is clearly a qualified internal candidate who meets all relevant criteria, and all constituents agree, the internal candidate should be promoted. This will avoid what will surely become a counterproductive competition. Second, if there is doubt about an internal candidate, and the goal is to create a definitive competition, make it clear to the internal candidate that the consequences will be the same for all losing candidates, whether internal or external - the external candidate who fails will obviously not be hired but, likewise, the internal candidate who fails to become the incumbent will be asked to resign. This, in turn, eliminates the dastardly role of the internal saboteur, thus maximizing the incumbent's opportunities for success in discharging their responsibilities. In short, no internal candidate should be allowed to compromise an organization. Asking for a resignation when it is a clear expectation is far easier than firing someone.

In conclusion, subjecting a highly qualified internal candidate to a competition before granting a promotion has deleterious consequences. This situation should be avoided.