This talk focused on the role of the unit-based medical director and the skills needed to be effective in this position. Although there are some similarities to other leadership positions, such as division or department leadership, this role has key differences and requires distinct skills and attitudes to succeed.
Unit-based medical directors often have a broad range of responsibilities. Common responsibilities include quality, safety, operations, patient safety review, interdisciplinary liaison work, conflict resolution, and serving as a source of general expertise. A challenge is that the scope of these roles is variable across institutions. These positions must have clear definitions and role clarity, as their responsibilities can overlap with those of division leaders, nurse managers, service line leaders, or quality teams, particularly in areas where conflict is likely to arise.
This role is commonly supported with dedicated effort, typically ranging from 5% to 20%, with higher support when the role spans multiple units or very large service lines. These roles are commonly structured as dyads or triads, pairing the medical director with a nurse director and an administrative partner such as a finance partner or quality coach. Effective medical directors approach this relationship as shared governance, aligning with nursing leaders as physician partners rather than trying to lead the unit independently. Medical directors should seek complementary strengths within dyad pairing, as matching complementary styles can improve the function of the unit.
One example discussed was the common institutional goal of focusing on early discharges. This case had a unit medical director approached by a hospitalist who voiced frustration with the pressure to enter early discharge orders. They felt this priority conflicted with the need to see sicker, more acute patients early in the morning. This case illustrates how the medical director can serve as a “translator” between larger institutional goals and the day-to-day realities of the frontline staff. An important lesson is to avoid a leadership-versus-staff dynamic, such as saying, “They just want us to do this.” Instead, the medical director should own the outcome and connect the goal to patient care. Dr. Helgerson recommended developing a library of stories to help translate these abstract clinical goals into tangible, patient-centered scenarios. For example, in this case, the goal is not simply to meet a metric. Instead, earlier discharge orders can be framed around the number of patients boarding in the emergency department and, more powerfully, around a specific patient waiting for a bed to advance their care in the hospital. This approach helps frontline clinicians see the clinical importance behind operational priorities.
Another case highlighted the medical director’s role in building a culture of safety. It can be tempting to view safety events as individual errors, but the role of the medical director is to examine the system that allowed the event to occur. Even when an event initially appears to involve a nursing workflow issue, it should be approached as a shared unit-based problem. The medical director should help create a standard, equitable method for reviewing safety events, with clear criteria for which events require escalation or additional attention. There should also be a commonly understood improvement framework, such as Plan-Do-Check-Act or Lean, to guide the review and response. Safety events also highlight the medical director’s role in supporting the people involved. Staff involved in errors may experience significant distress as “second victims.” While medical directors do not need to counsel staff personally, they should know institutional resources such as peer support, risk management, ethics, coaching, counseling, and faculty or staff wellness programs.
Unit-based medical directors also often serve as an escalation pathway when differing opinions arise on the unit. These situations may involve a long-stay patient for whom care management has identified a discharge plan that the physician team feels uncomfortable with, or a patient with logistical barriers such as durable medical equipment needs. Helpful strategies include embedding the medical director in interdisciplinary rounds, becoming familiar with long-stay patients on the unit, and focusing attention on complex cases that are clinically, ethically, or logistically challenging. Medical directors will not be able to solve every problem, but they can help identify which cases need their attention and ensure the right people are available to work through those cases.
There is also a significant opportunity for medical directors to use operational work to pursue academic and professional interests. Issues that arise on the unit can become quality improvement projects, scholarly products, new care models, or administrative improvements that enhance patient outcomes and staff workflows. Selecting the right person for the role and ensuring the role aligns with that person’s career trajectory is important. Early-career leaders may benefit from developing leadership competencies and gaining exposure to multidisciplinary leaders across the health system. However, this role also demands high clinical credibility and a broad skill set. Depending on how the medical director role is structured, it may not align naturally with academic promotion unless the individual actively seeks opportunities to turn operational work into scholarship or measurable administrative impact.
To maximize their role in an academic setting, clinicians should identify opportunities for leadership development and mentorship. They should look for projects with academic potential and build the necessary infrastructure to support those projects. Because the role exposes medical directors to many areas of the hospital, it also creates opportunities for mentorship outside their immediate division or department.
Finally, Dr. Helgerson recommended thinking intentionally about a long-term off-ramp. Medical directors should consider how the role helps them develop skills for future opportunities, while also identifying and mentoring others who can eventually step into the role. He recommended building an administrative curriculum vitae, tracking outcomes, and documenting measurable accomplishments to help this work develop into future leadership opportunities.
Overall, this session highlighted that effective unit-based medical directors do more than relay institutional priorities. The role requires partnership, role clarity, clinical credibility, process expertise, and the ability to translate operational goals into meaningful patient-care priorities. When approached intentionally, it can improve unit culture and patient outcomes while also supporting the medical director’s own leadership development.
Key Takeaways
- The medical director succeeds by being a partner and supporter, not by trying to own or control the unit.
- Safety events and operational problems should be approached as shared unit-based process issues.
- The medical director role can support career growth when leaders seek mentorship, track outcomes, and turn operational work into scholarship or administrative impact.
Dr. Miller
Dr. Miller is an associate professor of medicine and vice division chief of hospital medicine at the University of New Mexico in Albuquerque, N.M.