Table 1

Roles and key tasks for leadership services in an academic division of general surgery

Role; level	Key tasks
Division head	Provide overarching divisional leadership and direction
Macro^*	Be the face of the division: do activities that reflect the strength of the university nationally and internationally; do activities that are in the best interest of the division Contribute to fundraising activities Create a positive culture Facilitate efforts to enhance/evolve the division Liaise with hospital regarding union rules and issues Recruit faculty Represent the division at external meetings
Meso^*	Allocate resources or assign a designate (e.g., clinic time, operating room schedule, on-call schedules, outpatient resources) Chair/coordinate/attend internal executive and operational meetings Complete annual reporting requirements Coordinate functioning of the division (maintain a broad overview of research and education activities within the division) Deal with division-wide clinical service delivery issues Ensure adequate administrative support Ensure that quality-based metrics, volumes and targets are met (quality assurance/improvement) Oversee budget assigned from hospital to services Provide updates on provincial changes in policy
Micro^*	Adjudicate clinical and behavioural issues (e.g., disciplinary matters) Appoint surgeons into nonclinical roles Coach and assign mentors for junior surgeons Deal with complaints Facilitate/support surgeons’ academic careers (e.g., promotions, learning environment, Grand Rounds, annual update, other continuing medical education activity) Lead/participate in faculty evaluation for hospital and university reappointment Organize or delegate division Grand Rounds
Divisional director of finance	Oversee budgeting for all divisional activities Division may have representation only at the departmental level
Meso	Allocate budget to each nonclinical pillar, including research, education and leadership Fundraise for various initiatives Consult on personnel and equipment negotiations relevant to the division Present budget to and seek budget approval from division members/divisional executive
Micro	Supervise accounts Prepare yearly accounting reports Authorize disbursements
Section head	Responsible for clinical functioning and coordination of a section^†
Micro	Deal with offences and complaints
Meso	Coordinate clinical functioning and appropriate resource allocation of the section Lead program-specific committee Liaise with hospital or cross-organizational administration Lead quality assurance/improvement responsibilities (e.g., meeting provincial standards for wait times, review and respond to disease site NSQIP data) Lead specialty-specific rounds (e.g., tumour board)
Site chief	Extension of division head responsibilities dealing primarily with scheduling
Meso	Represent division head at departmental/hospital committees (e.g., hospital perioperative services committee, department of surgery executive committee) as needed Manage site-specific issues including scheduling (operating room and on-call) and resource allocation
Quality assurance/improvement lead	Oversee adherence to relevant quality standards and develop quality-improvement initiatives
Meso	Develop division-wide quality-improvement activities Represent division at departmental/hospital quality assurance/improvement committee Monitor and report morbidity and mortality within division Represent/lead division in quality initiatives

NSQIP = American College of Surgeons National Surgical Quality Improvement Program.
↵* These tasks describe the mandate for both the academic (university) and clinical (hospital) organization. If these roles are not occupied by the same person, there would be a need to clarify the allocation of responsibilities.
↵† Sections refer to a subspecialty and could also be referred to as clinical services, units or programs. Examples include colorectal surgery, foregut/bariatric, general surgical oncology, breast surgical oncology and hepatobiliary surgery.