To compare perceptions and perspectives of medical school deans and hospital chief executive officers (CEOs) regarding roles, responsibilities, and attributes of effective clinical department chairs. In 2009, the authors surveyed the deans of 126 U.S. medical schools and the CEOs of the primary teaching hospitals in the schools' academic health centers. All were queried on 34 items about clinical department chair performance in six categories (mission prioritization, leadership responsibilities, leadership values, skill sets, barriers to success, and competitive differentiators). Eighty-four deans (67%) and 57 CEOs (45%) responded. Both groups ranked ensuring good patient care as the chair's primary responsibility; agreement between CEOs on that responsibility was much stronger than among deans (P < .01). CEOs placed greater emphasis on getting results (P < .01), whereas mentoring was a higher priority for deans (P < .01). CEOs identified the inability to work within budgeted resources as a barrier to chair success more than did deans (P < .01). CEOs reported that high-quality care and cutting-edge hospital technologies were keys to competitive distinction, whereas deans put more weight on clinical and translational research and educating future physicians. The majority of deans and CEOs rated the alignment and relationship between themselves and their counterpart as "excellent" or "good." Deans and their "partner" hospital CEOs agreed on most of the attributes, skills, and responsibilities characterizing the successful clinical department chair. CEOs were biased toward patient care, clinical quality, and results, whereas deans placed more emphasis on research, education, and mentoring.
