In January 2022, renowned transplant surgeon and healthcare leader Prof Elmi Muller took office as Dean of the Faculty of Medicine and Health Sciences (FMHS). Following the announcement of her second term, which will run from 2027 to 2031, we asked her to reflect on her first term in the role and share some of the highlights, challenges and lessons from her leadership journey so far.

Reflecting on your first term as Dean of the Faculty of Medicine and Health Sciences, what would you highlight as the most significant achievements, both institutionally and personally?

Elmi Muller (EM): Moving from an academic career into the role of Dean has been one of the biggest transitions of my professional life. Before becoming Dean, I was primarily a clinician, transplant surgeon and researcher. I had management experience, of course, and I believe that leading a large clinical division is among the most demanding management roles in medicine. Clinical leaders constantly balance limited resources, patient care, research, teaching, staff management and budgets, while trying to sustain their own academic careers. That experience gave me enormous respect for the Executive Heads and clinical leaders across our faculty, who carry these competing responsibilities every day.

Yet becoming Dean required a very different set of skills. I had to let go of much of the clinical and research work that had shaped my identity for decades. Instead, I found myself spending far more time in meetings, listening carefully to people, navigating institutional complexity and understanding what the University needed from me as its academic leader. There is no blueprint for becoming a Dean. Much of the role is learned through experience, reflection and countless conversations.

Personally, I think my greatest achievement has been finding a way to retain the values and interests that define me while leading a faculty of this size and complexity. I did not want to lose myself in the administrative demands of the position. I have tried to remain curious, engaged and connected to people and patients, while keeping sight of the bigger purpose of the Faculty.

Institutionally, I believe one of my most important contributions has been building a strong leadership team. I have learned that no Dean succeeds alone. If you do not have an outstanding team around you, you have nothing. I am immensely proud of the people we have recruited into key positions and of the trust we have built together. I deliberately sought colleagues who bring strengths that complement and often exceed my own. My role is not to be the smartest person in the room, but to create an environment where talented people can thrive and where we work together towards a shared vision for the Faculty.

Perhaps what I am proudest of, however, is something less tangible. I hope that, despite the pressures of leadership, I have remained deeply human. I have tried to support colleagues through difficult times, to listen before judging, and to understand the personal challenges that people bring with them to work every day. Leadership can easily become consumed by strategy, budgets and performance indicators, but universities are ultimately communities of people.

I still care deeply - for our patients, our students and our staff. I believe compassion is not separate from leadership; it is central to it. If we lose our humanity, we may become efficient managers, but we will never become the kind of leaders who inspire trust and build institutions that people genuinely want to belong to.

Looking back, what key lessons have you taken from your first term in this role?

EM: One of the biggest lessons I have learned is that people often place you in a box before they truly know you. About two months after I became Dean, during our first strategic planning meeting, one of the Executive Heads challenged me quite directly, suggesting that I was only interested in supporting clinicians and was neglecting colleagues working in areas such as research and global health.

At the time, my immediate reaction was to apologise. I felt I had somehow failed, even though I had barely had the opportunity to demonstrate how I wanted to lead. Looking back, I realise that criticism was not really about anything I had done. It reflected assumptions about my background. I arrived in the role as a transplant surgeon and clinician, and some people had already formed expectations about the kind of Dean I would be.

That experience taught me an important lesson: it is impossible to please everyone. Leadership is not about trying to become the person that every individual wants you to be. It is about listening carefully, treating people with respect, remaining open to having your own perspectives challenged, and making decisions that are fair and in the best interests of the institution.

I have also learned that resilience is an essential part of leadership. Early criticism affected me deeply. Today, I no longer carry every criticism as a personal burden. I listen carefully because sometimes criticism is justified and helps me grow. But I have also learned to distinguish between constructive feedback and assumptions that arise from people's own expectations or experiences.

Most importantly, I have realised that I cannot change who I am in order to gain universal approval. My responsibility is to lead with integrity, to be fair, to listen, and to make the best decisions I can with the information available. I often say that a Dean cannot be everyone's friend, but neither should a Dean have favourites. My role is to serve the entire Faculty, even when that means making difficult decisions that not everyone will support.

At the end of each day, I have to be able to look back with a clear conscience, knowing that I listened, that I acted fairly, and that I did what I believed was right for the Faculty. That, ultimately, is the standard by which I now judge my leadership - not whether everyone agrees with me, but whether I have led with honesty, fairness and integrity.

What were some of the most pressing challenges you faced during your first term, and how did you navigate them?

EM: There were many institutional challenges that demanded constant attention. We had to respond to the loss of American research funding and the uncertainty it created for researchers and professional staff whose livelihoods depended on those grants. There were difficult negotiations with the Provincial Department of Health around budget reductions and registrar posts, raising concerns about our ability to sustain the quality of postgraduate specialist training. We faced the ongoing complexity of student over-enrolment in some programmes and under-enrolment in others, while also navigating broader University budget pressures and what these meant for our Faculty.

Each of these issues required careful balancing. As Dean, there are rarely perfect solutions. You have to make difficult decisions, communicate openly, and try to protect both the long-term interests of the Faculty and the people who work and study within it.

Alongside these institutional challenges, I also experienced some of the most difficult personal moments of my life.

My eldest son, who has Type 1 diabetes, suffered a severe hypoglycaemic episode. I had to resuscitate him myself, and during the collapse he sustained multiple vertebral fractures. It was a traumatic experience. What I remember most, however, is the extraordinary kindness of colleagues in this Faculty. People offered medical advice, reviewed X-rays, checked in on us, and, perhaps most importantly, simply stood beside me. I experienced firsthand what it means to belong to a compassionate academic community.

During the same period, my marriage came to an end. For a long time, I carried that grief privately. I came to work every day, fulfilled my responsibilities, and tried not to let others see how deeply I was struggling. Eventually, I spoke openly about that experience during my address at our Faculty Research Day in 2025. I was overwhelmed by the response. Colleagues came to me afterwards and said, "Now I know you will understand when I come to you with my own struggles."

That experience changed my understanding of leadership. Vulnerability, when shared appropriately, is not a weakness. It allows people to see one another as human beings rather than simply as titles or positions.

Although I would never have chosen those experiences, they shaped me profoundly. They strengthened my resilience, deepened my understanding of mental health and loss, and reminded me that every person we work with is carrying burdens that may be invisible to others.

Perhaps that has become one of the defining principles of my leadership. Universities are not simply organisations; they are communities of people. Every one of us experiences joy, disappointment, fear and grief. If we can acknowledge our shared humanity and create an environment where people feel supported through both their successes and their struggles, we build not only a stronger Faculty but a kinder one as well.

As you enter the next phase, what are your strategic priorities for the faculty over the coming five years?

EM: I am incredibly proud of our new Faculty Strategic Plan. More than the document itself, I am proud of the process that produced it. We deliberately involved a much broader group of colleagues than before - people whose judgment I respect and whose perspectives challenged and enriched our thinking. The process was exceptionally well facilitated by Arnold Smit, and I believe it was transparent, inclusive and fair. Because of that, I have complete confidence in the direction we have set for the Faculty. Our next task is to bring the strategy to life and to communicate it clearly across the Faculty so that everyone understands both the vision and the role they can play in achieving it.

One of my highest priorities is strengthening our postgraduate training platform. I believe this is one of the most important investments we can make in the future of healthcare in South Africa. The quality of specialist training determines the quality of our health system for decades to come. Despite the many challenges our country faces, we have extraordinary clinical expertise. Our specialists are internationally respected, and our clinical environment offers a breadth of experience that few institutions can match. My goal is to ensure that we continue to train specialists who meet the highest international standards while responding to the healthcare needs of our own communities.

Another priority is creating a stronger home for the social sciences and humanities within the Faculty. Medicine is not only about scientific discovery and technical excellence; it is also about understanding people, society, ethics and the lived experience of illness. Integrating these disciplines more fully into our Faculty will enrich our teaching, strengthen our research and help us educate healthcare professionals who are not only scientifically outstanding but also thoughtful, compassionate and ethically grounded.

Receiving an honorary doctorate from Lund University in the social sciences last year was a particularly meaningful moment for me. It made me reflect on how much of my own career has been shaped not only by surgery and transplantation, but by broader questions of equity, justice and society. My work on access to transplantation, HIV-positive organ transplantation, organ trafficking and global health policy has always sat at the intersection of medicine, ethics, law and the social sciences. That experience has strengthened my conviction that these disciplines belong at the heart of a modern medical faculty, and I hope to help create an environment where they can flourish alongside the biomedical sciences.

I am also tremendously excited about the future of the Biomedical Research Institute (BMRI). We have an opportunity to build translational research hubs that bring together basic scientists, clinician-scientists and other disciplines to accelerate discoveries that improve patient care. I believe this has the potential to transform the research landscape of our Faculty and strengthen our position as one of Africa's leading centres for biomedical research.

I have been deeply encouraged by the support of our new Rector, Prof Deresh Ramjugernath, whose commitment to these ambitions has been invaluable. Equally important is the outstanding group of colleagues who are helping to shape this next chapter. I am fortunate to work alongside people whose expertise I admire, whose ideas continually inspire me, and whose commitment to the Faculty gives me great confidence in what we can achieve together.

Ultimately, my ambition is not simply to grow the Faculty, but to strengthen its impact. I want us to remain a place where outstanding clinicians are trained, world-class research is conducted, innovation flourishes, and people feel they belong. If we can achieve that, I believe we will continue to make a meaningful contribution not only to Stellenbosch University, but to the health of South Africa and the African continent.

When you think about your overall legacy, what is the bigger vision (“big picture”) you hope to realise for the faculty during your tenure as dean?

EM: I have never been particularly driven by the idea of legacy. People often ask me what I want my legacy to be, but that is not how I think about my career. I have always believed that if you focus on doing the right thing every day, your legacy will take care of itself.

Each day I simply want to do the best I can – for our students, our staff, our patients, our researchers and the colleagues with whom I work. Leadership, to me, is not about being remembered for a single achievement. It is about creating an environment where other people can flourish and do the very best work of their lives.

One of the greatest privileges of this role has been working alongside exceptional people. Colleagues such as Prof Karin Baatjes and Prof Nico Gey van Pittius are leading important initiatives in education and research, and I am immensely proud of what they are achieving. My role is not to stand in front of them, but to stand behind them – to remove barriers, provide support, and create opportunities for talented people to succeed.

If there is one thing I hope people will remember about my time as Dean, it is that I built a Faculty where people felt trusted, valued and empowered to contribute. I hope we will be known as a place that attracts outstanding people because they know they will have the freedom to innovate, to collaborate and to make a meaningful difference.

Ultimately, institutions endure because of their people, not because of their leaders. If, when I eventually leave this role, the Faculty is stronger because outstanding people have grown, new leaders have emerged, and others have been able to realise ideas that might otherwise never have been possible, then I will feel I have done my job well.

Is there a guiding principle or motto that has shaped your leadership approach?

EM: If I had to summarise my leadership philosophy in one word, it would be fairness. I know that I cannot make everyone happy, but I can strive to treat every person with respect, to listen carefully, and to make decisions that are as fair and transparent as possible.

I also believe that leadership requires both compassion and discipline. I want to understand what people are going through. I want to recognise their disappointments, celebrate their successes and, when life becomes difficult, be present for them. Universities are built by people, not by policies, and I never want to lose sight of that.

At the same time, I have learned that effective leadership requires healthy boundaries. Early in my career I often carried other people's problems as if they were my own. Over time I realised that this is not sustainable. If you absorb every disappointment and every conflict, you eventually lose the ability to lead well. I have learned to care deeply without carrying everything myself.

Leadership also requires neutrality. Whether people disagree with me or support me wholeheartedly, I cannot allow either criticism or praise to determine my decisions. My responsibility is to step back, consider the evidence, listen to different perspectives and act in what I believe is the best interest of the Faculty.

I also believe in being a good steward of the resources entrusted to us. That means respecting people's time, using public funds responsibly and making decisions rather than allowing difficult issues to drift. Efficiency is not about rushing; it is about recognising that every decision has consequences for the people we serve.

If, at the end of my time as Dean, people remember me as someone who was fair, who listened, who cared, and who acted with integrity, I will be content. That, to me, is what good leadership looks like.

Compassion should shape our relationships, but fairness should shape our decisions.

Outside of your professional role, who is Elmi Muller? Could you share a bit about your interests, hobbies, or how you like to spend your time when you’re not at the faculty?

EM: I love my home. It is my sanctuary. I love my garden, where I can slow down and reconnect with nature after busy days. My greatest joy, however, is my two sons, Johan and Willem, whom many in the Faculty know well. Like any parent, my greatest hope is simply that they will lead happy, meaningful lives.

I also have two rather opinionated companions - a Bull Terrier, Addie, who often joins me on my runs through Jack Muller Park, and a Bengal cat who firmly believes he owns the house.

Travel has become an important source of renewal for me, particularly when I can share it with good friends. A recent hike in Breedekloof reminded me how restorative nature can be and how important it is to make time for beauty and stillness amidst busy lives.

Music has always been one of my great passions, especially classical music. Whenever I travel overseas, I always look to see what concerts or operas are being performed. I recently had the privilege of hearing Pretty Yende perform the role of Violetta in La Traviata in Paris, just after I heard her sister, Nonhlanhla Yende, perform in La Bohème in Cape Town. Watching two sisters from Piet Retief achieve such extraordinary success on the world's operatic stages filled me with immense pride.

I also love art. I recently spent many happy hours wandering through the Musée d'Orsay, enjoying the remarkable exhibitions of Henri Matisse and Pierre-Auguste Renoir. I am not an art historian or a literary critic, and perhaps that is a gift. I don't feel compelled to analyse every work. I simply allow art to speak to me and to move me.

One experience in particular changed something in me. Earlier this year I visited an exhibition by artist Nicola Deane that explored memory, loss and the slow fading of photographs. It affected me far more deeply than I expected. Afterwards I found myself writing about a family photograph slowly disappearing, becoming paler until only the outlines remained - a reflection on my own life and the loss of a marriage that had once defined me. When I shared it with Nicola, she encouraged me to keep writing. She told me, "Write it out. Let it bleed; the stitching can come later." Those words have stayed with me.

I have realised that writing has become another way for me to understand difficult experiences. Throughout my career as a surgeon, and now as Dean, I have learned to contain my emotions. Patients, colleagues and students need someone who can remain calm in moments of uncertainty. But that does not mean those emotions disappear. Writing allows me to acknowledge them rather than suppress them. It has become a quiet place where I can make sense of grief, joy, uncertainty and hope.

Perhaps that is also how I think about leadership. People sometimes imagine that leaders should be detached or invulnerable. I have come to believe the opposite. We need resilience, certainly, but we should never become hardened. I hope I never lose my capacity to be moved - by music, by art, by nature, by words and, above all, by people. Those experiences remind me why I chose medicine in the first place and why, despite the pressures of leadership, I still believe our greatest responsibility is to remain deeply human.