AB Purpose: To gain a better understanding of the values that medical school deans and surgery chairs consider most essential for effective leadership, to assess their perceptions of the values and leadership climate in their institutions, and to test the premise that agreement on leadership values and climate predict greater organizational effectiveness and performance. Method: From June 2005 through March 2006, questionnaires designed to assess leadership core values and organizational leadership climate were mailed to medical school deans and surgery chairs of the 125 U.S. academic health centers. Institutional performance measures used were the National Institutes of Health (NIH) standing and U.S. News and World Report ranking of each institution. Results: Sixty-eight surgery chairs (54%) and 60 deans (48%) returned surveys. Q-sort results on 38 positive leadership values indicated that integrity, trust, and vision were considered the most important core values for effective leadership by both chairs and deans. Both groups ranked business acumen, authority, and institutional reputation as least important. Deans consistently ranked the leadership climate as being healthier (more positive) than did their surgery chairs on multiple scale items: leadership is widely shared (P = .005), information is widely shared (P = .002), missions are aligned (P = .003), open communication is the norm (P = .009), good performance is rewarded (P = .01), teamwork is widely practiced (P = .01), and leaders are held accountable (P = 002). Tighter alignment between chairs and deans on core values and on the leadership climate scale correlated with higher school and department NIH standing and higher U.S. News and World Report medical school and hospital ranking (P <.05). Conclusions: Although surgery chairs and deans espouse similar core leadership values, deans believe that a healthier leadership climate exists in their institutions than their surgery chairs do. The study findings suggest that tighter leadership alignment between deans and surgery chairs may predict a higher level of institutional performance in the clinical and academic arenas.