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Leadership in Radiology: The 2007 ACR Forum

2008; Elsevier BV; Volume: 5; Issue: 2 Linguagem: Inglês

10.1016/j.jacr.2007.10.009

1558-349X

Richard B. Gunderman, Jeffrey C. Weinreb, Bruce J. Hillman, Arl Van Moore, Harvey L. Neiman,

Radiation Dose and Imaging

The 2007 ACR Forum highlighted the importance of cultivating leadership, identified key traits of effective leaders, and outlined a number of practical steps the ACR, radiology leaders, and the field as a whole can take to promote leadership. If we heed this message, we can develop the abilities of people who will provide effective leadership for radiology organizations and assume even wider leadership roles in medicine and health care. The 2007 ACR Forum highlighted the importance of cultivating leadership, identified key traits of effective leaders, and outlined a number of practical steps the ACR, radiology leaders, and the field as a whole can take to promote leadership. If we heed this message, we can develop the abilities of people who will provide effective leadership for radiology organizations and assume even wider leadership roles in medicine and health care. The performance of radiology organizations is powerfully influenced by the quality of leadership they enjoy. If the people in charge do not lead effectively, our organizations are unlikely to prosper in the future. On the other hand, if our leaders are highly knowledgeable, skilled, generous, admirable, and committed and operate with strong support from their colleagues, our prospects seem considerably brighter. Hence, leadership and leadership development represent opportunities in which every radiologist and every radiology organization should take a deep interest.Since 2001, the annual ACR Forum has brought together leaders from inside and outside radiology to discuss topics of long-range significance to the field. Past topics have included molecular imaging, strategic planning, quality and safety, the future of screening, disruptive technologies, and cardiovascular imaging. Each forum results in the publication of a white paper, a series of recommendations to the ACR Board of Chancellors, and actions by the ACR. The topic of the 2007 ACR Forum, held at ACR headquarters in July 2007, was leadership in radiology.The 2007 ACR Forum brought together a wide range of participants from industry, government, the military, hospital administration, university administration, business schools, practice management, academic and private practice radiology, and the ACR to discuss fundamental questions about the future of radiology leadership: What are the characteristics of effective leaders? How can organizations do a better job of identifying and developing leaders? What is the current state of leadership in radiology, and what could be done to improve it? The following sections encapsulate the conversations of the participants. The article concludes with recommendations for improving leadership in the field of radiology.Effective LeadersLeadership alone will not make an organization successful. Other ingredients, such as the quality of an organization’s human and financial resources and the innovativeness of its products and services, also play a crucial role. Yet, without effective leadership, it is difficult for the other organizational success factors to gel successfully. Effective leaders help people come together around a common vision that not only unites but motivates. Such a vision should be direct, easily communicated, and reinforce the organization’s mission and its image in the community.Leadership styles vary. Some leaders are “hands on” and detail oriented and focus their energy on running a tight ship. Others are more empowering, placing trust in others to fulfill their responsibilities as they see fit. In either case, effective leaders generally exhibit a number of characteristics, including trustworthiness, loyalty, courage, optimism, empathy, a relatively high energy level, the ability to motivate others, and a strong commitment to leadership. Charisma can be a valuable trait in a leader, but many effective leaders are not particularly charismatic, and charisma alone will not make a leader effective [1Bennis W. On becoming a leader. Perseus, Cambridge, Mass2003Google Scholar].One approach to describing the traits of effective leaders is captured in the term emotional intelligence, which consists of 5 basic groups of abilities [2Goleman D. Boyatzis R. McKee A. Primal leadership: learning to lead with emotional intelligence. Harvard Business School Press, Boston2004Google Scholar]:•Leaders need to be self-aware, understanding their strengths and weaknesses, being confident about their goals and principles, and striking a balance between dreams and realistic expectations. Unless leaders know who they are and what they stand for, it is difficult to cultivate respect and trust.•Leaders need to be effective self-regulators, able to choose their words carefully, mediate conflicts without becoming entrapped in them, and remain open to change. One way some leaders have developed their own capacity for self-regulation is to make a point of doing something every day that is personally uncomfortable but necessary for the organization.•Leaders need to be strongly motivated, drive themselves beyond expectations, persevere in the face of hardship, and constantly look for opportunities to raise the bar of performance expectations. Keeping score is an important source of motivation, and effective leaders keep score less in terms of their own achievement than that of the organization. In the words of Jack Welch [3Welch J. Welch S. Winning. HarperCollins, New York2005Google Scholar], former CEO of General Electric, “Before you become a leader, success is about growing yourself. Once you become a leader, success is about growing others.”•Leaders need to be empathetic, genuinely interested in their colleagues’ lives both at work and home. They need to see them not as replaceable parts in a machine but as human beings with their own unique perspectives and abilities. If colleagues feel that a leader does not care about them, motivation and loyalty are likely to suffer.•Leaders need social skills, including the ability to build and maintain interpersonal relationships, sufficient approachability to know what is happening in the organization, and proficiency at persuading and collaborating with others. Good leaders also get outside their organizational silos, exploring other domains and strengthening ties with other groups.Dwight Eisenhower once remarked that the sign of a great leader is getting people to follow not because they have to but because they want to [4D’Este C. Eisenhower: a soldier’s life. Henry Holt, New York2002Google Scholar]. Leadership involves helping colleagues see what they ought to want, as well as inspiring others to follow that vision. Hence, leadership cannot mean simply being out in front on everything. Occasionally the person out in front turns around and realizes that no one is following, in which case the “leader” is not really leading but merely taking a walk.There is some tension between the usual modus operandi of practicing physicians and the responsibilities of a physician-leader [5Kurtz M.E. The dual role dilemma.in: Curry W. New leadership in healthcare management: the physician executive. American College of Physician Executives, Tampa, FL1988: 65-73Google Scholar]. A practicing physician is generally action oriented, reactive, inclined toward a short-term perspective, and accustomed to making decisions alone, operating as an advocate for the patient, and identifying with the profession. A physician-leader needs to be more focused on planning than action, working proactively, delaying gratification, delegating to others, operating collaboratively, and identifying with and advocating for an organization.Peter Drucker [6Drucker P. The essential Drucker: the best of sixty years of Peter Drucker’s essential writings on management. HarperCollins, New York2003Google Scholar] famously declared that management is doing things right, whereas leadership is doing the right things. Although this is certainly true, good management is no less important than good leadership, and many physician-leaders are most effective working in tandem with managers. In such situations, physician-leaders function as the strategic thinkers, taking full responsibility for physician issues, overseeing the managers, and representing their groups before senior management in health care organizations. By contrast, managers represent their groups with hospital operations, oversee the day-to-day business, and help push and stretch personnel toward their practices’ goals.A major pitfall in leadership is hypocrisy, which erodes respect and trust very quickly. If leaders wish to have integrity, they must live by their word, put the needs of the organization first, be willing to choose the harder but fairer alternative, and stick to what is right, no matter the consequences. This means leading by example, being willing to admit mistakes, giving trust in order to gain it, surrounding themselves with good people, praising in public while criticizing in private, and avoiding the temptation to micromanage the work of others.Leaders need to set goals for organizations and their members that are achievable but extend everyone beyond their prior levels of performance. One of the traits that leaders need to foster in others is leadership itself. In the words of Walter Lippmann, “the final test of a leader is that he leaves behind him in other men the will and the conviction to carry on” [7Steel R. Walter Lippmann and the American century. Transaction, Edison, NJ1999Google Scholar]. This means putting in place a leadership development program. It can prove disastrous for an organization for a leader to allow the fear of being overshadowed to squelch the full expression of colleagues’ leadership abilities.Leadership DevelopmentHospitals and health care organizations have emulated the business community by putting in place leadership development programs. What was once an apprenticeship model of leadership development for hospital CEOs now resembles a traditional master’s in business administration program. With such programs devoting years to the development of future leaders, it is no wonder that the profession of medicine and the field of radiology, whose curricula devote little or no attention to leadership, find themselves at a competitive disadvantage in dealings with hospitals and health care organizations.There are other examples of leadership development that radiology might emulate to improve its focus on leadership development. The military devotes a great deal of time and attention to developing leaders. Its program is based on a well-defined leadership continuum that permeates every level of the organization. If the military failed to inculcate its own values and traditions, it could not succeed, and the same thing could be said for any profession or professional organization. One way to bring out the best in the younger generation is never to underestimate what they are capable of and to let an organization’s pride in what they do shine through as a source of inspiration.Leaders need to know and care about people. One of the ways leaders can inspire colleagues to seize opportunities and reach their full potential is to show how much they care about them, recognizing and valuing their contributions. One practical way to develop this habit is to offer sincere thanks and appreciation to multiple people every week. In the final analysis, one of the most powerful things a leader can do to bring out the best in others is to take a sincere personal interest in their development.To say that organizations need to develop their members’ leadership capabilities is not to say that everyone in an organization should be groomed to be chair, president, dean, or CEO. This is impractical for several reasons, not least of which is the fact that only one person can serve as CEO at any one time. Repeatedly moving people into and out of the top leadership position will take a serious toll on any organization. It is not necessary to sit atop the organization chart to lead, and leadership is important at every level if an organization is to flourish.The desire to lead is not universal, and some people may be able to make greater contributions outside formal leadership roles. In choosing people to lead, it is important that they not only exemplify high levels of excellence in their field but also feel a sense of personal responsibility toward leadership. Once people assume demanding positions of leadership, they need to remember to continue to practice their profession. If they forget to do so, they may lose touch with the work of their colleagues, eroding the respect of more junior people.It is vital that organizations avoid making positions of leadership the automatic next steps in the careers of successful people. The simple fact that people are high achievers does not mean that they will be effective leaders. To lead requires a different focus, with less emphasis on individual creativity and success and a greater focus on working for others and building consensus. People should accept important leadership positions only if they sincerely want to work to make things better and exhibit a real passion for the mission of the organization.People groomed to lead an organization should be so excited about making it better that they can hardly stand it. They must really care about the development of their colleagues and want to make their success part of their personal missions. They must also reconcile themselves to the fact that the rigors of leadership will make it virtually impossible to remain the most knowledgeable people in their particular areas of expertise. The leader of an organization needs a broader level of understanding that makes it difficult to retain the deepest expertise in any particular area.A key component of leadership development is mentorship. People can take courses in leadership development and even pursue academic degrees in areas such as business and health care administration, but there is no substitute for good role models. In many fields, retired leaders represent a largely untapped leadership resource. By finding ways for seniors to contribute, organizations can provide invaluable support to developing leaders and enable some of their wisest and most experienced people to continue to contribute.One way to help junior people identify and develop their interest in leadership is through service. Even the most junior people in an organization can become involved in committee service, help formulate budgets and business plans, play a role in human resources management, and assist with quality assurance and quality improvement initiatives. Such activities foster a deeper understanding of the structure and function of organizations and provide an introduction to the vocabulary and processes of running a successful organization. They also groom young radiologists to assume larger and more central leadership roles.An area of particular concern in leadership development is the underrepresentation of women and minorities in leadership positions. No field can afford to leave leadership talent untapped. With the proper mentorship and encouragement, members of underrepresented groups will learn that their leadership abilities are needed and that they can make substantial contributions. The question is not whether women and minorities can conform to the established models of leadership but whether organizations can engage members of these groups and tap into the new perspectives and styles they bring to the table.Leadership in RadiologyIt would be foolish for radiology to rely purely on chance or fate to produce its leaders. There is too much at stake. Leadership is needed at all levels, from individual sections and departments to national and international organizations. Yet, leadership development has not been a strong focus of the field. In academic radiology, people make careers primarily through excellence in research or clinical work in a particular subspecialty. Unfortunately, such excellence lies on a different axis than leadership. The knowledge and skills required to perform at a high level as a researcher or clinician are not the same as those required to excel as a leader, and many academic stars are ill-prepared to lead their organizations.Radiology has a lot going for it. It is full of bright people who tend to practice in groups, which should promote an organizational perspective and interest in leadership. On the other hand, radiologists as a group may be less interested in leadership than other medical specialties. The current radiology training system does little to promote leadership, and radiology itself is a rather fragmented field, with no fewer than 53 organizations vying for radiologists’ attention. Perhaps one of the greatest attractions of radiology is also one of its greatest liabilities, at least when it comes to motivating radiologists to assume leadership roles—many radiologists earn good livings and lead comfortable lives, meaning that they are not very “hungry.” Fat cats tend not to hunt.At this time, many radiologists and radiologists-in-training may perceive leadership responsibility as more of a burden than a blessing, more of a punishment than a reward. In many groups, individuals who assume leadership roles receive little or no additional time to carry out their responsibilities, and their incomes may suffer because of time taken away from clinical practice. This is a particular problem with service to organizations outside group practices. Even a group member in the very highest national leadership position may be expected to use limited vacation time to fulfill service commitments.There is a dearth of people in all medical specialties looking to lead, but the problem seems to be somewhat more severe in radiology and radiation oncology. Prospective leaders see department chairs being repeatedly subjected to severe criticism, and they recognize that many leaders do not last long in their positions. Leadership seems to many a difficult, unappreciated, and unrewarding calling, and people who accept leadership roles are as likely to receive condolences as congratulations. Why should radiologists exert themselves to give something back to the profession?There is a sense that apathy is at the root of much of the leadership problem. Radiologists are working harder and attempting to meet higher performance expectations than ever before. Many feel that once their routine responsibilities are fulfilled, they have little or no remaining energy to devote to service. Moreover, some younger radiologists feel neither a strong sense of citizenship in the radiologic community nor a calling to serve. It is important to understand the distinctive motivations of each generation, as strategies that have generated interest in leadership and service in one may not work effectively for another.What could the field of radiology do to counteract this creeping apathy? Part of the solution is to make palpable to younger radiologists the challenges and opportunities in the field and let them know that by rolling up their sleeves and getting involved, they can make a real difference. If junior people in the field are not actively engaged in service and leadership, then radiology organizations and their leaders need to do a better job of involving them. The early decades of a radiologist’s career are a vital leadership development opportunity that the field cannot afford to neglect.RecommendationsWorking collectively, and on the basis of the discussion detailed above, forum participants formulated a number of recommendations for the Board of Chancellors regarding specific steps the ACR should take to improve leadership in radiology:•The ACR should explicitly acknowledge that the future of radiology and its role in health care hinges on the quality of its future leaders.•The ACR should study current practices to determine the levels of administrative time, compensation, and support services that radiology organizations provide to individuals who play leadership roles.•The ACR should study the obstacles that deter radiologists from leadership, including negative perceptions of leaders and leadership, and ways radiology leaders deal with competing demands.•The ACR should assume responsibility for collecting and disseminating information about existing leadership development programs.•The ACR should commit itself, in collaboration with other organizations, to developing resources to promote leadership, including a statement that voluntary service to the profession is an expectation of all radiologists.•The ACR should work to highlight and promote the importance of leadership at every level of radiology, including academic and private practices, residency and fellowship training programs, local and state chapters of radiology organizations, accrediting bodies such as the Residency Review Committee and the American Board of Radiology, and other national and international radiology organizations.•The ACR should encourage practices to promote member leadership activities by removing disincentives and providing sufficient time and resources for leadership excellence.•The ACR should promote leadership by inviting young radiologists and radiologists-in-training to serve in important positions in the organization.•The ACR should make a special effort to promote leadership opportunities for women and members of underrepresented minorities.•The ACR should encourage the Residency Review Committee and the American Board of Radiology to incorporate leadership into radiology training curricula and work with the Association of Program Directors in Radiology to embed leadership training in residency and fellowship programs. Such curricula should include didactic instruction, on-the-job training, and mentoring.•Existing ACR education and training programs should be configured to provide participants with opportunities to identify and begin to develop their own leadership abilities.ConclusionMany radiology practices spend millions and even tens of millions of dollars annually on facilities and equipment. By contrast, our specialty as a whole devotes relatively few resources to developing our most important resource of all, our people. The performance of radiology organizations is powerfully influenced by the quality of leadership they enjoy. If the people in charge do not lead effectively, our organizations are unlikely to prosper in the future. On the other hand, if our leaders are highly knowledgeable, skilled, generous, admirable, and committed and operate with strong support from their colleagues, our prospects seem considerably brighter. Hence, leadership and leadership development represent opportunities in which every radiologist and every radiology organization should take a deep interest. Since 2001, the annual ACR Forum has brought together leaders from inside and outside radiology to discuss topics of long-range significance to the field. Past topics have included molecular imaging, strategic planning, quality and safety, the future of screening, disruptive technologies, and cardiovascular imaging. Each forum results in the publication of a white paper, a series of recommendations to the ACR Board of Chancellors, and actions by the ACR. The topic of the 2007 ACR Forum, held at ACR headquarters in July 2007, was leadership in radiology. The 2007 ACR Forum brought together a wide range of participants from industry, government, the military, hospital administration, university administration, business schools, practice management, academic and private practice radiology, and the ACR to discuss fundamental questions about the future of radiology leadership: What are the characteristics of effective leaders? How can organizations do a better job of identifying and developing leaders? What is the current state of leadership in radiology, and what could be done to improve it? The following sections encapsulate the conversations of the participants. The article concludes with recommendations for improving leadership in the field of radiology. Effective LeadersLeadership alone will not make an organization successful. Other ingredients, such as the quality of an organization’s human and financial resources and the innovativeness of its products and services, also play a crucial role. Yet, without effective leadership, it is difficult for the other organizational success factors to gel successfully. Effective leaders help people come together around a common vision that not only unites but motivates. Such a vision should be direct, easily communicated, and reinforce the organization’s mission and its image in the community.Leadership styles vary. Some leaders are “hands on” and detail oriented and focus their energy on running a tight ship. Others are more empowering, placing trust in others to fulfill their responsibilities as they see fit. In either case, effective leaders generally exhibit a number of characteristics, including trustworthiness, loyalty, courage, optimism, empathy, a relatively high energy level, the ability to motivate others, and a strong commitment to leadership. Charisma can be a valuable trait in a leader, but many effective leaders are not particularly charismatic, and charisma alone will not make a leader effective [1Bennis W. On becoming a leader. Perseus, Cambridge, Mass2003Google Scholar].One approach to describing the traits of effective leaders is captured in the term emotional intelligence, which consists of 5 basic groups of abilities [2Goleman D. Boyatzis R. McKee A. Primal leadership: learning to lead with emotional intelligence. Harvard Business School Press, Boston2004Google Scholar]:•Leaders need to be self-aware, understanding their strengths and weaknesses, being confident about their goals and principles, and striking a balance between dreams and realistic expectations. Unless leaders know who they are and what they stand for, it is difficult to cultivate respect and trust.•Leaders need to be effective self-regulators, able to choose their words carefully, mediate conflicts without becoming entrapped in them, and remain open to change. One way some leaders have developed their own capacity for self-regulation is to make a point of doing something every day that is personally uncomfortable but necessary for the organization.•Leaders need to be strongly motivated, drive themselves beyond expectations, persevere in the face of hardship, and constantly look for opportunities to raise the bar of performance expectations. Keeping score is an important source of motivation, and effective leaders keep score less in terms of their own achievement than that of the organization. In the words of Jack Welch [3Welch J. Welch S. Winning. HarperCollins, New York2005Google Scholar], former CEO of General Electric, “Before you become a leader, success is about growing yourself. Once you become a leader, success is about growing others.”•Leaders need to be empathetic, genuinely interested in their colleagues’ lives both at work and home. They need to see them not as replaceable parts in a machine but as human beings with their own unique perspectives and abilities. If colleagues feel that a leader does not care about them, motivation and loyalty are likely to suffer.•Leaders need social skills, including the ability to build and maintain interpersonal relationships, sufficient approachability to know what is happening in the organization, and proficiency at persuading and collaborating with others. Good leaders also get outside their organizational silos, exploring other domains and strengthening ties with other groups.Dwight Eisenhower once remarked that the sign of a great leader is getting people to follow not because they have to but because they want to [4D’Este C. Eisenhower: a soldier’s life. Henry Holt, New York2002Google Scholar]. Leadership involves helping colleagues see what they ought to want, as well as inspiring others to follow that vision. Hence, leadership cannot mean simply being out in front on everything. Occasionally the person out in front turns around and realizes that no one is following, in which case the “leader” is not really leading but merely taking a walk.There is some tension between the usual modus operandi of practicing physicians and the responsibilities of a physician-leader [5Kurtz M.E. The dual role dilemma.in: Curry W. New leadership in healthcare management: the physician executive. American College of Physician Executives, Tampa, FL1988: 65-73Google Scholar]. A practicing physician is generally action oriented, reactive, inclined toward a short-term perspective, and accustomed to making decisions alone, operating as an advocate for the patient, and identifying with the profession. A physician-leader needs to be more focused on planning than action, working proactively, delaying gratification, delegating to others, operating collaboratively, and identifying with and advocating for an organization.Peter Drucker [6Drucker P. The essential Drucker: the best of sixty years of Peter Drucker’s essential writings on management. HarperCollins, New York2003Google Scholar] famously declared that management is doing things right, whereas leadership is doing the right things. Although this is certainly true, good management is no less important than good leadership, and many physician-leaders are most effective working in tandem with managers. In such situations, physician-leaders function as the strategic thinkers, taking full responsibility for physician issues, overseeing the managers, and representing their groups before senior management in health care organizations. By contrast, managers represent their groups with hospital operations, oversee the day-to-day business, and help push and stretch personnel toward their practices’ goa