Leading the Charge
What is leadership in radiology and how is it developed?
Merriam-Webster defines "leading" as the act of directing or guiding on a course.
For radiologists and other physicians, however, a leader can be synonymous with many different roles: manager, evaluator, administrator, mentor, volunteer, and researcher. Yet, what are the characteristics of a good leader? Are some individuals born with leadership traits? Or are these skills developed over time?
Just as being a leader in health care can have many shapes and definitions, there is also a spectrum of skills that define those who lead. "You can't just say leadership is 'X.' It's way beyond that," explains Joel I. Shalowitz, M.D., M.B.A., clinical professor of health enterprise management and director of health industry management at the Kellogg School of Management at Northwestern University in Evanston, Ill. Becoming a leader, he notes, requires several different skills and abilities, ranging from financial management to establishing a long-term mission for the organization. Among the first steps in becoming a leader, according to Shalowitz, is being able to evaluate an organization to see how it can be improved. Before an individual can perform an evaluation, however, he or she must have a comprehensive understanding of the field and its intricacies. Physicians just out of residency should not expect to become a leader within the field as soon as they begin clinical practice, explains Irene B. Frederick, M.D., FACOG, academic director of the health-care leadership masters program at University of Denver's University College. "The first thing that you need to do is become clinically proficient," she says. "Know what [issues] you are dealing with; know what your problems are, and know what your population is. You can't try to lead something that you are completely unfamiliar with."
Another attribute of a leader, according to Frederick, is to observe and listen. Being a good leader includes the ability to listen and hear what's going on around you. "You need to listen to your employees, coworkers, and superiors," she says. Through listening and observation, adds Shalowitz, individuals can evaluate their organization "using whatever accepted metrics exist in [their] field." For example, radiologists could take advantage of such resources as the ACR National Radiology Data Registry™ to compare their clinical data with those of other practices. Then they could create a plan of action based on the data.
Are Leaders Born or Made?
Individuals with their proper attributes and tools can make a difference in their organizations. But are some leadership attributes, such as the ability to listen, or even successfully evaluate their organization, inherent? The phrase, "born leader," suggests that leadership is innate, whereas myriad leadership courses and programs throughout the country imply that these skills can be learned.
Shalowitz believes that being a leader requires both learned skills and internal characteristics, and that some demonstrate more aptitude toward leadership than others. He compares it to playing a musical instrument. "You have heard of cases in which people can pick up an instrument and become a virtuoso," he explains. "But that doesn't mean that you can't be an outstanding performer just because you're not a prodigy. You just have to work harder at it."
In addition, Shalowitz, who is also organizing the inaugural event of the ACR's Radiology Leadership Institute (www.acr.org/rli), says that the purpose of academic training in leadership is not necessarily to teach individuals the answers to all of the questions or how to address scenarios a leader might encounter. Instead, it helps students become critical thinkers and problem solvers. It "teaches you what questions to ask," he says.
One question that radiologists might ask is "How does health-care leadership differ from leadership in other fields?" Several significant differences exist between the CEO of a hospital organization and a computer chip company, Shalowitz explains. A computer chip company can encourage innovation so it can remain current and meet its bottom line. It develops experimental models and takes a trial-and-error approach to research and development. Its leaders can also change the dynamic of its organizational structure to better suit a particular product.
Like the computer chip company, radiology practices — as well as those in other health-care fields — are encouraged to innovate and meet their budgets. But the similarities end there. Health-care organizations are also heavily constrained by a high standard of what Shalowitz calls "predictability and reliability." In other words, health-care organizations must adhere to the rules and regulations established for their field. To illustrate, Shalowitz uses the example of an airline pilot who is about to take off. "You don't want the pilot to say, 'I think we're going to take off a little differently today.' [The process] has to be reliable and rules based," he says.
Balancing innovation with regulation is not the only challenge for health-care leaders; they must also keep an eye on the organization's big-picture goals. Then, they must establish a culture that, on one hand, must be heavily regulated and, on the other, must be open to group decisions and innovative feedback. For example, radiologists cannot legally defer reads or reports to a subordinate. However, they must consult with support staff when facing such changes as their organization's transition to ICD-10.
"Technology comes and goes as does the expertise of individuals. People leave organizations; they join organizations," Shalowitz says. "They could be lured away with benefits and more money, but the thing that is very difficult to create, maintain, and duplicate is a highly functional organizational culture."
To establish a positive, productive culture, leaders must also address the diversity of highly trained, independently minded professionals that might exist within a single health-care organization. "You are dealing more with a greater variety of those kinds of people [in health care] than in any other business," Shalowitz says.
Serving the Greater Good
Yet to create these cohesive cultures and organizational qualities, do leaders in radiology have to cut down on clinical work? According to the results of an informal survey featured in the October ACR Bulletin, more than one-third of all radiologists have needed to reduce their clinical practice work to take on additional duties. Although some may have taken on additional administrative work to compensate for layoffs, many radiologists have also reduced portions of their daily clinical reads to assume leadership responsibilities within their organization.
"First and foremost, you have to love it," notes Shalowitz about taking on large leadership responsibility at the expense of clinical time. "Second is that you must decide how your time would be most effectively spent given there is something you do as a leader that no one else can do," he explains. For example, a leader taking time away from his or her clinical work should not be spending time doing payroll or working specifically on the financial statements. Although a leader may supervise budgetary processes, he or she should also examine the larger picture, trends, strategies, policies, and other aspects that relate to maintaining a successful culture.
A potential pitfall for those who believe they can do everything is that they are reluctant to sacrifice their clinical time but still wish to lead their organizations. Such individuals may become truly overworked. "If you are tired and stressed and going in 100 different directions, then you are not a good leader and not a good clinician," Frederick says. In addition to cutting down hours, leaders must budget their time wisely and delegate when necessary.
Despite the difficulties in becoming an organization's leader, the benefits can be rewarding. "Being the academic director for the University of Denver's University College program was a way that — at this point in my life, career, and age — I could pass on these skills to other people," Frederick says.
By Brett Hansen