Leadership in Radiology

What’s expected of leaders in radiology has changed, Frank J. Lexa, MD, MBA, informed his audience at the 23rd Annual Economics of Diagnostic Imaging 2008: National Symposium on October 24, 2008, in Arlington, Va. Lexa is clinical professor of radiology at the University of Pennsylvania Medical Center, Philadelphia, and adjunct professor of marketing and East Asia manager, the Global Consulting Practicum, the Wharton School, Philadelphia. His presentation, Fundamentals of Great Leadership: Lessons for Success, examines what he describes as antidotes for the top 10 bad ideas in leadership and debunks the five most common leadership myths.

“Leadership is too important a function to be left in the hands of only one person. Everyone in an organization has the opportunity to lead, at some time and to some degree. In addition, all established leaders can take advantage of circumstances, as they arise, that allow them to help others in the organization become better leaders.” —Frank J. Lexa, MD, MBA

It can be difficult to understand how better leadership skills in radiology should be developed, Lexa says, because the leadership needs of US businesses have altered over time. In addition to these new expectations, which may be unfamiliar, the more familiar ideas of what good leadership involves may be fallacies. Between the unknown new and the untrue old principles of leadership, both current and future leaders in radiology can be left on shaky ground. Their success depends not on their innate characteristics, Lexa notes, but on their willingness to recognize and develop fundamental leadership attributes. Leadership, Lexa adds, must be evaluated in a context that is larger than the leader’s own skills and achievements. While Napoleon’s statement that there are no bad regiments—only bad colonels—holds some truth, even good leaders can have good or bad followers and can serve good or bad organizations. Leadership’s context also includes the business environment and broader economy, Lexa says, and today’s conditions will make leadership (or lack of it) more apparent than it might be in better economic circumstances. Today, it is more necessary to take risks in response to financial pressures, and a greater level of risk requires stronger leadership. The first step in building that leadership, Lexa says, is to erase the five most common myths that deter the pursuit of better leadership skills. Five Fallacies These destructive misconceptions, Lexa explains, are the legacy of old leadership styles that not only no longer apply in US business, but were never good policy anywhere. The first myth is that leadership is one person’s responsibility. Not only is leadership too important a function to be left in the hands of only one person, he says, but everyone in an organization has the opportunity to lead, at some time and to some degree. In addition, all established leaders can take advantage of circumstances, as they arise, that allow them to help others in the organization become better leaders. The second myth is that leaders are not made, but born. This, Lexa says, is simply nonsense. The tasks and qualities of leaders can be described, so they are no mystery—and what can be described can also be learned. Many, or even most, people have the ability to carry out leadership duties, although they may require training that strengthens their aptitude. The third myth is that leader is a title. It is, instead, a job, Lexa says, and it involves more than one’s position. In addition to providing both strategic and managerial leadership, the leader resolves conflicts, represents the organization and the individuals within it, negotiates both inside and outside the institution, and provides a role model. The fourth myth is that coercion is leadership. Giving orders is not, in itself, leadership—whether those orders are good or bad. Leadership is not dictatorship; in fact, the more dictatorial a leader’s style is, the less respected his or her leadership will be. Leaders must treat people as individuals to be guided and inspired, while dictators treat them as objects to be deployed. The fifth myth is that personal charisma is the source of leadership. For example, Lexa says, the celebrity CEOs who come and go at major corporations are publicity opportunities, not effective leaders. Long-term positive results are more likely to be associated with quieter leadership styles that do not substitute activity for achievement, and that are unwilling to pursue success at the expense of colleagues and friends. The real attributes of a leader are not charisma, but intelligence, trustworthiness, humaneness, and courage, as master strategist Sun-Tzu put it 2,500 years ago. Ten Antidotes Lexa says that a countdown of the top 10 bad ideas in leadership can be useful because each bad idea has specific countermeasures. In increasing order of importance, his countdown consists of:

• leading from behind,
• breaking promises,
• focusing only on details,
• ignoring details,
• reacting instead of acting,
• letting urgent matters displace important ones,
• forgetting the long term,
• ignoring one’s constituents,
• failing to develop skills, and
• omitting a commitment to future leaders.

The antidote for leading from the rear, Lexa says, is to pull out in front and lead by example, particularly when it’s possible to act instead of talking about the necessary action. If a change in how the organization does things is called for, be the first to make that change instead of calling for others to make it. The cure for breaking promises, of course, is to begin by taking care to make only promises that can be kept—and to keep them. Be accountable, and tell the truth even when it is difficult to do so. Missing the big picture by focusing on the details can be avoided by prioritizing tasks and delegating them appropriately. First, though, it’s necessary to trust those to whom one delegates those tasks, and that is accomplished by hiring the best people available. Then, develop their skills and talents as fully as possible. The opposite mistake, in which details are ignored in favor of the view from above, can also be prevented through wise delegation. In this case, avoid ignoring what has been delegated, and be willing to intervene as needed to keep the progress and quality of delegated task on track. Be certain, too, that followers know that you are competent in performing the duties that you delegate to them. This lets them know that you understand their work and appreciate their contributions, and that you can step in to help, if necessary. The cure for reacting instead of acting is to anticipate events well enough to formulate a useful plan. That plan should be shared with the organization’s other leaders and most important followers; with their help, explore various probable scenarios. This will minimize surprises and reduce the likelihood that the institution will be caught off guard at a critical moment. The minimum acceptable in planning, Lexa says, is having a realistic five-year plan. Letting urgent problems prevent attention to other important matters can be avoided by guarding one’s time carefully, particularly against what Lexa calls the electronic shackles of pagers, phones, and email. Set aside uninterrupted time for reflection and planning; then, don’t just do something—stand there, Lexa says. Assess the outlook for the years ahead often, not just during formal planning sessions, and find out what you might reasonably expect to happen in the coming few months (as opposed to next week). Lack of long-term commitment on the part of leaders is best countered by hiring the right leaders in the first place. They shouldn’t be well-known figures who may just be passing through a region or industry on the way to greater fame. They should have a permanent interest in the welfare of the organization and its people. This can be augmented, Lexa says, by compensation arrangements that reward permanence, which he calls golden manacles. The tendency to forget one’s constituents is best avoided by remembering that one is leading a designated group, not the world at large, and that the failures and successes of that group belong not only to them, but to their leader. In all decisions, the welfare and interests of the group should come before those of the leader; ideally, they will be identical. The antidote for failure to develop leadership skills is long-term commitment not only to the organization, but to leadership itself as a profession (rather than as a source of short-term gain). Continue to learn as much as possible, and keep in mind that the more uncertain the business environment becomes, the more vital it will be to acquire advanced leadership skills. The cure for what Lexa calls the worst leadership lapse, which is failing to develop the next generation of leaders, is to become aware of one’s legacy. Find and reward good leaders among the followers; become a mentor to them, and be sure that they are given the time and resources needed to gain leadership skills. Let the leaders of the future practice those skills as often as possible, Lexa says, bearing in mind that this experience is vital not only to their success, but to that of the organization as a whole. Both today’s leaders and those who will step up to help (and, one day, replace) them will need to display vision, empathy, decisiveness, responsibility, courage, and commitment; they will need to be strong negotiators, effective networkers, and good trainers. Perhaps most of all, they will need to inspire others to do—and to be—their best.