First Year in a New Leadership Role: Lessons Learned

Abstract

When discussing leadership, multiple questions arise: what does it mean to be an effective leader?; what are the characteristics of a person that make them so?; and are leaders born, or are they made? Organizations need effective leaders at all levels, especially in the constant and rapidly changing landscape that is healthcare provision. Those in senior leadership roles should encourage junior team members to engage in leadership activities appropriate to their level of comfort and expertise. Integrity and principle are also essential leadership characteristics, particularly when faced with making decisions that are difficult, or considered to be “unpopular.” Organizations that wish to develop and maintain effective leadership programs must ensure that they balance the needs of the organization with those of the leaders. Adequate space must be made to facilitate leadership activities as well as personal, academic, and clinical duties. Ultimately, leadership takes practice and persistence on the part of the leader themselves, but also on the part of the organization in which they work.

In the words of Dwight D. Eisenhower, “leadership is the art of getting someone else to do something you want done because he wants to do it.” ¹ Aspirational quotes about what it is to be a leader abound. But, what does it mean to be an effective leader? What are the characteristics of a person that make them so? One of the most fundamental questions that arises in relation to leadership is: are leaders born or made? Most contemporary literature on the topic suggests that leaders are both born and made.^2,3 Some individuals are born with characteristics and attributes that will naturally incline them to become an effective leader. It is through their childhood, education, and career experience that their leadership abilities will be developed and their skills honed. ⁴ If one can be made a leader, then the assumption is that one can “learn to lead.” ⁴ Furthermore, if one can learn to be a leader, this suggests that leadership can be taught as an entity in and of itself. Another important consideration is who is suitable to lead within an organization or institution. One of the senior authors of this paper, Dr. Patlas, is the Chair on one of the largest radiology departments in the word, leading a team of over 550 individuals, including faculty and trainee radiologists. Dr. Hanneman is Vice-Chair for Research at the same department. Appointed just over 1 year prior, Drs. Hanneman and Patlas share their learnings during their first year as leaders in radiology with the lead author of this paper, Dr. Hughes.

From an organizational perspective, leadership development can be defined as the process of improving the efficacy and efficiency of its leadership processes in order to drive direction and engender commitment to an organization’s vision. ⁵ From an individual perspective, leadership development can be thought of as the learning of knowledge, skills, and abilities that enable one to be effective in formal leadership roles. ⁵ The belief that leadership talents can be developed through learning and practice reflects a growth mindset. This is essential to staying current, adapting to changing demands and challenges, and identifying opportunities for growth. Not all leadership roles are formal in nature. Many people engage in informal leadership roles both inside and outside of work.^5,6 A leadership title is neither a requisite nor sufficient to define a leader—you don’t need a title to be a leader and not all people with titles are leaders. Leadership development can be considered as a process that spans an entire lifetime. Life can be thought of as a natural classroom for acquiring and honing leadership skills, where “every form of growth or stage of development in the life cycle” can “promote, encourage and assist in one’s leadership potential.” ⁴ Most importantly, however, one must be interested in their own sense of leadership development in order to learn the lessons on offer throughout their day-to-day life. According to Hughes et al, “leadership development is advanced when leaders take time to think deeply about their successful and unsuccessful actions.”^4,7

“Some are born great, some achieve greatness, and others have greatness thrust upon them.” ⁸ While this infamous quote from Shakespeare’s play Twelfth Night refers to “greatness,” the same perspective could be applied to leadership. Not everyone is born a leader. In fact, most of us are not. Furthermore, the desire to lead is by no means universal. In some organizations, success is an automatic stepping-stone to the acquisition of leadership positions, whether one wishes for this career trajectory or not. It is important that organizations remain cognizant of the fact that it is not realistic to expect that all high achieving individuals will be effective leaders. In particular, physicians often establish their careers through excellence in academia, research, or through their hands-on clinical work. ⁹ The knowledge and skills required to excel in these areas are not necessarily the same as those required to be an effective leader. ⁹ Leadership requires a shift in focus from individual success to the realization of a shared vision and mission through collective consensus.

In the words of J. Wolfgang von Goethe, “instruction does much, but encouragement, everything.” ¹⁰ For those who are interested in holding leadership positions within their organizations, there are a myriad of ways in which leadership skills can be acquired, nurtured, and sharpened. Leadership skills can be learned through taking courses or pursuing academic degrees with this aim, for example. However, it can sometimes be difficult to extrapolate and incorporate didactic teachings into busy, every-day, working lives. ¹¹ Mentorship plays a crucial role in leadership development, which can be formally or informally established.^12-14 Mentoring is a “two-way-street” and provides benefits to both the mentor and the mentee by fostering self-reflection, identifying gaps in knowledge and skills and providing awareness of different approaches to certain challenges. ¹² Furthermore, mentorship has been shown to reduce stress and anxiety and to improve the self-esteem of those involved. ¹³ Due to the constant and rapidly changing landscape of healthcare, organizations need effective leaders at all levels. ¹⁵ Therefore, the importance of involving individuals at all levels within the organization should not be overlooked. Encouraging junior colleagues to become involved in leadership roles, for example sitting on committees or acting as representatives for their requisite level of employment, helps to foster a greater understanding of the structure and complexities involved in the running of a successful organization or institution. ⁹

Another important facet of physician leadership to consider is that of academic productivity, especially for those leaders working in academic institutions such as universities or in university hospitals. University hospitals are complex organizations that navigate multi-faceted objectives, including training future physicians, providing patient care and facilitating research output in order to improve the quality of the patient care delivered.^16,17 Thus, a key role of clinician leaders in academic hospitals is encouraging and fostering academic output from both their peers and junior colleagues. Once aspect of medical academia is that of conducting research and formulating one’s findings into a readable, digestible format, which commonly takes the form of an article for publication in a scientific journal. Writing for academic publication is not an innate skill. ¹⁸ Rather it is a skill that requires practice, patience, and perseverance. Hurdles to getting research completed or “over the line” include procrastination as well as manuscript rejection by academic journal editors. This makes it all the more important for those involved in research to have a mentor, someone they can turn to for advice, guidance, writing assistance, and sometimes reassurance. ¹⁸ It is vital that clinicians at all levels in academic organizations are both adequately trained and supported to contribute to the betterment of patient care through research.

“A genuine leader is not a searcher for consensus but a moulder of consensus.” ¹⁹ Leaders in healthcare organizations are required to navigate increasingly complex and ever-changing landscapes whilst taking into account the requirements of multiple stakeholders, from nurses to doctors, patients, and administrators, to name but a few. They must galvanize those they lead through consensus and collaboration, whilst balancing priorities in order to achieve high quality, safe, and effective patient care. ²⁰ However, the size, scale, and complexity of modern healthcare systems can pose challenges for those physicians who wish to understand the rationale behind many of the decisions made by those in leadership roles and how these decisions align with their patients’ needs, as well as their own professional values. ²¹ It is vital that leaders effectively communicate the aims of the organization—the “why”—and translate these aims into achievable means through which their team can achieve the desired outcomes— “what” is to be done and “how” a team can do it. ²¹

What happens when a difficult decision needs to be made? A well-known idiom comes to mind: “in the fullness of time.” In order to avoid the pitfall of knee-jerk decision-making, a helpful way for leaders to approach a difficult decision is to consider how the results of a decision made will reverberate and settle “in the fullness of time.” As a leader, it is imperative to have a strong moral compass, especially when the right thing to do may be the most difficult road to take. ²² Effective leaders understand that they may be required to “swim against the tide” from time to time. In these situations, one must have the courage to stick to their principles rather than bending to the will of others and to act with integrity instead of choosing convenience. In the event that a wrong decision or mistake is made, it is essential to reflect, acknowledge, and accept responsibility rather than “passing the buck” to another party. ⁴

Effective communication is essential for leaders to engage, inspire, and motivate people to act. This encompasses sharing ideas persuasively to ensure the message is received as intended. At the same time, leaders should foster a culture of safety within their teams, encouraging those they work with to speak up and voice their opinions, concerns, and ideas without fear of retaliation or negative consequence. A culture of safety around speaking up improves worker performance, satisfaction, retention, productivity, innovation, and growth. In radiology, open communication about safety concerns and unprofessional behaviour is essential to optimize patient outcomes and radiologist performance.^23,24 Self-awareness is also needed in order to listen to diverse perspectives, especially when they may differ from one’s own beliefs and perceptions.

Leadership plays a crucial role in the professional well-being of employees. It has been shown that the behaviour of immediate superiors can affect clinicians’ sense of professional fulfilment.^21,25 When a healthcare leader’s perceived performance metrics are scored by their team, better performance is associated with higher rates of individual physician job satisfaction and lower rates of burn-out. ²⁶ Behaviours that scored most highly included encouraging suggestions for organizational improvement, keeping one’s team informed, facilitating and fostering career development conversations, providing feedback and, importantly, showing appreciation for a job well done. ²⁶ In addition, the importance of empathy in the context of leadership cannot be underestimated. Empathy is defined as “the ability to comprehend another’s feelings and to re-experience them oneself.”^27,28 Researchers have shown that through empathy, effective leaders generate a “resonance” between team members, which in turn fosters positive emotional output and behaviours. ²⁷ Essentially, empathy is a key factor in promoting and maintaining positive interpersonal professional relationships that facilitate institutional change and growth. ²⁷ Objective measurements of the quality of care delivered by physicians is also associated with how closely individuals perceive their values to align with those of their leader. ²⁹ Through training programs, regular assessment, and feedback, leaders can acquire and develop vital skills that contribute to their team’s psychosocial well-being. Of particular benefit is training relating to emotional intelligence, identifying individual intrinsic motivating factors, how to build consensus and how to lead by example. ²¹ Ultimately, self-reflection and self-awareness are critical if a leader wishes to succeed and effectively lead their team.

Goal-setting is a fundamental feature of successful organizations and effective leadership. ³⁰ Goals provide a foundational framework onto which organizations and institutions can be built.^30,31 The benefits of well-formulated goals are multifaceted. First, they provide a conceptual framework around which strategies can be planned and activities organized in order to achieve the desired outcome.^30,31 Second, goals can be used as benchmarks to assess the quality and progress of task management and to appraise whether or not an organization is meeting its required targets within the required or expected timeframe.^30,31 Finally, once a goal has been implemented, it can serve as a tool to measure the effectiveness and relevance of policies, services, and departments across an organization, as well as highlighting managerial accountability for expenditure.^30,31 A basic trajectory of goal-setting in healthcare can be divided into 3 levels of results; immediate goals (work output), intermediate goals (expressed objectives of work outcomes), and terminal goals (the desired impact of the outcomes themselves). ³² Goals are intrinsically hierarchical with respect to the organizational level at which they are set, as well as their expected timeframe for deliverance. ³⁰ The underlying expectation of all basic human activity is the achievement of goals. ³³ Thus, organizations without goals lack purpose and motivational drive; they are directionless ships with no destination for their journey. ³⁰ It is vital that leaders do not overlook the importance of goal setting throughout all levels of their team and organization.

“A great man doesn’t seek to lead. He’s called to it. And he answers.” ³⁴ There is a perception amongst some physicians that appointment to a leadership position is equally deserving of commiserations as it is congratulations; occasionally as much a punishment as it is a reward. In some institutions and organizations, those in leadership roles are expected to fulfill their commitment without protected allocated time or additional remuneration. Therefore, an individual’s personal time or annual leave entitlements may be used into in order to carry out the responsibilities of the leadership role. Their income may also suffer due to reduced available time for clinical practice. ⁹ This is particularly relevant as up to 72% of Canadian radiologists report symptoms of burnout, making the additional time required to take on additional roles challenging in a landscape of high clinical workloads. ³⁵ Trade-offs are part of our personal and professional lives. However, leaders should not have to sacrifice their research or clinical ambitions, jeopardize professional relationships or minimize their own personal or family time for the sake of an organization. On the other hand, leadership roles provide ample opportunity for personal growth and development in the name of serving a purpose beyond oneself. ³⁶ Involvement in leadership roles can foster the development of important attributes such as courage, compassion, justice, and integrity. Ideally, organizations should provide room for leaders on every rung of the career ladder to continue to pursue what is important to them alongside their additional duties. ¹³ Multiple initiatives have been investigated to try to mitigate burnout of physician leaders. Burnout is characterized by emotional exhaustion, feelings of negativism or cynicism related to one’s job, and reduced professional accomplishment or effectiveness. Moral distress is often the root cause of burnout, while burnout is the symptom.^37,38 Burnout is a critical issue, linked to increased medical errors, poor quality of care, decreased patient safety, and higher physician turnover.^37,38 Ensuring adequate departmental staffing levels, allocation of appropriate protected time for administrative activities, reducing workload as well as reducing expectations for academic activity or output can help to improve work-life balance, increase job satisfaction and lower rates of physician burn-out. ³⁵ Ultimately, it is necessary to strike a balance between the need for leaders within an organization and those leaders’ needs both within and beyond the organization.

Radiologists at all levels of professional development should consider their leadership roles and responsibilities. Those in senior leadership roles should encourage junior team members to engage in leadership activities appropriate to their level of comfort and expertise. It is imperative that leaders incorporate self-reflection and self-awareness into their everyday practice to ensure they contribute positively to their team’s psychosocial well-being. In addition, organizations should endeavour to improve goal and value alignment between leaders and their teams, as this can significantly affect individual physician job satisfaction and rates of burnout. It is vital that those in leadership roles effectively communicate the aims of the organization to their teams and foster a culture of collaboration and cohesiveness where possible. Furthermore, integrity and principle are essential, particularly when faced with making decisions that are difficult, or considered to be “unpopular.” Organizations that wish to develop and maintain effective leadership programs must ensure that they balance the needs of the organization with those of their leaders. Adequate space must be made to facilitate leadership activities as well as personal, academic, and clinical duties. Ultimately, leadership takes practice and persistence on the part of the leader themselves, but also on the part of the organization in which they work.