Leadership in Academic Medicine

Bldg. E/ Lecture F Leadership in Academic Medicine Kent A. Corso, PsyD, BCBA-D Walter Reed Bethesda USUHS Department of Family Medicine

OBJECTIVES • To describe the leadership theories that are most applicable to leadership in academic medicine. • To apply one leadership theory to a project, work relationship, or future planning endeavor within your academic medical center. Distribute Learning Probe

SCHEDULE • 20 Oct 11: • Lecture and Discussion • Administer MLQ Form 6S • Discuss results and limitations • Experiential learning assignment • 27 Oct 11: • Review experiential learning assignment • Discussion: reasons to continue working on these leadership skills; exchanging ideas about leadership • Case study of 4 hospitals using transformational leadership • Complete feedback forms/course evaluation

Introductions • Where do you work? • What is your role? • Do you have a management/supervisor position? • Any prior experience with leadership training/development that you found particularly beneficial? If so, please explain briefly. • What did you hope to gain today?

OVERVIEW • Introductions • Leadership Theory Overview • Leadership in Academic Medicine • Relevant Primary Literature Findings • Assessing your own level of development as a transformational leader • Experiential Learning Assignment

Leadership Defined The Anglo-Saxon etymological origin of the words lead, leader and leadership is laid, which means 'path' or 'road'. The verb læden means 'to travel'. Thus a leader is one who shows fellow travellers the way by walking ahead (Kets de Vries, Vrignaud, & Florent-Treacy, 2004).

Leadership Defined Management produces order and consistency Leadership produces change and movement Assigned versus Emergent

Self-Monitoring • Think of a time when you implemented leadership skills and it did not go well. • What went wrong? • What are THE pitfalls? • What are YOUR pitfalls or areas for improvement?

Leadership Defined • Leaders exert Power and Influence • How? • Persuasion • Power

Persuasion/Influence • Subtle versus obvious • Systematic versus sporadic

Power and Leadership • Legitimate/Positional • Reward • Coercive • Expert • Referent (French and Raven, 1959) Why is power important when you are the leader?

Context is Everything • What are the unique aspects of academic medicine that demand leadership? • What type of leadership would best fit? Why?

Primary Leadership Theories Trait Theory Style Theory Contingency Theory Situational Theory Path-Goal Theory Leader-Member Exchange Theory Psychodynamic Theory Transformational Theory Team Theory

Leadership in Academic Medicine • Charismatic Leadership • Servant Leadership • Transformational Leadership • Full Range Leadership Model

Charismatic Leadership • These leaders effect their followers in a way which suggests that they have superhuman or exceptional powers, the result is that the person is treated like a leader by the followers (Weber, 1976) Recall a person you’ve known who was treated in a “special” way due to his/her natural disposition? • This is similar to trait theory in that you either have it or you don’t – it is not something that can be taught

Charismatic Leadership Personality Characteristics -Dominant -Desire to influence -Confident -Strong values Behaviors -Strong role model -Shows competence -Articulates goals -Communicates high expectations -Expresses confidence -Arouses motives Effects on Followers -Trust in leader’s ideology -Beliefs become similar to the leader’s -Unquestioning acceptance -Affection toward leader -Obedience -Identification with leader -Emotional involvement with leader -Heightened goals -Increased confidence

Name that Charismatic Leader • “The ultimate measure of a man is not where he stands in moments of comfort, but where he stands at times of challenge and controversy.”

Name that Charismatic Leader • “Everyone needs to be valued. Everyone has the potential to give something back.”

Name that Charismatic Leader • “Ask not what your country can do for you...”

Name that Charismatic Leader • “Yes we can…”

Emotional involvement with the leader • Identification with the leader • Heightened goals

Leadership in Academic Medicine • What unique benefit can charismatic leadership deliver to academic medicine? • To your specific role/job?

Servant Leadership • Term arising in the 1970s by Robert Greenleaf • Premise: a just society is dependent on leaders who should care about all who are affected by their enterprise • Most applicable to directors and administrators • Leader leads by example

Servant Leadership • Emphasizes: • increased service to others • a holistic approach to work • promoting a sense of community • sharing power in decision making • It’s a long-term transformational approach to life and work that creates a more positive society What does this concept remind us of?

Servant Leadership • According to Greenleaf the true test of whether or not one is a servant-leader is to ask the following questions: • Do those served grow as persons? • Do they, while being served, become healthier, wiser, freer, more autonomous, more likely themselves to become servants? • What is the effect on the least privileged in society? Will they benefit or at least not be further deprived?

Servant Leadership • Ten Central Characteristics: 1) Listening – listening to others, coupled with regular periods of reflection 2) Empathy – accept others; assume good intentions of others even when their behavior is unacceptable 3) Healing – emotionally building/healing self and others

Servant Leadership 4) Awareness – awareness of self and others in a way which helps the leader to better understand values and ethics 5) Persuasion – convincing others instead of coercing others; persuasion versus use of positional authority/power 6) Conceptualization – examining a problem and envisioning the relevant future variables; delicately balancing conceptual thinking and a day-to-day approach

Servant Leadership 7) Foresight – involves intuition, but also involves the ability to learn from past mistakes, the reality of the present and the best future actions 8) Stewardship – “holding something in trust for another” 9) Commitment to the growth of people – premise is that people have intrinsic value beyond their contribution as workers; commitment to nurturing employees’ growth

Servant Leadership 10) Building Community – predicated on the idea that our community helps shape us; we have a responsibility to cultivate positive communities (Spears, 2004)

Servant Leadership • Many current corporations utilize this model as their primary training module for higher level staff: • The Toro Company (Minneapolis, Minnesota) • Synovus Financial Corporation (Columbus, Georgia) • ServiceMaster Company (Downers Grove, Illinois) • Men's Wearhouse (Fremont, California) • Southwest Airlines (Dallas, Texas) • TDIndustries (Dallas, Texas) • The Herman Miller Company

Servant Leadership in Organizations • The concepts have been adopted within corporate/business circles in response to the idea that business organizations only hold interest in the bottom line • Addresses the need for organizations to become better social assets • Applies to corporations, hospitals, churches, universities, governments etc.

Servant Leadership in Organizations • The institution must be regarded as socially responsible to all parties involved: • Employees (including administrators) – safety, rights, privileges, regulations • Customers – product descriptions, services, and benefits • Suppliers - positive working relationships, cultivate faith and trust • Local agencies – government, university, church

Servant Leadership in Organizations • Make the good of society the focal point of the organization • Helps the entire workforce focus on one end-state and helps them excel in this direction • Place honest and highly capable people in charge • Directors in assuming their positions, must act socially responsible • There is the acceptance that their role creates a challenge or problem for the rest of the organization • Directors and administrators must welcome this adjustment

Leadership in Academic Medicine • What unique benefit can servant leadership deliver to academic medicine? • To your specific role/job?

Transformational Leadership • Coined in 1973 by Downton • Burns expanded on this in 1978 • Transformational leadership is the process by which a leader creates a connection with others which raises the motivation and morality of the leaders and followers. • Transformational leaders are attentive to the needs of their followers and try to help followers reach their fullest potential.

Transformational Leadership • Is different from transactional leadership, in which the focus is the exchange of constructive (rewards) and corrective (consequences) between leader and followers • Transformational leadership refers not the content that each person exchanges, but instead, the process by which they exchange interactions and the outcome of this process on both follower and leader

Transformational Leadership • Transformational leadership changes and transforms individuals • It is concerned with values, ethics, standards, and long-term goals • The process involves charismatic and visionary leadership skills (Bryman, 1992)

Transformational Leadership • Transformational leadership sits on one end of a continuum with laissez-faire leadership at the other end and transactional leadership lying in between. • Transformational leadership motivates the followers to: • Raise their consciousness about the importance/value of specific, idealized goals • Transcend from self-interest to group interest • Address their higher level needs (Bass, 1985) Who comes to mind when you hear these descriptions?

Transformational Leadership • Factor I: Charisma/Idealized influence • Leaders are role models, followers emulate them • High ethical and moral standards • Deeply respected by followers • Provide followers with a sense of purpose

Transformational Leadership • Factor II: Inspirational Motivation • Leaders communicate high expectations and inspire followers to become committed to a shared vision • Use of symbols and emotional appeals to focus the followers on interest in the group • Enhances team spirit and camaraderie

Transformational Leadership • Factor III: Intellectual Stimulation • Leaders stimulate creativity and innovation among followers • Leaders encourage followers to challenge their own beliefs and values, while also challenging the leader and organization • Perpetuates critical thinking, innovation, and problem-solving

Transformational Leadership • Factor IV: Individualized Consideration • Leaders create a supportive climate in which they listen carefully to the needs of the followers • What does this remind you of? • Leaders act as coaches and advisors while trying to assist followers in self-actualization – the highest stage of moral development

Transformational Leadership • Strengths of this model • Widely researched model including qualitative studies of prominent leaders and CEOs • It is intuitive conceptually – most people assume that the role of their leader is to advocate for them and to also be in front of them • The role of followers is prominent - their needs and attributions are instrumental in helping the transformation evolve • Followers give leaders power

Transformational Leadership • It augments other leadership models by drawing attention to the process • It is the only model of leadership that introduces a moral dimension • whereby leaders attempt to move followers to higher standards of moral responsibility • whereby followers become interested in the group, team, or organization over themselves

Transformational Leadership • Weaknesses of this model • It lacks conceptual clarity and has been criticized as being difficult to clearly define and measure • People often fail to see the model as a spectrum and instead perceive it as either being present or absent • It looks at leadership as a personality trait – not a series of behaviors that can be taught

Transformational Leadership • Elitist and antidemocratic • These leaders play a direct role in establishing the vision, initiating changes • It is based primarily on qualitative research of leaders who were at the top of their organizations • What about the transformational leaders within, but not at the top of the organization? • High potential for abuse… why?

Transformational Leadership • In summary, this model does NOT tell leaders what to do to be successful • It does tell leaders HOW to approach their leadership position…by attending to the needs of their constituents, with the priority of furthering the development of those constituents

Leadership in Academic Medicine