10 Lessons on Radiology Leadership for Every ‘Change Agent’ in the Field

The late, great business guru Peter Drucker (d. 2005) held that management is doing things right while leadership is doing the right things. The observation is timeless across industries, but “the right things” surely change over time and within arenas of human endeavor.

Take radiology, for example.

“In many respects, things are different now than they were even a few years ago,” says Matthew Davenport, MD, whose leadership duties in the health system of the University of Michigan include leading the body MRI team and chairing the Michigan Radiology Quality Collaborative.

In fact, effective leaders today are change agents by their very nature, maintains Davenport, who makes the case in a 2018 paper published in RadioGraphics and co-authored by N. Reed Dunnick, MD, longtime radiology chair at Michigan. What’s more, these “agents” aren’t secret—but neither are they always easy to spot.

“If you wish to be a leader but believe that you first need a title, think again. The most effective leaders do not need one,” Davenport and Dunnick write. “Practice, train and emphasize your colleagues and organization above yourself, and the rest will take care of itself.”

That’s a good place to begin. Here are 10 similarly piquant observations on modern radiology leadership from some radiologists who know the subject because they’ve walked it as well as talked it.

An insatiable appetite for research and an authoritative bearing were once considered must-have marks of great leadership. Now, not so much.

When Amy Kotsenas, MD, of the Mayo Clinic entered the radiology field more than two decades ago, most individuals who were regarded as “great leaders” had built their reputations as top-tier researchers.

Amy Kotsenas, MD, Mayo Clinic
Amy Kotsenas, MD,
Mayo Clinic

“Today there is a much stronger—and in my opinion more appropriate—shift toward leaders who understand the clinical practice,” says Kotsenas, who chairs the enterprise radiology IT committee at Mayo and has won a leadership award from the American Society of Neuroradiology. (She also is a member of RBJ’s editorial advisory board.) “Those who understand the needs of their radiology staff and employees, as well as the needs of their patients, stand out in the current environment.”

Cheri Canon, MD, chair of radiology at the University of Alabama at Birmingham and a member of the board of directors of the ACR’s Radiology Leadership Institute, describes yesterday’s leadership as “more autocratic and very top-down” in nature, with leaders who were not only strong but also outspoken and sometimes even domineering.

Canon says the complexities of today’s radiology landscape warrant an interdisciplinary, team-oriented approach to leadership. And in order to be effective, leaders must be emotionally competent, thoughtful and open to suggestions. The best of the best, in Canon’s experience, are confident enough to demonstrate vulnerability.

“We not only need to learn to lead,” Canon tells RBJ. “We need to learn to work together as a team, respecting everyone’s contributions as well as valuing diversity of thought.”

Some of the most effective radiology leaders see things from all sides.

Originally implemented in business settings, the “360-degree” leadership model can and should be adopted in radiology, says Nupur Verma, MD, who serves University of Florida Health as director of both abdominal CT and critical care imaging.

“Compared to autocratic or topdown leadership, the 360-degree style emphasizes that all individuals within an organization, not just the leader, have a leadership responsibility and role,” Verma explains. “This fundamental difference is very empowering for all team members and can create a fantastic crossflow of ideas that might otherwise go unexplored.”

According to Verma, the model further fits the moment because radiology has become so highly subspecialized and technology-driven that a leader operating purely in the traditional mold will often run into trouble trying, for example, to build problem-solving consensus in committees. Using 360-degree techniques, leaders can facilitate group problem-solving without worrying about which ideas have behind them the weight of seniority, past accolades or present job titles.

In “Developing Your 360-Degree Leadership Potential,” published in the March 2017 JACR, Verma and co-authors encourage radiologists to reflect on ways they participate in a variety of leadership roles throughout their careers. The good habits of the 360-degree leader, they suggest, include practicing selflessness, demonstrating trust in those they lead and abstaining from bias.

“Defining moments can be prepared for,” the authors write, adding that such moments allow the 360-degree leader to “demonstrate consistency and thoughtful action” when faced with a challenging situation. “Leadership skills can be integrated into your leadership style through introspection and mindfulness,” Verma et al. conclude, “and can motivate and empower radiology teams to perform effectively.”

LeadershipMaking the grade with the C-suite while rallying the troops in the trenches calls for supple leadership skills.

In Kotsenas’s view, the ability to think strategically—and to continually monitor the radiology organization for new dynamics that could affect the rest of the institution—tops the list of change-proof skills needed to sustain support from executives in the hospital C-suite. Not far behind is the foresight to recognize when a major change or transformation is needed in the organization.

Also important, Kotsenas says, are team-building skills, which are needed if physician leaders are to guide teams and gain team members’ willing cooperation and active participation. “Change-proof teams are dissatisfied with the status quo,” Kotsenas says. When identifying co-leaders, she looks for individuals who are curious, tenacious, flexible and willing to take calculated risks.

“Leaders need to move their teams forward with focus, purpose and direction,” Kotsenas continues. “It’s critical for them to be able to clearly articulate a vision for the future so that every member of the team can carry it forward.”

Great physician leaders prioritize partnerships and don’t dismiss diversity.

An essential component of the Mayo Clinic’s change management model is close collaboration and partnership between physician and business leaders, as well as between radiology leaders and their colleagues in primary care and other specialties.

“We as physicians can only lead effectively and move medicine forward if we understand who’s on the other side of the desk,” says Mayo radiologist John Wald, MD, whose leadership roles include serving as medical director of public affairs and marketing. “We have to understand their expectations—and vice versa.”

Effective leaders, Wald adds, recognize the importance of soliciting input and ideas from individuals who vary in age, hail from disparate cultural backgrounds and have their own perspectives on the practice and business of medicine. An equal mix of men and women is equally desirable, he emphasizes.

“It’s easy to get mired in skewed information,” Wald says, “but leaders know the right answers are rooted in diversity.”

Sometimes the best leader is a follower.

Good leaders understand the value of drawing leadership-level contributions out of team members who aren’t leaders in any formal sense.

“I’ve seen multiple examples of leadership from all levels,” Verma says. She describes a group of radiology residents who “took the lead” and identified how changing the labeling of contrast management boxes would make it easier for their peers to understand. The residents were empowered to create an internal focus group among their junior colleagues and, based on input, effect a change that still resonates nearly two years later.

Cheri Canon, MD, University of Alabama at Birmingham/UAB Medicine
Cheri Canon, MD, University of Alabama at Birmingham/UAB Medicine

Canon agrees, noting that an important part of leadership is what she calls “followership.” Leaders change positions, she clarifies, and circumstances may call for nimbleness in role distribution. “All must understand their role in a particular situation, knowing when to step up as a leader or step out as a team member,” she says.

Sometimes, Verma adds, it’s best to give all interested stakeholders a chance to take the reins, applying their expertise to a particular situation. For instance, she states, a breast imager would understand some issues at a mammography center far better than would its chairperson.

Even those content with life at the back of the pack can benefit from leadership training.

Some have questioned whether every radiology resident should have in mind the goal of pursuing leadership in one way or another. Canon contends the answer is “no,” noting that leadership isn’t for everyone.

However, she thinks leadership training should be more inclusive, not reserved only for those who aspire to be academic chairs or practice leaders. Her rationale: A hefty portion of leadership development is personal development, which makes for better communicators and team members.

Bad behavior brings bye-bye.

More than a few institutions used to tolerate all sorts of bad manners in their leaders—testiness, arrogance, condescension, you name it—as long as said leaders seemed effective “on paper.”

“Ten years ago, if a leader was acting this way, nothing happened,” Davenport says. “Now it’s a cause to be asked to leave” the leadership position, at least, if not the institution itself.

Long-lasting good can come of short-term struggles to lead well.

Leaders who fail to effectively lead often tend to focus too much on their own performance, Canon says, speaking
from her own work experience as well as her time with the Radiology Leadership Institute. This mis-aiming of attention sometimes manifests as a lack of “emotional intelligence,” particularly an inability to empathize.

However, she says, all leaders—even the best ones—struggle on occasion. In fact, Canon says, “if a leader consistently demonstrates confidence with no apparent struggle, there is likely more going on.”

Meanwhile some leaders recoil from admitting mistakes or acknowledging disappointing results in projects and initiatives, which only makes it harder for teams to get past trouble spots. “We need to accept that it happens, and if something went wrong or didn’t work, at least we learned from it,” Wald says. “Effective leaders take that knowledge into what they do going forward.”

To lead is to accept that you may take the blame, deserved or not, for missed goals.

When a leader is ousted for apparent cause, many will see the action as a sign of failure. However, Davenport
points out, the individual may not be at fault. Rather, the cause could be a cultural mismatch between the leader
and the radiology practice or hospital. Or goals set by the institution or practice may not align with those believed by the leader to be attainable under his or her guidance.

Another possible culprit: a lack of understanding among practice or hospital management as to the qualities that particular imaging provider requires in a leader.

On the flip side, responsibility for a leadership failure can rest on the shoulders of that individual—even if he or she exhibits trust, selflessness, flexibility and many of the other traits now associated with great leadership.

According to Davenport, the disconnect between the typical path leaders follow to the top and what is needed for effective leadership is a likely contributor to failure—within and outside the radiology realm.

“Most of the time, at least in academic careers, all success is dependent on personal experience and achievement—for example, high grades, first author of a publication, etc.,” Davenport says. “However, this type of success, personal success, does not make a successful leader. Being able to work for the greater good and as part of a team—those are the building blocks and will remain so” for the foreseeable future.

It can never hurt to listen before leading or to put organization before self.

In the Davenport-Dunnick paper published by RadioGraphics, the bulk of which is an interview of the latter by the former, Davenport asks what advice Dunnick would give others who are recruiting a new leader. Two things, Dunnick says.

“First, I would ensure that the leader is a good listener,” Dunnick replies, in part. “The people who do the work will know much more about what they are doing than the leader will. Leaders should avoid thinking they know more than others or know all the answers.”

Second, the organization should look for leaders who value the organization above themselves.

“Beware of leaders who seek the position for personal gain,” Dunnick warns. “Instead, look for those who are seeking to improve the organization, the field and the people they serve. Physician-leaders must place their patients and their organization first.”