Presentation on theme: "Leadership in Academic Medicine"— Presentation transcript:
1Leadership in Academic Medicine Bldg. E/ Lecture FLeadership in Academic MedicineKent A. Corso, PsyD, BCBA-DWalter Reed BethesdaUSUHS Department of Family Medicine
2OBJECTIVESTo 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
3SCHEDULE 20 Oct 11: Lecture and Discussion Administer MLQ Form 6S Discuss results and limitationsExperiential learning assignment27 Oct 11:Review experiential learning assignmentDiscussion: reasons to continue working on these leadership skills; exchanging ideas about leadershipCase study of 4 hospitals using transformational leadershipComplete feedback forms/course evaluation
4Introductions 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?
5OVERVIEW Introductions Leadership Theory Overview Leadership in Academic MedicineRelevant Primary Literature FindingsAssessing your own level of development as a transformational leaderExperiential Learning Assignment
6Leadership DefinedThe 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).
7Leadership Defined Management produces order and consistency Leadership produces change and movementAssigned versus Emergent
8Self-MonitoringThink 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?
9Leadership Defined Leaders exert Power and Influence How? Persuasion
10Persuasion/Influence Subtle versus obviousSystematic versus sporadic
11Power and Leadership Legitimate/Positional Reward Coercive Expert Referent(French and Raven, 1959)Why is power important when you are the leader?Because you have to be careful not to abuse itBecause you have the position to exert itBecause you are vulnerable to using it for your personal gain versus the gain of others – few things are as dangerous as this: it leads to unethical/immoral behavior and it also detracts from your character, credibility, trustworthiness, and therefore your leadership potential
12Context is EverythingWhat are the unique aspects of academic medicine that demand leadership?What type of leadership would best fit? Why?
14Leadership in Academic Medicine Charismatic LeadershipServant LeadershipTransformational LeadershipFull Range Leadership Model
15Charismatic 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
16Charismatic Leadership Personality Characteristics-Dominant-Desire to influence-Confident-Strong valuesBehaviors-Strong role model-Shows competence-Articulates goals-Communicates high expectations-Expresses confidence-Arouses motivesEffects 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
17Name 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.”
18Name that Charismatic Leader “Everyone needs to be valued. Everyone has the potential to give something back.”
19Name that Charismatic Leader “Ask not what your country can do for you...”
21Emotional involvement with the leader Identification with the leaderHeightened goals
22Emotional involvement with the leader Identification with the leaderHeightened goals
23Leadership in Academic Medicine What unique benefit can charismatic leadership deliver to academic medicine?To your specific role/job?
24Leadership in Academic Medicine Charismatic LeadershipServant LeadershipTransformational LeadershipFull Range Leadership Model
25Servant 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 enterpriseMost applicable to directors and administratorsLeader leads by example
26Servant Leadership Emphasizes: increased service to othersa holistic approach to workpromoting a sense of communitysharing power in decision makingIt’s a long-term transformational approach to life and work that creates a more positive societyWhat does this concept remind us of?Beneficence from medical ethics
27Servant LeadershipAccording 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?
28Servant Leadership Ten Central Characteristics: 1) Listening – listening to others, coupled with regular periods of reflection2) Empathy – accept others; assume good intentions of others even when their behavior is unacceptable3) Healing – emotionally building/healing self and others
29Servant Leadership4) 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
30Servant Leadership7) 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
31Servant Leadership10) Building Community – predicated on the idea that our community helps shape us; we have a responsibility to cultivate positive communities (Spears, 2004)
32Servant LeadershipMany 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
33Servant 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 lineAddresses the need for organizations to become better social assetsApplies to corporations, hospitals, churches, universities, governments etc.
34Servant Leadership in Organizations The institution must be regarded as socially responsible to all parties involved:Employees (including administrators) – safety, rights, privileges, regulationsCustomers – product descriptions, services, and benefitsSuppliers - positive working relationships, cultivate faith and trustLocal agencies – government, university, church
35Servant Leadership in Organizations Make the good of society the focal point of the organizationHelps the entire workforce focus on one end-state and helps them excel in this directionPlace honest and highly capable people in chargeDirectors in assuming their positions, must act socially responsibleThere is the acceptance that their role creates a challenge or problem for the rest of the organizationDirectors and administrators must welcome this adjustment
36Leadership in Academic Medicine What unique benefit can servant leadership deliver to academic medicine?To your specific role/job?
37Leadership in Academic Medicine Charismatic LeadershipServant LeadershipTransformational LeadershipFull Range Leadership Model
38Transformational Leadership Coined in 1973 by DowntonBurns expanded on this in 1978Transformational 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.
39Transformational Leadership Is different from transactional leadership, in which the focus is the exchange of constructive (rewards) and corrective (consequences) between leader and followersTransformational 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
40Transformational Leadership Transformational leadership changes and transforms individualsIt is concerned with values, ethics, standards, and long-term goalsThe process involves charismatic and visionary leadership skills (Bryman, 1992)
41Transformational 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 goalsTranscend from self-interest to group interestAddress their higher level needs (Bass, 1985)It is important to ask who comes to mind so that we start recognizing transformational leaders we have had in the past. This enables us to follow the behavior they’ve role-modeled for usWho comes to mind when you hear these descriptions?
42Transformational Leadership Factor I: Charisma/Idealized influenceLeaders are role models, followers emulate themHigh ethical and moral standardsDeeply respected by followersProvide followers with a sense of purpose
43Transformational Leadership Factor II: Inspirational MotivationLeaders communicate high expectations and inspire followers to become committed to a shared visionUse of symbols and emotional appeals to focus the followers on interest in the groupEnhances team spirit and camaraderie
44Transformational Leadership Factor III: Intellectual StimulationLeaders stimulate creativity and innovation among followersLeaders encourage followers to challenge their own beliefs and values, while also challenging the leader and organizationPerpetuates critical thinking, innovation, and problem-solving
45Transformational Leadership Factor IV: Individualized ConsiderationLeaders create a supportive climate in which they listen carefully to the needs of the followersWhat 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
46Transformational Leadership Strengths of this modelWidely researched model including qualitative studies of prominent leaders and CEOsIt is intuitive conceptually – most people assume that the role of their leader is to advocate for them and to also be in front of themThe role of followers is prominent - their needs and attributions are instrumental in helping the transformation evolveFollowers give leaders power
47Transformational Leadership It augments other leadership models by drawing attention to the processIt is the only model of leadership that introduces a moral dimensionwhereby leaders attempt to move followers to higher standards of moral responsibilitywhereby followers become interested in the group, team, or organization over themselves
48Transformational Leadership Weaknesses of this modelIt lacks conceptual clarity and has been criticized as being difficult to clearly define and measurePeople often fail to see the model as a spectrum and instead perceive it as either being present or absentIt looks at leadership as a personality trait – not a series of behaviors that can be taught
49Transformational Leadership Elitist and antidemocraticThese leaders play a direct role in establishing the vision, initiating changesIt is based primarily on qualitative research of leaders who were at the top of their organizationsWhat about the transformational leaders within, but not at the top of the organization?High potential for abuse… why?
50Transformational Leadership In summary, this model does NOT tell leaders what to do to be successfulIt 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
51Transformational Leadership ExamplesGhandi – raised the hopes and demands of millions of his people and in the process was also changedNelson Mandela – transformed the nation of South Africa through high moral standardsMother Theresa – advocated for the poor and helpless; incredible charity led others to give
52Transformational Leadership Several Corporations have been led by transformational leaders or have invested in creating this organizational culture:The Chrystler Corporation (1980s)Wal-MartAppleTargetFedExJack Welch – GE (1980s and 1990s)Studies comparing successful and unsuccessful companies find that managers and employees within successful companies display higher average transformational leadership actions (Jandaghi, Matin, & Farjami, 2008).
53Leadership in Academic Medicine What unique benefit can transformational leadership deliver to academic medicine?To your specific role/job?
54Leadership in Academic Medicine Charismatic LeadershipServant LeadershipTransformational LeadershipFull Range Leadership Model
55Full Range Leadership Model This is the entire spectrum of leadership behaviors ranging from laissez-faire to transformationalOptimal model involves using each leadership type in a “dosed” manner
56Full Range LeadershipLaissez-faireTransactionalTransformational
57Full Range Leadership Model Laissez-faire (LF) represents nontransactional leadershipInactive /Non-leadershipResearch finds this to be the least effective (Bass & Avolio, 1998)Transactional Leadership – corrective and constructive exchanges between leader and followers based on followers’ performance
58Full Range Leadership Model Contingent Reward (CR) – rewarding positive behavior/performance with a rewardManagement by exception - passive (MBE-P)Waits for deviances from standards, mistakes, errors and then takes corrective actionManagement by exception - active (MBE-A)Actively monitors followers for deviances from standards, mistakes, errors and takes corrective action as needed
60A Complimentary Visual This is a spectrum of leadership from primitive role to sophisticated role
61Leadership in Academic Medicine What unique benefit can full range leadership deliver to the academic medicine?To your specific role/job?
62The SO WHAT FactorIn a cross-sectional survey of 465 faculty and chairpersons in accredited allied health programs in the northeast US offering undergraduate and graduate degrees (Firestone, 2010)Mean scores for self-perceived transactional leadership among chairpersons were higher than faculty-rated chairperson scoresSo What?Has anyone watched the Fear Factor? It’s a reality tv show whereby people competitively do daring things that are often gross and detestable to see who can last the longest. My game is slightly different…So What? When advanced academic health professionals have not made formal attempts/received formal training in transactional leadership, which by definition involves the assessment of employee needs, they rate themselves more highly… in other words, they are more out of touch with the needs of their followers and also may have lower self awareness
63The SO WHAT FactorIn a study of 601 Finnish nurses the authors examined how laissez-faire versus transformational leadership among nurse managers impacted the following outcomes: willingness to exert extra effort, perception of the nurse manager’s effectiveness, satisfaction with nurse manager (Kanste, Kaariainaen, & Kyngas, 2009)Transformational leadership led to increased willingness to exert extra effort, higher perceptions of nurse manager’s effectiveness, and higher satisfaction with nurse manager – these outcomes held at 1 year follow-upLaissez-faire led to lower nurse ratings on all outcomesSo What?Willingness to exert extra effort??!!The full range theory can be helpful in analyzing, training, and improving medical systems involving nurses…in Finland
64The SO WHAT FactorA study of 497 physicians, nurses and residents in the southeastern US assessed the participants’ attitudes toward collaboration and servant leadership (Garber, Madigan, Click & Fitzpatrick, 2009).RN attitudes regarding collaboration were more positive than physicians’RN attitudes had a more positive self-perception of themselves as servant leaders than physiciansRN’s and physicians’ self-perceptions of servant leadership were higher than their perceptions of their organization’s use of servant leadership practicesMinimal differences between residents and physiciansSo What?Relationships are critical to quality healthcare – it makes sense that the people lower on the heirarchy – who are more subject to NOT having their needs heard, would be more positive about servant leadership compared with those at the top of the hierarchyIllustrates an obstacle for those leaders in this room who may seek to implement a servant leadership modelNursing is also a more consistent role with serving, with physicans’ in a leading roleA self-enhancing bias remains
65The SO WHAT FactorA Chinese study across 59 medical/health centers, made comparisons between personality traits and self-reports of ethical leadership among 162 directors at varying levels. They also solicited collateral reports from 3-4 corresponding subordinates for each director (Xu, Yu, & Shi, 2011).Neuroticism was negatively associated with ethical leadershipConscientiousness, agreeableness, and extraversion were positively correlated with ethical leadershipSo What?Who are our neurotics? –our Type A people…more likely to lead in the first placeThe more neurotic we are, the poorer our ethical leadership
66The SO WHAT FactorA study of 91 college students explored the relationship between charismatic leadership, work engagement, and organizational citizenship behaviors (Babcock-Roberson & Strickland, 2009).When a charismatic leader/supervisor was present, there was increased work engagement and this led to increased organizational citizenship behaviorsSo What?Charisma alone can increase engagement in the task – think about these applications from studyign to teaching to soliciting research participants from the student body, to increasing the likelihood that students will help one another (i.e, in labs settings)Is there an emotional contaigion when charismatic leaders are present?
67The SO WHAT FactorA study of 72 American light infantry platoon leaders and sergeants examined how transactional leadership (CR) and transformational leadership correlated to unit potency and cohesion, and how each of these predict performance under challenging and uncertain conditions (Bass, Avolio, Jung, Berson, 2003).Transformational leadership and active transactional leadership led to performance successUnit cohesion and potency partially mediated the relationship between leadership and performanceTransformational leadership augmented transactional leadership when the reward was based on specific contracts or quid pro quo exchangesSo What?Re: mediation – indicates the need for unifying goals, mission, values, etcTransactional leadership that offers intrinsic rewards may be a bridge to transformational leadership along with the work of Goodwin et al. 2001
68The SO WHAT FactorIn a study of 43 Norwegian military officers participating in a week-long exercise (Eid, Johnsen, Brun, Laberg, Nyhus, Larsson, 2004)Transformational leadership emerged as a predictor of situational awareness and interpersonal influence – specifically Factor 3: intellectual stimulationSo What?This enhances military readinessThis also transfers to working and training in various acute care settings, whereby situational awareness may be critical
69The SO WHAT FactorIn a study of 324 employees in India of various industries to include steel manufacturing, dredging, banks, R&D, airlines, real estate, telcom, and IT firms the authors examined age and job experience as these relate to leadership style (Giri & Santra, 2010)Less experienced/junior level employees had significantly higher mean scores on transformational leadershipMore experienced/senior level employees had significantly higher mean scores on laissez-faire leadershipSo What?Junior level employees may be more interested or concerned with the needs of those below themSenior level employees were far less activeCultural factors?
70Issues You May Face While Leading in Academic Medicine Women have reached equal rates of entry into the medical field without proportionate entry into leadership positions (Morrissey & Schmidt, 2008)Among 96 medical faculty, there hierarchy of department chairs in academic medicine reduces transparency of decision-making, impedes advancement by way of a bottle-neck effect, negatively affects inclusion across professionals, and appears to be more consequential among women (Conrad et al., 2010)Managing different generations, particularly with regard to old models of “paying your dues” (Kennedy, 2003)
71Issues You May Face While Leading in Academic Medicine Other examples??Please take a few moments and write some examples down. We will discuss these later.
72Leadership Assessment Research clearly indicates that 360-degree feedback systems give a much more accurate picture than self-assessment of what executives really do and how executives actually behave (London et al., 1990; Hazucha et al., 1993; Kluger and DeNisi, 1996; Walker and Smither, 1999).The observation of outsiders appears to be more reliable than self-evaluation (Kets de Vries, Vrignaud, & Florent-Treacy, 2004).
73Multifactorial Leadership Questionnaire (MLQ Form 5X) 45-item instrumentThe single most widely used, heavily researched , and empirically supported measure of transformational leadershipSelf and other-rater formsShort Form is 21 questions, Form 6S
74Multifactorial Leadership Questionnaire (MLQ Form 5X) **Earlier literature criticized the instrument’s subscale utility for leadership training and consultation, indicating that the constructs overlapped; yet the entire instrument clearly measures a unique construct360 degree evaluation aimed at providing feedback about your level of development as a transformational leader (i.e., where do you spend most of your time on the full spectrum model?)
75Multifactorial Leadership Questionnaire (MLQ Form 5X) DISCLAIMER
76Evaluating Your Readiness What are the benefits to developing and implementing transactional leadership skills?What are the drawbacks?How important is it to you to develop your leadership skills?What obstacles do you see with regard to implementing a transactional leadership project?
77Experiential Learning Assignment Mentally review your last several meetings with subordinatesWhat tasks were you engaged in or goals did you need to meet?How did you go about meeting them?Where were you on the full scale spectrum?Is that where you’d like to remain?Are you interested in progressing toward the active and transformational direction?
78Experiential Learning Assignment Transformational Leadership by definition fosters reciprocal change between leader and followersHow can you see yourself changing?What would you hate to see this reciprocal process change about how you currently lead?
79Experiential Learning Assignment Select a work relationship, project, team, planning document and sketch its trajectory with the intention of using transformational leadershipWhat is your own timeline for learning, planning and implementing transformational skills in general?How will you assess needs of your followers?How will you convey a shared vision?How will you engender and maintain their trust?How will you show interest in them?How will you motivate them?How will you interest them in the group priorities?How will you raise their morality? (identify the relevant work-place moral issues that are currently of concern)