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Perspective |
1 Department of Radiology, Indiana University School of Medicine, 702 North Barnhill Dr., RI 1053, Indianapolis, IN 46202-5200.
Received May 19, 2004; accepted after revision September 22, 2004.
Address correspondence to R. B. Gunderman
(rbgunder{at}iupui.edu).
As radiologists contemplate the future of the field, one of the most promising investments we can make is to cultivate the knowledge and skills of radiology's future leaders, preparing them to meet the challenges and opportunities that lie ahead. Yet many capable medical students, residents, and newly minted radiologists pay leadership little heed. Arrested leadership development may be traced in part to widely prevalent misconceptions or fallacies about leadership. In an effort to unlock more of this leadership potential, this article describes seven of the most debilitating of these leadership fallacies and what can be done about them.
Irrelevance
The first leadership fallacy concerns the relevance of leadership. Some very intelligent, highly skilled, and dedicated people believe that leadership has little or nothing to do with us. We see ourselves as future clinicians, or scientists, or educators, but not as leaders. We have spent hundreds or even thousands of hours studying anatomy, pathology, imaging technology, lesion detection, differential diagnosis, and diagnostic reasoning. We see ourselves as experts in these areas and continue to study such subjects throughout our careers in an effort to remain on top of our field.
Many of us enjoyed little or no opportunity during medical school, residency, and continuing education to study leadership. We tend to see leadership as the province of business school graduates and politicians. To many of us, leadership is a black box. Leaders seem to us like the Wizard of Oz, mysteriously manipulating their organizations' levers from behind a curtain.
Viewing leadership as a mystery creates problems for our departments, institutions, and profession. If many of the best junior people in a field such as radiology regard leadership as a black box, who will be prepared to play leadership roles? In some cases, it is inevitable that future leaders will be drawn from the ranks of the less qualified.
More likely, leadership of hospitals and health care organizations will devolve to people such as business school graduates who have received training in leadership. In many such cases, these business school graduates will be people with little or no experience in patient care, medical research, and educating the next generation of health professionals.
In this scenario, the people who make decisions about what equipment to purchase, or whom to hire, or how the budget will be allocated, or how the strategic priorities of the organization will be formulated may be people who do not think like physicians and radiologists. This may affect the field in ways that undermine the effectiveness and career satisfaction of radiologists and compromise the achievement of our core missions.
Leadership is not an esoteric topic relevant to only a select few, but a ubiquitous feature of daily life for every radiologist. Every clinician is a leader of a team of colleagues composed of technologists, nurses, and secretarial staff. Every educator is a leader of medical students, radiologic technology students, or residents. Every parent is a leader of children.
Every person who bears any responsibility for any area or function within an organization is a leader, at least insofar as we must influence others to ensure that the work gets done properly. Even those of us who think of ourselves as followers are leaders. People in positions of greater formal authority depend on us for an understanding of what is happening in the organization. In shaping the perceptions of leaders, we function as leaders ourselves.
In many organizations, the people with the greatest formal authority do not necessarily exert the greatest influence. In meetings, for example, it is not always the person who presides that shapes the opinions of others to the greatest degree. Even a very junior person may wield a great deal of influence by expressing important ideas in a powerful fashion. In short, leaders are not so rare as we sometimes suppose. Far rarer, in fact, are individuals who enjoy no opportunity to lead.
Disqualification
Another disabling fallacy concerns the lack of leadership qualifications. Many of us who are otherwise capable people fear that we simply lack what it takes to be a leader. As a result, when opportunities to lead present themselves, we duck and cover, hoping that someone else will step forward to shoulder the responsibility.
This is a venerable theme in Western culture. In the Bible, God recruits Moses to go to Pharaoh and tell him to release the people of Israel from bondage [1]. The reluctant Moses responds, "Who am I to go to Pharaoh, and that I should bring the children of Israel out of Egypt?" Later, as God tells him how this will be accomplished, Moses expresses doubts about his ability to convince the Israelites to follow him: "But suppose they will not believe me or listen to my voice?" A bit later, Moses again resists, saying, "I am not eloquent, neither before nor since you have spoken to your servant; I am slow of speech and slow of tongue." Finally, Moses reluctantly agrees to serve as God's spokesperson, but only with the stipulation that his silver-tongued brother, Aaron, will speak to the people for him.
Many of us operate with the mistaken notion that leaders are born and not made. Having known few successful leadership experiences in our lives and recognizing that people do not seem to turn to us in times of crisis, we suppose that we are missing a crucial set of genes that makes some people innately effective leaders. In meetings, we are not the first to speak up. We do not feel compelled to ensure that our will always prevails. We are not the life of every cocktail party, and groups of people do not necessarily coalesce around us in social settings. Perhaps we may have been disappointed by the few formal leadership opportunities that came our way, or we may have found the experience baffling, or unrewarding, or even a failure.
In fact, however, effective leaders need not be the tallest, or best looking, or most naturally congenial people. They are not necessarily the best conversationalists, nor would they necessarily be voted the most popular. Many effective leaders, such as Abraham Lincoln, have been rather private, shy, and even self-conscious people [2].
Leadership is more an art than an ability. People are born with abilities, including abilities in different arts. For example, some people have a knack for musicianship, others for art, others for mathematics, and still others for simple congeniality. Yet even more important than sheer ability are factors such as how hard we work at cultivating our innate talents, how strongly we wish to excel at what we do, and above all, how much we care about the people with whom we work.
Even people with many natural gifts for leadership may fail. We fail because we do not understand what the organization should be trying to do. Plato once wrote that power should be entrusted only to people who are not in love with it [3]. Why? Because people who are in love with power may not care about what happens to other people in the organization, or about achieving the organization's missions. Instead, they simply want to be in charge.
There is something reassuring about Moses' attitude. He did not set out to lead. Instead, he doubted that he was qualified for the job. It was only as he came to understand the importance of the goal for which leadership was needed that he became a great leader. For Moses, knowledge of the good came before the desire to lead. With time and experience, he grew into a role he was not initially prepared to play. So, too, those of us who recognize opportunities to lead should spend less time worrying about our lack of qualifications and more time trying to understand where our organizations need to go.
Tyranny
Another leadership fallacy concerns the nature of leadership. Many people suppose that the most important measure of leaders is the ability to get other people to do what we want. The further we can move others from where they want to go, the more effective we are as leaders. Leadership, in other words, is conceptualized in terms of influence.
What means could leaders use to exert influence? One approach would be persuasion, using reasoned argument to try to convince people that it is in everyone's interest to pursue a different goal. Yet other less noble approaches might work too. For example, withholding information, or even outright deception, might help to change people's minds. Similarly, bribing people might change their priorities. So too might the use of coercion, threatening people with the loss of their jobs.
As these examples indicate, leadership is not about getting people to do what we want. When we bully others, we are not acting as a leader but merely imposing our will on others. Instead, leadership is about helping people to see what we ought to want, because it is best for us, or best for our organization, or best for the people the organization serves. Merely getting people to do what we want is the definition of tyranny.
How do tyrants think about the needs and aspirations of others? In most cases, they see others as tools for the satisfaction of their own desires. They regard them as buttons and levers they need to manipulate to get what they want. When people fail to follow orders, tyrants are quite prepared to do away with them because tyrants are not interested in people. They could not care less with whom they work, so long as they get what they want.
True leaders, by contrast, really care about the people we work with and want to see them happy and fulfilled in the work they do. Really caring about other people as people, and not merely as cogs in a machine, means refraining from shouting at them like a tyrant, and instead talking with them and, above all, listening to them. True leaders are not mere talkers. We should be listeners too. We should recognize that a two-way flow of information is vital if we are to understand our organization and the people who make it up. True leaders are not so much dictators as learners, always seeking to understand our colleagues and putting that understanding to work in the life of the organization.
Technique
Is leadership a matter of technique? From a technician's point of view, what matters most about leadership is how you lead. Should you be open with people or secretive? Should you be readily available to meet with people on a moment's notice, or be difficult to get hold of? Should you deal with people through intermediaries, or face to face? Should you delegate most of your authority, or attempt to do as much as possible yourself? These are the questions that preoccupy a leadership technician.
There is no doubt that some approaches to leadership are more likely to succeed than others. Yet the role of technique tends to be overemphasized. Whether we are traveling by air, sea, rail, or road, it is more important to understand where we are headed than how we are getting there. To know how to travel, we must first define our destination.
Knowing how to lead requires knowing where the organization should be headed. Merely moving quickly and efficiently is no advantage if we are moving in the wrong direction. In other words, leadership techniques need to be adapted to the challenges and opportunities at hand. The approach that works best when things are going well may not be well suited to a crisis. So, too, different leadership approaches are called for depending on the colleagues with whom responsibility can be shared. Good leaders focus on the goals first and the technique second.
Courses on leadership tend to focus too much on technique, in part because techniques are relatively easy to teach. For example, we can easily teach participants different techniques for brain-storming, or ranking priorities, or delivering bad news. Harder but much more important is educating people to better define what our priorities should be. To do that, it is not sufficient merely to master a technique. Our need for leadership techniques is far exceeded by our need to understand ourselves, our colleagues, our organizations, and the changing environments in which we are situated.
It would be unfortunate if people could seize power in an organization simply by mastering techniques learned at a weekend seminar. Like most important things in life, earning the prerogative of leadership and excelling as a leader require serious effort. There are no short cuts to understanding what an organization should strive to become.
Vanity
One of the most seductive features of leadership is the prestige associated with it. There is a natural tendency to suppose that people in positions of leadership are the best. We look at the higher compensation, larger offices, special privileges, greater authority, and enhanced access to information leaders enjoy and suppose that being placed in a leadership position instantly makes a person a big shot.
Nothing could be further from the truth. Often people who get the corner office do not last long. In some cases, the fault lies not with the newly appointed leader, but with the impossibility of the situations into which we have been placed. Moreover, the prestige associated with leadership can undermine relationships with colleagues, rendering them shallow and even artificial. Prestige can also be a distraction, so entrancing us with the trappings of the office that we lose track of the legitimate reasons we wanted to lead in the first place.
Good leaders do not spend much time looking in the mirror. There is no room for selfishness. Placed in a position of authority, selfish people regard the organization as a springboard for their own success. As far as they are concerned, the people they work with exist to provide them the means to advance their own careers, in power, wealth, and prestige.
By contrast, truly great leaders regard their own knowledge, skill, and experience as tools with which to serve. Our first commitment should be not to ourselves, but to the mission of the organization we lead. If we seek authority, it should not be to make ourselves look bigger, but to make a contribution. Our goal should be to make a difference in the life of the organization and the people who work in it. We want to know that the organization would suffer if we were not there. We want to play an important role in forming teams, helping teams succeed, and enabling our colleagues to perform at their best.
The desire for authority is not a bad thing. So long as we intend to use it for the appropriate purposes, it is a good thing. It would spell trouble for organizations if no one cared enough about us to want to serve.
Ease
Really good leaders can make leadership look easy. Faced with a difficult situation, the best seem to know instinctively what to do to diffuse tension, or cut through the fog, or jumpstart a stalling project. In fact, however, effective leadership is not easy. It is like practicing radiology. A medical student watching a radiologist interpret cross-sectional imaging studies might conclude that radiology takes little effort, because the radiologist can form an accurate diagnostic impression after studying the images for only a few seconds. In fact, however, the radiologist has invested years or even decades of effort to be able to make such rapid and apparently effortless assessments.
To become a good leader requires a great deal of effort to get to know the organization, the people in it, and the environment in which it operates. What seems like a spur-of-the-moment, instinctive stroke of brilliance in fact requires long study of the organization's priorities and its style of operation. Only people who really care about their organizations and work hard to learn as much as they can about them will be in a position to succeed.
A famous example of a leader who made it look easy is Sir Winston Churchill, one of the most important political leaders of the 20th century and a Nobel Laureate in Literature for his mammoth History of the English-Speaking Peoples. Churchill was also known as one of the greatest orators of the 20th century, achieving worldwide fame for such memorable utterances as, "Never in the field of human conflict was so much owed by so many to so few," "We shall draw from the heart of suffering itself the means of inspiration and survival," and "Let us therefore brace ourselves to our duty, and so bear ourselves that, if the British Empire and its Commonwealth lasts for a thousand years, men will still say, `This was their finest hour' " [4].
Listening to Churchill's famous radio broadcasts during the Second World War or witnessing his speeches in person, many people had the impression that he spoke extemporaneously and was simply an extraordinarily gifted speaker. However, we know from Churchill's own writings and those of others close to him that he worked for hours, sometimes days, to formulate what he would say, and practiced his speeches many times over. In fact, Churchill was a stutterer, and he struggled with a speech impediment his entire life.
Sacrifice
Perhaps the greatest leadership fallacy of all is the notion that accepting formal leadership responsibility means sacrificing the other things in life we really care about. Must great leaders give up all pretense of maintaining a happy family life? Must leaders set aside personal ambitions for such areas as clinical work, research, and education to such a degree that we lose ourselves in our organizations? Must those of us who aspire to formal leadership positions be prepared to relinquish even our own moral scruples for the good of our organization?
These are very dangerous misconceptions, in part because they inevitably turn gifted people away from leadership. If playing a formal leadership role means wrecking our personal life, abandoning the professional challenges that attracted us to radiology in the first place, or even being forced to do things that trouble our conscience, then who wants it?
Far from diminishing a person, however, leadership provides wonderful opportunities for personal development through service. Excelling as a leader requires a person to develop many of the most important human virtues, such as courage, self-control, compassion, justice, moral discernment, and wisdom. To become a great leader requires sustained personal growth and satisfies the human need to serve a purpose larger than oneself.
Instead of abandoning what we care most about, leadership invites us to pursue it to an even greater extent. We should try to make our organizations places where people can flourish both personally and professionally. Ideally, everyone, including leaders, should feel fully engaged in what the organization does. There is no reason that even chairpersons should not continue to devote some time and energy to former professional pursuits. Continued clinical work and scholarly activity helps leaders remain more in touch with the life of the faculty and become better acquainted with the day-to-day activities of the department.
Above all, prospective leaders should not assume that we must check our moral and religious convictions at the portal of leadership. It is simply not the case that only Machiavellian types need apply. One of the hallmarks of great leaders is a moral vision for the organization, one that places integrity and commitment to high principles at the core of organizational life. No matter how clever, urbane, and politically adroit we might be, great leadership is not possible absent that moral vision.
Conclusion
It is vital that radiologists at every stage of professional development pause from time to time to reflect on leadership. Talented people who never saw ourselves as leadership material need to discover the hidden leader within us. People who already aspire to formal leadership need to acquire a deeper understanding of what it means to be a leader, and what leaders need to do well to promote the success of our organizations.
People who occupy leadership positions need to reexamine our leadership performance and seek out opportunities to perform even better. Departments and national professional organizations need to recognize the importance of fostering future leaders, and to continue to develop and refine leadership development programs. Even people who think of ourselves primarily as followers need to reexamine what we expect from our leaders and consider what we might contribute to make leaders more effective. Above all, we need to recognize, study, and effectively respond to the fallacies that lead leaders and potential leaders astray.
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  P. J. Kenney and R. B. Gunderman The Role of Leadership in Radiology Am. J. Roentgenol., October 1, 2005; 185(4): 1081 - 1081. [Full Text] [PDF]
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