Leadership in Academic Medicine - PowerPoint Presentation

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Leadership in Academic Medicine

Kent A. Corso, PsyD, BCBA-DWalter Reed BethesdaUSUHS Department of Family Medicine

Bldg. E/ Lecture FSlide2

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 ProbeSlide3

SCHEDULE

20 Oct 11:Lecture and DiscussionAdminister 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

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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?Slide5

OVERVIEW

Introductions Leadership Theory OverviewLeadership in Academic Medicine

Relevant Primary Literature Findings

Assessing your own level of development as a transformational leader

Experiential Learning Assignment

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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).Slide7

Leadership Defined

Management produces order and consistencyLeadership produces change and movementAssigned versus EmergentSlide8

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?Slide9

Leadership Defined

Leaders exert Power and InfluenceHow?PersuasionPower Slide10

Persuasion/Influence

Subtle versus obviousSystematic versus sporadicSlide11

Power and Leadership

Legitimate/PositionalRewardCoerciveExpertReferent (French and Raven, 1959)

Why is power important when you are the leader?Slide12

Context is Everything

What are the unique aspects of academic medicine that demand leadership?What type of leadership would best fit? Why?Slide13

Primary Leadership Theories

Trait TheoryStyle TheoryContingency TheorySituational TheoryPath-Goal TheoryLeader-Member Exchange TheoryPsychodynamic TheoryTransformational Theory

Team TheorySlide14

Leadership in Academic Medicine

Charismatic LeadershipServant Leadership

Transformational Leadership

Full Range Leadership ModelSlide15

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 taughtSlide16

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 confidenceSlide17

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.”Slide18

Name that Charismatic Leader

“Everyone needs to be valued. Everyone has the potential to give something back.”Slide19

Name that Charismatic Leader

“Ask not what your country can do for you...”Slide20

Name that Charismatic Leader

“Yes we can…”Slide21

Emotional involvement with the leader

Identification with the leaderHeightened goalsSlide22

Emotional involvement with the leader

Identification with the leaderHeightened goalsSlide23

Leadership in Academic Medicine

What unique benefit can charismatic leadership deliver to academic medicine?To your specific role/job?Slide24

Leadership in Academic Medicine

Charismatic LeadershipServant Leadership

Transformational Leadership

Full Range Leadership ModelSlide25

Servant Leadership

Term arising in the 1970s by Robert GreenleafPremise: a just society is dependent on leaders who should care about all who are affected by their enterpriseMost applicable to directors and administrators

Leader leads by exampleSlide26

Servant Leadership

Emphasizes: increased service to othersa holistic approach to workpromoting 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?Slide27

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?Slide28

Servant 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 unacceptable

3) Healing – emotionally building/healing self and othersSlide29

Servant Leadership

4) Awareness – awareness of self and others in a way which helps the leader to better understand values and ethics5) Persuasion – convincing others instead of coercing others; persuasion versus use of positional authority/power6) Conceptualization – examining a problem and envisioning the relevant future variables; delicately balancing conceptual thinking and a day-to-day approachSlide30

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 actions8) 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’ growthSlide31

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)Slide32

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 CompanySlide33

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 lineAddresses the need for organizations to become better social assetsApplies to corporations, hospitals, churches, universities, governments etc.Slide34

Servant 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 benefits Suppliers - positive working relationships, cultivate faith and trustLocal agencies – government, university, churchSlide35

Servant 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 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 adjustmentSlide36

Leadership in Academic Medicine

What unique benefit can servant leadership deliver to academic medicine?To your specific role/job?Slide37

Leadership in Academic Medicine

Charismatic LeadershipServant Leadership

Transformational Leadership

Full Range Leadership ModelSlide38

Transformational 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.Slide39

Transformational 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 leaderSlide40

Transformational 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)Slide41

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 goalsTranscend from self-interest to group interest

Address their higher level needs (Bass, 1985)

Who comes to mind when you hear these descriptions?Slide42

Transformational Leadership

Factor I: Charisma/Idealized influenceLeaders are role models, followers emulate themHigh ethical and moral standardsDeeply respected by followersProvide followers with a sense of purposeSlide43

Transformational 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 Slide44

Transformational 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-solvingSlide45

Transformational 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 developmentSlide46

Transformational Leadership

Strengths of this modelWidely 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 powerSlide47

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 themselvesSlide48

Transformational Leadership

Weaknesses of this modelIt 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 taughtSlide49

Transformational Leadership

Elitist and antidemocraticThese 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?Slide50

Transformational 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 constituentsSlide51

Transformational 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 standards Mother Theresa – advocated for the poor and helpless; incredible charity led others to giveSlide52

Transformational Leadership

Several Corporations have been led by transformational leaders or have invested in creating this organizational culture:The Chrystler Corporation (1980s)Wal-Mart

Apple

Target

FedEx

Jack 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).Slide53

Leadership in Academic Medicine

What unique benefit can transformational leadership deliver to academic medicine?To your specific role/job?Slide54

Leadership in Academic Medicine

Charismatic LeadershipServant Leadership

Transformational Leadership

Full Range Leadership ModelSlide55

Full 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” mannerSlide56

Full Range Leadership

Laissez-faire

Transactional

TransformationalSlide57

Full Range Leadership Model

Laissez-faire (LF) represents nontransactional leadershipInactive /Non-leadership Research finds this to be the least effective (Bass &

Avolio

, 1998)

Transactional Leadership – corrective and constructive exchanges between leader and followers based on followers’ performanceSlide58

Full 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 neededSlide59

Full Range Leadership ModelSlide60

A Complimentary VisualSlide61

Leadership in Academic Medicine

What unique benefit can full range leadership deliver to the academic medicine?To your specific role/job?Slide62

The SO WHAT Factor

In 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 scores

So What?Slide63

The SO WHAT Factor

In 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-up

Laissez-faire led to lower nurse ratings on all outcomes

So What?Slide64

The SO WHAT Factor

A 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 physicians

RN’s and physicians’ self-perceptions of servant leadership were higher than their perceptions of their organization’s use of servant leadership practices

Minimal differences between residents and physicians

So What?Slide65

The SO WHAT Factor

A 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 leadership

Conscientiousness, agreeableness, and extraversion were positively correlated with ethical leadership

So What?Slide66

The SO WHAT Factor

A 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 behaviors

So What?Slide67

The SO WHAT Factor

A 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 success

Unit cohesion and potency partially mediated the relationship between leadership and performance

Transformational leadership augmented transactional leadership when the reward was based on specific contracts or quid pro quo exchanges

So What?Slide68

The SO WHAT Factor

In 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 stimulation

So What?Slide69

The SO WHAT Factor

In 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 leadership

More experienced/senior level employees had significantly higher mean scores on laissez-faire leadership

So What?Slide70

Issues 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)Slide71

Issues 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.Slide72

Leadership Assessment

AssessmentResearch 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).Slide73

Multifactorial 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 6SSlide74

Multifactorial 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?)Slide75

Multifactorial Leadership Questionnaire (MLQ Form 5X)

DISCLAIMERSlide76

Evaluating 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?Slide77

Experiential 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?Slide78

Experiential 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?Slide79

Experiential 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)Slide80

Questions

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