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

LEADERSHIP IN ACADEMIC MEDICINE

Kent A. Corso, PsyD, BCBA-D

Walter Reed BethesdaUSUHS Department of Family Medicine

Bldg. E/ Lecture F

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


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.”


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


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


“Yes we can…”

Emotional involvement with the leader Identification with the leader Heightened goals

Emotional involvement with the leader Identification with the leader Heightened goals


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 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

Servant 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

Servant Leadership10) 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.


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


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


What unique benefit can servant leadership deliver to academic medicine?




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.


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 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 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?


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


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


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


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


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


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


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


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?


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


Examples Ghandi – raised the hopes and demands of

millions of his people and in the process was also changed

Nelson Mandela – transformed the nation of South Africa through high moral standards

Mother Theresa – advocated for the poor and helpless; incredible charity led others to give


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).


What unique benefit can transformational leadership deliver to academic medicine?




Full Range Leadership Model

This is the entire spectrum of leadership behaviors ranging from laissez-faire to transformational

Optimal model involves using each leadership type in a “dosed” manner

Full Range Leadership

Laissez-faire

Transactional

Transformational


Laissez-faire (LF) represents nontransactional leadership Inactive /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’ performance


Contingent Reward (CR) – rewarding positive behavior/performance with a reward

Management by exception - passive (MBE-P) Waits for deviances from standards, mistakes,

errors and then takes corrective action

Management by exception - active (MBE-A) Actively monitors followers for deviances from

standards, mistakes, errors and takes corrective action as needed


A Complimentary Visual


What unique benefit can full range leadership deliver to the academic medicine?


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?

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?

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?

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?

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?

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?

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?

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?

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)

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.

Leadership Assessment

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).

Multifactorial Leadership Questionnaire (MLQ Form 5X)

45-item instrument

The single most widely used, heavily researched , and empirically supported measure of transformational leadership

Self and other-rater forms

Short Form is 21 questions, Form 6S


**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 construct

360 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?)


DISCLAIMER

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?


Mentally review your last several meetings with subordinates What 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?


Transformational Leadership by definition fosters reciprocal change between leader and followers How can you see yourself changing? What would you hate to see this reciprocal

process change about how you currently lead?


Select a work relationship, project, team, planning document and sketch its trajectory with the intention of using transformational leadership What 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)

Questions

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