Leadership in Academic Medicine - Uniformed Services

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					Bldg. E/ Lecture F


                      Kent A. Corso, PsyD, BCBA-D

                           Walter Reed Bethesda
                     USUHS Department of Family Medicine
 To describe the leadership theories that are
  most applicable to leadership in academic

 To apply one leadership theory to a project,
  work relationship, or future planning endeavor
  within your academic medical center.

      Distribute Learning Probe
 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
    Complete feedback forms/course evaluation
 Where do you work?
 What is your role?
 Do you have a management/supervisor
 Any prior experience with leadership
  training/development that you found
  particularly beneficial? If so, please explain
 What did you hope to gain today?
 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
 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

 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
Leadership in Academic Medicine

 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   Behaviors               Effects on Followers
-Dominant                     -Strong role model      -Trust in leader’s ideology
-Desire to influence          -Shows competence       -Beliefs become similar to
-Confident                    -Articulates goals      the leader’s
-Strong values                -Communicates high      -Unquestioning acceptance
                              expectations            -Affection toward leader
                              -Expresses confidence   -Obedience
                              -Arouses motives        -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.”
 Name that Charismatic Leader

 “Everyone needs to be valued. Everyone has
  the potential to give something back.”
 Name that Charismatic Leader

 “Ask not what your country can do for you...”
 Name that Charismatic Leader

 “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
Leadership in Academic Medicine

 What unique benefit can charismatic leadership
  deliver to academic medicine?
 To your specific role/job?
Leadership in Academic Medicine

 Charismatic Leadership
 Servant Leadership
 Transformational Leadership
 Full Range Leadership Model
        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
       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 Leadership
4) 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 Leadership
7) Foresight – involves intuition, but also involves
   the ability to learn from past mistakes, the
   reality of the present and the best future

8) Stewardship – “holding something in trust for

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 Leadership
10) 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
  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

 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.
        Servant Leadership in
 The institution must be regarded as socially
  responsible to all parties involved:
   Employees (including administrators) – safety, rights,
    privileges, regulations
   Customers – product descriptions, services, and
   Suppliers - positive working relationships, cultivate
    faith and trust
   Local agencies – government, university, church
         Servant Leadership in
 Make the good of society the focal point of the
    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
Leadership in Academic Medicine

 What unique benefit can servant leadership
  deliver to academic medicine?
 To your specific role/job?
Leadership in Academic Medicine

 Charismatic Leadership
 Servant Leadership
 Transformational Leadership
 Full Range Leadership Model
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
   Transformational leaders are attentive to the needs
    of their followers and try to help followers reach
    their fullest potential.
Transformational Leadership
 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
 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
 Transformational leadership sits on one end of
  a continuum with laissez-faire leadership at the
  other end and transactional leadership lying in
 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?
Transformational Leadership
 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
Transformational Leadership
 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
Transformational Leadership
 Factor III: Intellectual Stimulation
   Leaders stimulate creativity and innovation among
   Leaders encourage followers to challenge their own
    beliefs and values, while also challenging the leader
    and organization
   Perpetuates critical thinking, innovation, and
Transformational Leadership
 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
Transformational Leadership
 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
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 themselves
Transformational Leadership
 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

   It looks at leadership as a personality trait – not a
    series of behaviors that can be taught
Transformational Leadership
  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?
Transformational Leadership
 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
Transformational Leadership
 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
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).
Leadership in Academic Medicine

 What unique benefit can transformational
  leadership deliver to academic medicine?
 To your specific role/job?
Leadership in Academic Medicine

 Charismatic Leadership
 Servant Leadership
 Transformational Leadership
 Full Range Leadership Model
Full Range Leadership Model
 This is the entire spectrum of leadership
  behaviors ranging from laissez-faire to

 Optimal model involves using each leadership
  type in a “dosed” manner
        Full Range Leadership

Laissez-faire   Transactional   Transformational
Full Range Leadership Model
 Laissez-faire (LF) represents nontransactional
  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
Full Range Leadership Model
 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
Full Range Leadership Model
A Complimentary Visual
Leadership in Academic Medicine

 What unique benefit can full range leadership
  deliver to the academic medicine?
 To your specific role/job?
       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
    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
    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
    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
    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.,
 Managing different generations, particularly with
  regard to old models of “paying your dues” (Kennedy,
   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
    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 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
  Multifactorial Leadership
Questionnaire (MLQ Form 5X)

  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?
        Experiential Learning

 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?
        Experiential Learning

 Transformational Leadership by definition
  fosters reciprocal change between leader and
   How can you see yourself changing?
   What would you hate to see this reciprocal process
    change about how you currently lead?
          Experiential Learning
 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)

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