Transformation and Transformational Leadership

With the US healthcare system on an unsustainable course, change is inevitable. Changes in the healthcare landscape impacting radiology include changing payment models, rapid adoption of digital technology, changes in radiology resident certifying exams, and the rise of consumerism in health care. Academic Radiology will be part of that change with none of its missions spared. What matters is not that change is coming but how Academic Radiology responds to change. Do we ignore, adapt, adopt others’ practices, or lead change? Change management or transformation is a management skill set that can be learned and developed. Transformational leadership is a leadership style defined by the relationships between the leaders and the followers and the results they are able to achieve together to meet organizational goals. In this paper, we provide a review of key change management theories, as well as practical advice for self-reflection and development of leadership behaviors that promote effective change management and organizational transformation, particularly in a complex industry like Academic Radiology.

Introduction

The healthcare system consumes approximately 18% of the gross domestic product in the United States. The system is on an unsustainable course with an aging population, increasing chronic disease, and increasing consumption of the gross domestic product . Estimates of waste or nonvalue added activities in health care show significant opportunity for the transformation of the US healthcare system to improve cost, access, and quality with realignment of funds and activities. Berwick and Hackbarth estimate waste in health care to be 20%. A 2012 report of the Institute of Medicine estimated $750 billion of the $2.2 trillion spent on US health care to be waste. With the rollout of the Affordable Care Act in combination with the Supreme Court ruling to not require Medicaid expansion on a state level, the United States has embarked on 50 natural experiments in change management to improve the health of the population.

Academic Radiology is not isolated from the external environment of healthcare management. Indeed, the move to increase the corporatization of academic medicine touches all disciplines and thus, change will likely impact all missions of the Academic Radiology department . Rapidly evolving payment reforms, the deployment of electronic health record systems, changes in American Board of Radiology certifying exams, and the rise of healthcare consumerism are major change agents impacting Academic Radiology. The Department of Health and Human Services has set goals of transforming 30% of traditional Medicare fee-for-service payments into alternative payment models by 2016, with a 50% target by 2018 . These forces will be major drivers of the transformation from volume to value in US health care. The rapid deployment of often problematic electronic health record systems, driven by Meaningful Use and the Health Information Technology for Economic and Clinical Health Act, is an added change driver in radiology . The recent changes in the timing and content of the American Board of Radiology certifying exams and Accreditation Council for Graduate Medical Education training requirements are driving changes in radiology resident training, evaluation, and education. The rise of consumerism and patient-centered care may be the most powerful transformational force impacting US health care over the next decade .

Approximately 70% of organizational change management projects fail, and failed innovation projects are particularly common in academic medicine . Whereas the legal and regulatory environment is rapidly changing, the adoption of new technologies and new practices demonstrated to improve patient outcomes is likely to be delayed for a variety of reasons. The Institute of Medicine estimates that it takes 17 years for new knowledge to be adopted into clinical practice. Thus, currently deployed technology may not be the major driver in how Academic Radiology deals with the transformation in the US healthcare system over the next two decades.

This is keen evidence of the types of pervasive change in our discipline. Some aspects of change are rapid and others are slow and incremental, and that calls for transformational leadership where the focus is on visionary change as opposed to rewards for the maintenance of the status quo or minor accomplishments. In this environment, an understanding of different models of change management and the role of transformational leadership is critical. Transformational leadership, defined originally by Burns and Bass as a moral commitment to change for the betterment of an organization, engages followers in a way that traditional transactional leadership, or rewards and punishments for specific tasks, fails. Transformational leaders work with followers, generating enthusiasm and motivation for needed change. Transactional leaders primarily address their followers’ self-centered needs and in this context do not accomplish effective transformation of industries and disciplines undergoing dramatic change. According to Kotter, the noted expert on leadership and business success, change management is the essence of successful businesses and the purpose of leadership is to produce useful change .

We are mindful of the complexity of healthcare reform and that some aspects of the system such as financing and regulation are changing rapidly and others like technology advancement into clinical practice are slowing. That means that there is a place for all types of transformational leaders, including those who deal well with extreme change and those who deal well with slow and incremental change. To that end, we discuss situational leadership and leadership styles. We stress the need for leaders to know themselves and their leadership styles so that they can recognize situations where they will be more or less effective. We promote forming alliances between leaders with different styles to increase the likelihood of successful transformation of our industry.

Get Radiology Tree app to read full this article<

Change Management Models

Get Radiology Tree app to read full this article<

Table 1

Bringing Together the Change Models Based on the Idea of Change Management as Resisting Loss

Kubler-Ross

On Death and Dying Lewin

Group Decisions and Social Change

Kotter

Leading Change

Stages of Change Denial

Anger Unfreeze Increase Urgency

Building the Right Team

Get the Right Vision Bargaining

Depression Change Communicate for Buy In

Empower Action

Create Short-term Wins Acceptance Freeze/Refreeze Don’t let up

Make it stick

Get Radiology Tree app to read full this article<

Table 2

Kotter’s Eight Reasons for Failed Change Management Projects

Not establishing a great enough sense of urgency Not creating a powerful enough guiding coalition Lacking a coherent vision Under communicating the vision by a factor of 10 Not removing obstacles to the new vision Not systematically planning for, and creating, short-term wins Declaring victory too soon Not anchoring changes in the corporate culture

Get Radiology Tree app to read full this article<

Transformational Leadership

Get Radiology Tree app to read full this article<

Table 3

The Transformational Leadership Qualities According to Bass

Idealized Influence (Charisma)

Inspirational

Motivation

Intellectual

Stimulation

Individualized

Consideration

Get Radiology Tree app to read full this article<

Transformational Leadership Styles and Situational Favorableness

Get Radiology Tree app to read full this article<

Table 4

Fiedler’s Least Preferred Coworker Scale to Determine Leadership Style

Instructions:

Here are the instructions for completing the instrument (Least Preferred Coworker Scale): Think of a person with whom you work or have worked least well. You may have liked or disliked the person; what is important for the purpose of the questionnaire is that the two of you did not work well together. (That is why it is called the “Least Preferred Coworker” questionnaire.) Describe the person using the following scale (eg, if you think of this person as “pleasant,” check number 8 on the first item). Go through the material carefully; the scales reverse throughout the questionnaire.SCORE Pleasant __ __ __ __ __ __ __ __ Unpleasant __ 8 7 6 5 4 3 2 1 Friendly __ __ __ __ __ __ __ __ Unfriendly __ 8 7 6 5 4 3 2 1 Rejecting __ __ __ __ __ __ __ __ Accepting __ 1 2 3 4 5 6 7 8 Tense __ __ __ __ __ __ __ __ Relaxed __ 1 2 3 4 5 6 7 8 Distant __ __ __ __ __ __ __ __ Close __ 1 2 3 4 5 6 7 8 Cold __ __ __ __ __ __ __ __ Warm __ 1 2 3 4 5 6 7 8 Supportive __ __ __ __ __ __ __ __ Hostile __ 8 7 6 5 4 3 2 1 Boring __ __ __ __ __ __ __ __ Interesting __ 1 2 3 4 5 6 7 8 Quarrelsome __ __ __ __ __ __ __ __ Harmonious __ 1 2 3 4 5 6 7 8 Gloomy __ __ __ __ __ __ __ __ Cheerful __ 1 2 3 4 5 6 7 8 Open __ __ __ __ __ __ __ __ Guarded __ 8 7 6 5 4 3 2 1 Backbiting __ __ __ __ __ __ __ __ Loyal __ 1 2 3 4 5 6 7 8 Untrustworthy __ __ __ __ __ __ __ __ Trustworthy __ 1 2 3 4 5 6 7 8 Considerate __ __ __ __ __ __ __ __ Inconsiderate __ 8 7 6 5 4 3 2 1 Nasty __ __ __ __ __ __ __ __ Nice __ 1 2 3 4 5 6 7 8 Agreeable __ __ __ __ __ __ __ __ Disagreeable __ 8 7 6 5 4 3 2 1 Insincere __ __ __ __ __ __ __ __ Sincere __ 1 2 3 4 5 6 7 8 Kind __ __ __ __ __ __ __ __ Unkind __ 8 7 6 5 4 3 2 1TOTAL SCORE __ When you have finished, sum your answers for your total score (which will be between 18 and 144). If your total score was between 18 and 64, you have a tendency to be task focused. If your score was between 73 and 144, you have a tendency to be relationship focused. If you scored between 58 and 63, then you are mid-range so pick the end point to which you were closer (lower means task oriented and higher means relationship oriented).

Get Radiology Tree app to read full this article<

Practical Applications of Transformational Leadership Theories, Models, and Frameworks

Get Radiology Tree app to read full this article<

Conclusion

Get Radiology Tree app to read full this article<

References

1. Rawson James V.: Roots of health care reform. JACR 2012; 9: pp. 684-688.
2. Berwick D.M., Hackbarth A.D.: Eliminating waste in US health care. JAMA 2012; 307: pp. 1513-1516.
3. Smith M.Saunders R.Stuckhardt L. et. al.Best care at lower cost: the path to continuously learning health care in America.2013.The National Academies PressWashington, DC:
4. Rawson J.V., Baron R.L.: Balancing the three missions and the impact on academic radiology. Acad Radiol 2013; 20: pp. 1190-1194.
5. Bloom S.W.: Structure and ideology in medical education: an analysis of resistance to change. J Health Soc Behav 1988; pp. 294-306.
6. Centers for Medicare & Medicaid Services : Better care. Smarter spending. Healthier people: paying providers for value, not volume. Available at: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-01-26-3.html Accessed August 8, 2015
7. Wachter R.: The digital doctor: hope, hype, and harm at the dawn of medicine’s computer age.2015.McGraw-Hill EducationNew York
8. Topel E.: The patient will see you now: the future of medicine is in your hands.2015.Basic BooksNew York
9. Isern J., Pung C.: Driving radical change. McKinsey Quarterly 2007; 4: pp. 24-35.
10. Levine A.: Why innovation fails.1980.SUNY Press
11. Institute of Medicine (US) : Committee on quality of health care in America.Crossing the quality chasm: a new health system for the 21st century.2001.National Academy PressWashington, DC:
12. Burns J.M.: Leadership.1978.Harper & RowNew York
13. Bass B.M.: Leadership and performance beyond expectation.1985.Free PressNew York
14. Bass B.M.: From transactional to transformational leadership: learning to share the vision. Organ Dyn 1991; 18: pp. 19-31.
15. Kotter J.P.: Leading Change.1996.Harvard Business School PressBoston
16. Kubler-Ross E.: On death and dying. [e-book]1973.Tavistock PublicationsLondon Available at: eBookCollection(EBSCOhost),Ipswich,MA.AN122641; Accessed January 20, 2015
17. Lewin K.: Group decision and social change. Readings Soc Psychol 1947; 3: pp. 197-211.
18. Kotter J.P.: Leading change: why transformation efforts fail. Harv Bus Rev 1995; 73: pp. 59-67.
19. Box G.E.P.: Science and statistics. J Am Stat Assoc 1976; 71: pp. 791-799.
20. Kotter J.P., Cohen D.S.: The heart of change: real-life stories of how people change their organizations.2012.Harvard Business PressBrighton MA
21. Fuda P.: Leadership transformed: how ordinary managers become extraordinary leaders.2013.Profile BooksLondon
22. Fiedler F.E., Garcia J.E.: New approaches to effective leadership: cognitive resources and organizational performance.1987.John Wiley & SonsHoboken, NJ
23. Rogers E.M.: Diffusion of innovation.1995.Free PressNew York
24. Lowe K.B., Kroeck K.G., Sivasubramaniam N.: Effectiveness correlates of transformational and transactional leadership: a meta-analytic review of the MLQ literature. Leadersh Quart 1996; 7: pp. 385-425.
25. Judge T.A., Piccolo R.F.: Transformational and transactional leadership: a meta-analytic test of their relative validity. J Appl Psychol 2004; 89: pp. 755-768.
26. Yukl G.: An evaluation of conceptual weaknesses in transformational and charismatic leadership theories. Leadersh Quart 1999; 10: pp. 285-305.
27. Givens R.J.: Transformational leadership: the impact on organizational and personal outcomes. Emerg Leadersh Journeys 2008; 1: pp. 4-24.
28. Weberg D.: Transformational leadership and staff retention: an evidence review with implications for healthcare systems. Nurs Adm Q 2010; 34: pp. 246-258.
29. National Health Service : NHS change day. Available at: http://www.nhsiq.nhs.uk/capacity-capability/nhs-change-day/school-for-health-and-care-radicals.aspx Accessed January 4, 2015
30. Goleman D.: What makes a leader?. Harv Bus Rev 2004; 82: pp. 82-90.
31. Bons P.M., Fiedler F.E.: Changes in organizational leadership and the behavior of relationship- and task-motivated leaders. Adm Sci Q 1976; pp. 453-473.
32. Fiedler F.E., Chemers M.M.: A theory of leadership effectiveness.1967.McGraw-HillNew York
33. Fiedler F.E.: Personality, motivational systems, and behavior of high and low LPC persons. Hum Relat 1972; 25: pp. 391-412.
34. Grant A.M.: Leading with meaning: beneficiary contact, prosocial impact, and the performance effects of transformational leadership. Acad Manage J 2012; 55: pp. 458-476.
35. Mansoori B., Vidal L.L., Applegate K., et. al.: Impact of patient protection and affordable care act on academic radiology departments’ clinical, research, and education missions. Acad Radiol 2013; 20: pp. 1213-1217.
36. Gunderman R.B.: Leadership in radiology. Acad Radiol 1999; 6: pp. 444-451.
37. Gunderman R.B.: Take me to your (future) leader. Acad Radiol 2001; 8: pp. 762-767.
38. Gunderman R.B.: Perspective: pitfalls in radiology leadership. Acad Radiol 2002; 9: pp. 557-560.
39. Sinek S.: Leaders eat last: why some teams pull together and others don’t.2014.PenguinNew York
40. Collins J.: Level 5 leadership. The triumph of humility and fierce resolve. Harv Bus Rev 2001; 79: pp. 66-76.
41. Pan W., Wang T., Wang X., et. al.: Identifying the core components of emotional intelligence: evidence from amplitude of low-frequency fluctuations during resting state. PLoS ONE 2014; 9: pp. 1-8.
42. Bass B., Riggio R.: Transformational leadership. [e-book]2nd ed.2006.Lawrence Erlbaum Associates PublishersMahwah, NJ
43. Kohles M., Baker W., Donaho B.: Transformational leadership: renewing fundamental values and achieving new relationships in health care.1995.American Hospital AssociationChicago, IL
44. Mhatre K., Riggio R.: Charismatic and transformational leadership: past, present, and future. The Oxford handbook of leadership and organizations. [e-book]2014.Oxford University PressNew York, NY

Transformation and Transformational Leadership

Introduction

Change Management Models

Transformational Leadership

Transformational Leadership Styles and Situational Favorableness

Practical Applications of Transformational Leadership Theories, Models, and Frameworks

Conclusion

References

Further Reading

Assessing Medical Student Knowledge of Imaging Modality Selection Before and After a General Radiology Elective A Comparison of MS-IIs, MS-IIIs, and MS-IVs

Comparative Effectiveness of Imaging Modalities for the Diagnosis of Intestinal Obstruction in Neonates and Infants

Comparison of Diffusion Tensor Imaging and Magnetic Resonance Perfusion Imaging in Differentiating Recurrent Brain Neoplasm From Radiation Necrosis