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How to Be a Positive Radiology Leader in Times of Crisis

      “You never let a serious crisis go to waste. And what I mean by that is that it's an opportunity to do things you think you could not do before.” Rahm Emanuel, Former Mayor of Chicago.

      Introduction

      Due to the COVID-19 pandemic, we have witnessed examples of extraordinary leadership and less than stellar leadership in our institutions, communities, nation, and around the world. In some instances, we have been inspired to bring forth our very best selves and give far more than we ever thought capable of. In other instances, we have felt demoralized, depleted and overwhelmed. Sadly, many of the same mistakes made by leadership during the current crisis also occurred during the 1918 influenza pandemic. Precious time was lost while leaders denied the severity of the situation, social distancing measures were delayed and inadequate, and needed resources were lacking for those who became ill (

      History of the 1918 Flu Pandemic. Available at: https://www.cdc.gov/flu/pandemic-resources/1918-commemoration/1918-pandemic-history.htmAccessed April 7, 2020.

      ). The importance of effective leadership cannot be stressed enough, especially during times of crisis. In fact, the quality of leadership during pandemics such as these is truly a matter of life and death.
      The Army describes leadership as “all about influencing people by providing purpose, direction and motivation—while operating to accomplish the mission and improving the organization.” In addition, the Army's simple yet powerful leadership model is “Be, Know, Do” (
      • Hesselbein F
      • Shinseki General Eric K.
      Be-Know-Do.
      ).
      Positive organizational psychology is the discipline that inspires and enables leaders to build high-performing organizations that bring out the very best in their people. Whether we acknowledge it or not, we are shaping the culture of our departments for years to come in how we show up to lead our departments during this time. Not only is the virus contagious, but so are our attitudes, beliefs, and behaviors.
      During these times we come face to face with the challenge of responding quickly without a well-worn game plan, enough information or the time we would normally take to build consensus. Right now, our faculty and staff need our guidance now more than ever as we are called to come together in extraordinary ways to accomplish tasks previously considered impossible with little time and lack of complete information. Although positive leadership is important all of the time, it is particularly important in times of crisis. How we decide to show up will determine how they decide to show up.
      At the University of Michigan Department of Radiology, we have been working with the University of Michigan Ross Business School Center for Positive Organizations to learn best practices and measure the effect of positive leadership in our workplace (

      The University of Michigan Ross Business School Center for Positive Organizations. Available at: https://positiveorgs.bus.umich.edu. Accessed April 11, 2020.

      ). From our learnings, we have generated a list of positive leadership qualities and given concrete examples of how they have been used in our Department during this COVID crisis.

      Be Principled

      Know and communicate regularly your personal, departmental and organizational mission, vision, and values. If you don't have them written down, now is the time to do this. Reference these principles regularly to help guide you in solving problems and making decisions. Help your people connect their work to your stated higher purpose. When disagreements arise with others, take a step back and look to your guiding principles to find mutual agreement at a higher level to lead you forward together in a positive way.
      Example:The Department Chair has had a “people first” guiding principle since his time interviewing for the position as chair. He has repeatedly messaged to his leaders and to the department that we can continue to excel as an extraordinary program while building a culture that is centered on its “people” with kindness and compassion.

      Be Trustworthy

      Tell the truth without minimization or exaggeration. Use reliable and credible sources of data. Be a calm, nonanxious presence. Embrace uncertainty when you are not the expert. Instead, ask a lot of questions to more fully understand the situation and circle back to give people the answers they need. Find experts you can trust and have them speak to your people. Follow-through on your promises and commitments.
      Example:Just recently, the Department Chair and Chief Department Administrator held a townhall meeting for all 1310 of our faculty and staff to deliver the economic recovery plan from the institution that included loss of retirement funds and all discretionary funding as well as many permanent job cuts without adequate details or explanation. After several days of thoughtful consideration, they delivered the difficult message with compassion, hope and the promise to be transparent in the process. Most importantly, they acknowledged with sincere sadness the disproportionate affect this would have on our nonbargained for staff compared to those within unions and the faculty. Finally, they promised to address this second wave of economic disaster as creatively and compassionately as they met the first.

      Be Compassionate

      Being compassionate means feeling true empathy for others and taking action to relieve their suffering. First and foremost, use self-compassion regularly and model this for others. Understand all of your stakeholders and create a “map” of each group's concerns, needs, and how you will work to address them. Although large policy and programmatic changes are important and necessary, small random acts of kindness can have a tremendous impact. Demonstrating that you truly care about your people as human beings can make a significant difference. Build high quality connections with people at all levels.
      Example:The leadership team stepped up to organize regular food service to our frontline staff by providing breakfast, lunches and treats on a regular and rotating basis as well as “bling” in the form of personalized hand sanitizer bottles and T-shirts. Many of these items were delivered to staff at all of our locations by the Chair who reached out to thank the frontline workers personally. In addition, the leadership team conducted a childcare survey to determine the extent of the problem and what creative solutions we could recommend to help people within the Department to meet their needs.

      Be Transparent

      Communicate frequently, consistently and clearly. Make your thinking visible by sharing your thought processes and struggles. Be the source of information for your people or they will find other sources which will likely be less reliable. If information from leadership is lacking, the gap will be filled by rumors, stories and incorrect assumptions. The more anxiety that exists, the more you need to communicate. Use all of the communication tools at your disposal–blogs, townhalls, emails, twitter feeds, recorded webinars, meetings and small group rounds. Decide what methods and cadence are best for each stakeholder group.
      Example: During and before this crisis the leadership team understood the importance of communication by adopting the model of “nine ways, nine times”—nine different venues and nine different times for each important message. During this crisis that approach has been magnified with nearly daily blog posts and emailed department operational updates, twitter feeds, a shared intranet platform on the Department website and a new “Workplace” group developed by Facebook for posting resources and inspirational stories and pictures, weekly leadership and faculty meetings and full Department Town Halls when the need arose. Taking any and all live questions while talking to an audience you couldn't see became an elevated art form by the Chair during this time.

      Be Authentic

      Know yourself well–build on your strengths while acknowledging your weaknesses and finding ways to improve or support them. Find a small group of people who know and support you with expertise, perspective and laughter. Also appoint a “red team” that is assigned to finding faults with your ideas and thinking—the better they do, the better you do. Being vulnerable with others is a quick way to build trust.
      Example:Beginning on April Fools’ Day, the Associate Chair for Department Life and Culture held weekly “Find the Joy” Zoom meetings for the entire department to build community and improve morale during this uncertain time. One of the virtual meetings featured the Chair who shared his background of growing up in India, the difficult move to the United States as a young adolescent, his love of his family, cricket and nachos with “fake cheese” as well as his refusal to make his bed in the morning. Another long- term leader in the department shared openly his personal struggle with anxiety and how he was using an anxiety course and meditation to help him. Other leaders in the department exposed their vulnerabilities in new ways by performing their talents on a department wide Zoom talent show.

      Be Accountable

      Be willing to accept blame for your own mistakes when appropriate. You are where the buck stops. No one expects a leader to be perfect but everyone wants their leaders to admit when they were wrong, sincerely apologize, and chart a new course. Hold others accountable just like you hold yourself.
      Example:Early during this crisis the institution had told the Chair to ask our faculty to volunteer to be redeployed to our temporary field hospital or other units within the hospital. The Chair sent out an email requesting a turnaround time within hours and our faculty were appropriately anxious and angry about the request and lack of information. Sensing a rising revolt among the ranks, the Chair quickly reached out to his faculty on a Zoom meeting and took responsibility for his actions, the consequences, and the need to ask for more time and information before complying with this request from the institution. He subsequently had the Medical Director of the Army field hospital speak virtually to our faculty regarding their fears and concerns about redeployment. Of our clinical faculty members, 25% volunteered for redeployment after this discussion.

      Be a Learner

      Make psychological safety a priority in your department. Recognize that most mistakes occur not from personal transgressions, but rather from systemic causes. This will not only build good will, but will ultimately keep patients and staff safer. Empower everyone to contribute and have a voice in decision making. Ask more questions than you tell. Support others with additional training, coaching and timely feedback when needed. Reflect daily on what you did well and where you could have done better as a leader. Perform an “After Action Review” for major events in order to maximize learning (

      Darling M, Charles P, Moore J. Harvard business review. July-August 2005Issue.

      ).
      Example:The Chair and leadership team quickly reached out to colleagues across the nation and internationally to better understand what was happening and how best to respond in this crisis. Our subsequent staffing model we employed during this crisis was based on the “Lombardy” method used in the northeastern part of Italy to preserve healthy staff and faculty. To minimize exposure and maximize health and well-being, the faculty rotated their schedules as teams to work one week on and one week off at a time. In addition, the Radiology Wellness Committee created a long list of helpful resources on our Department webpage covering COVID medical information, money management, health and well-being, mental health, and food, family, and childcare services.

      Be Humble

      Recognize that medicine has become a team sport and everyone has an important role to play. Always look for ways to sincerely compliment those in your department with specific examples. Provide positive to negative feedback on at least a 3:1 ratio. Delegate duties to others with enough latitude and direction to help others be successful and grow professionally. Expect results but do not micromanage.
      Example:In order to help build a positive culture, the Chair appointed a former private practice radiologist recently hired by the Department to engage with the Ross Business School Center for Positive Organizations to study and implement this important change. The Faculty Director of this organization has been hired as an adjunct faculty member within the Department to help create, measure and sustain this culture change.

      Be Flexible

      Be ready and able to shift ideas and plans when needed. Acknowledge that this is not always easy or pleasant, but is necessary to meet challenges as they arise unexpectedly. Resist the temptation to keep doing what you have always been doing because that is how you have been successful in the past. Reach out to those who might have new ways of seeing or doing things.
      Think bigger.
      Example:The Department Chair was in his new position only eight months when he had to completely reorganize his priorities, operations and mobilize all of his leaders and people to do what was needed to meet the challenges. Within four weeks the Associate Chief of Medical Informatics for Radiology deployed 52 workstations to homes,

      Be Present

      Be the leader who eats last instead of first. Do not expect others to do what you are not willing to do. Volunteer first and “lean in”. Show up consistently, even when it is hard and you don't know what to do. Be the first one to arrive and the last to go home. Be willing to try new things, fail, and try again.
      Example:Despite opposition from the leadership team, the Chair was the first one to sign up for the voluntary redeployment list to work in our temporary field hospital. There was no way he was going to sit on the sidelines and not be in the trenches with his people. With every townhall he would quote Mark Twain who said “Courage is resistance to fear, mastery of fear, not the absence of fear”.
      Our leaders have done their best to be calm, to be clear, and to be there every day during this crisis. Robert Quinn, the world-renowned leadership and culture expert, describes times such as these as “storm cultures” because they disrupt our previous ways of getting work done and inspire us to achieve extraordinary outcomes through elevated human capacity and innovation (

      Becoming who you really are: how to grow yourself and your organization. Available at: https://michiganross.umich.edu/programs/executive-education/becoming-who-you-really-are-how-grow-yourself-and-your-organization?event=5409. Accessed April 9, 2020.

      ). Seizing the opportunity for change has required us to be deliberate in how we show up rather than relying on a “leadership through crisis” cookie-cutter strategy. We are called to bring the very best version of ourselves to work; the one that we aspire to be and the one that we can be if we were to rise to the challenge. Showing up as positive leaders today will help to make us a stronger and more unified department in the days and years to come.

      References

      1. History of the 1918 Flu Pandemic. Available at: https://www.cdc.gov/flu/pandemic-resources/1918-commemoration/1918-pandemic-history.htmAccessed April 7, 2020.

        • Hesselbein F
        • Shinseki General Eric K.
        Be-Know-Do.
        Leadership the army way adapted from the official army leadership manual. Jossey-Bass, 2004
      2. The University of Michigan Ross Business School Center for Positive Organizations. Available at: https://positiveorgs.bus.umich.edu. Accessed April 11, 2020.

      3. Darling M, Charles P, Moore J. Harvard business review. July-August 2005Issue.

      4. Becoming who you really are: how to grow yourself and your organization. Available at: https://michiganross.umich.edu/programs/executive-education/becoming-who-you-really-are-how-grow-yourself-and-your-organization?event=5409. Accessed April 9, 2020.