A Mostly Botched Attempt at Leadership

In my relatively new Twitter account, I’ve referenced some intellectual interests that have graced my life in recent months: the skills of persuasion and negotiation, underpinned by cognitive science. My undergrad degree being in psych, it’s not exactly surprising that this stuff would resonate.

I’ve found myself viewing much of daily life through these new-to-me lenses. Even when remembering events of years gone by, I see new angles to them. One episode harks back to my residency…I might have referenced it in a previous column.

Our hospital had given control of its radiology department to a local private-practice group, and while most of our attendings had opted to stay on as its employees, some of the group’s members were new faces in our corridors. Even the group’s leader would occasionally put in an appearance.

His first encounter with one of the junior residents was in the non-interventional fluoro area. The leader-guy marched into the room, eyeballed the day’s schedule (which never had more than half a dozen assorted barium exams, spread out over the morning and early afternoon), and told the resident, “I want all of these studies done by ten o’clock.”

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The resident was a good, likeable guy, easy to get along with but not afraid to be blunt. Surprised and irked by the demand, his bluntness was on full display as he informed the leader that there was no way the edict could be fulfilled. The leader, perhaps unaccustomed to being challenged by a subordinate, seemed somewhat horrified and left the scene. Fluoro cases proceeded with no more alacrity than they ever had, that day or any subsequent.

Until now, I’ve regarded the exchange in the same way I did as a resident, and, indeed, the way the junior did that day: the leader was being imperious and demanding. His first day in the place, he struts around, and tells folks who have been working there that they’re going to abruptly do everything differently on his say-so? Whether or not logistically possible?

I have no way of knowing what the leader’s goal was in that exchange. Maybe he genuinely did want the fluoro service to run more efficiently…or maybe he just wanted to impress the resident and nearby rad-techs that he was a take-change, watch-me-improve-everything kind of guy.

Whatever his motives, he could have gone about them more effectively. Rather than barking out demands and, then, retreating when they were not well-received, he would have been far better served by gathering information and recruiting the resident and techs to his cause.

For instance, instead of “I want all of these cases done by ten o’clock,” he might have taken a thoughtful look at the schedule and, then, started asking questions about it:

“Is this a typical daily case-load?” “How frequently do cases get added on?” “How long do these cases tend to take? Are they difficult?” “What else do you have to do, that doesn’t show up on the schedule?”

He would have done well to not only listen to the verbal responses, but also note tone of voice, posture, gestures, etc., accompanying them. The techs and the resident might have had valuable information or insights that could, then, be teased out with follow-up questions.

For instance, had the leader invited the staff to help him understand the situation, any one of them might have pointed out that the limiting reagent was not their desire or ability to get cases done…but, rather, the incredibly balky and inefficient system that got patients down from their rooms to the radiology department. Nurses on the wards and patient-transporters had plenty of other demands on their time, and/or weren’t particularly motivated to maximize throughput for imaging studies. You could go ahead and schedule two or three times as many fluoro studies each day, but all that would happen would be patients showing up hours after they were supposed to be there, and, then, sitting around even longer waiting to be brought back to their rooms.

Armed with such information, the leader might have understood that the problem he needed to attack was not his own staff in the rad department. He might have taken things up with hospital administration. Perhaps gotten a patient-transporter or three specifically assigned to radiology. Gotten dispensation for one or more rad-techs to go and fetch patients themselves, when feasible.

And, in his first interaction with the resident and rad-techs, he would have come off not as a haughty Grand Poobah, doing a drive-by on his high horse…but, a down-to-earth new guy, wanting to learn the ins-and-outs of the place just like anybody else. Except with the clout to maybe make some things better.

I did say, however, he only “mostly” botched this. What did he get right -- aside maybe from establishing that he was in charge and comfortable making demands?

One item is that he expressed what he wanted. Not everybody does that, and at some point in every negotiation you need to plainly communicate what you want to the people who can give it to you.

And, maybe he didn’t really want all of the cases done by 10:00 a.m. Maybe all he was after was moving the needle, getting cases done sooner in the day. In a negotiation, your first “ask” shouldn’t be the same thing as what you’re ultimately willing to settle for. So, if fluoro cases ordinarily got done by mid-afternoon, maybe an initial demand for 10 a.m. would ultimately lead to having things done by lunchtime. Turning fluoro from a full-day schedule into a half-day, after which your personnel can be allocated elsewhere? That’s a “win” for efficiency.

Believe it or not, this is just the tip of the iceberg. Tempted as I was to make this a marathon column delving into the various other ways this rad-group leader could have done better, let’s give your eyes a rest, shall we? Come on by my Twitter page and we can discuss the rest!

Follow Eric Postal, M.D., on Twitter: @EricPostal_MD​