By Matt Skoufalos
Leaders in the medical imaging space tend to fall into one of two categories. The first are former technologists. Passionate about their work, but often promoted into management roles without any formal leadership training, the tone set in their departments typically begins and ends with their own inclinations and personal experiences from years spent in the field.
The second group, from among which many top-level executives are sourced, can be people with some sort of business leadership background, but not necessarily any specific experience in medical imaging; maybe not even in health care. They have business training, but no practical understanding of the day-to-day mechanics of the job their subordinates do.
Set against the backdrop of a high-volume or high-stress work environment that places exceptional burdens of time and responsibility upon management-level positions, it’s easy to see why it can be a fraught proposition to sit in the captain’s chair at any level of the workplace. With technologist-level careers commanding strong salaries in a labor-driven market, mass retirements of baby-boomer-aged workers, and general transitions out of all manner of careers through the Great Resignation from the national labor force, leadership in the medical imaging space is in flux.
Elena Danilova, executive director of clinical development at the Gurnick Academy of Medical Arts in San Mateo, California, is an MRI technologist who sees medical imaging leadership as managing the obligations of the workplace, including its cultural expectations.
“Right now, I see two types of leaders,” Danilova said. “The first are leaders because of seniority. Often, they have no specific education, training or innate leadership skills. Sometimes they use sticks and carrots to get work done. Their primary focus is meeting deadlines and completing tasks by any means.”
“The second type of leaders are developed from imaging enthusiasts: they went to professional imaging school and possess required and specific training. Those leaders might frame how things should be done based on their feelings, knowledge of the current needs and trends, and experience,” she added.
Danilova foresees future imaging leaders emerging from imaging schools, or programs tailored to develop leadership skills specific to the imaging environment. She came from just such a program, and looks for some common characteristics of emergent leaders among students in her classes. After a strong command of practical skills in the field, those imaging professionals with the most innate potential for leadership demonstrate an analytic curiosity about how things should be done. They keep themselves accountable for their studies and the quality of their education, and when they graduate from imaging school, Danilova recommends that they continue their education comprehensively, and soon.
“Some of those technologists are very ambitious and they want to grow; they want to make things better,” she said. “They’re willing to go to school, receive their bachelor’s degrees, and go back in the field and lead.”
“Leaders have to have the right personality,” Danilova said. “If you want to make good, positive changes, you have to stand up for yourself; know how to manage people, how to delegate, and don’t micro-manage people.”
Importantly, Danilova also stressed that effective leaders demonstrate self-reliance, and model the approaches they want their staff to follow. Leadership requires the additional strategic thinking that supports effective team-building. Setting the example you wish others to follow establishes trust because it shows an equal willingness to take on any delegated task, no matter how unpleasant, and provides a basis for support that is built upon compassionate and empathetic understanding.
“If I ask somebody to do something, I have already done it,” she said. “If I’m not an expert in something I’ve assigned to you, how can I assess or evaluate the job you did? I need to know it first, I need to give you adequate training, and then assign the task to you.”
“You can only give me quality work if you know how to do it, if you’re confident, and if you are skilled in what you’re doing,” Danilova said.
Perhaps most significantly, she said, the best leaders understand that they won’t hold their titles and positions forever. Another component of leadership involves planning for exiting the leadership role, which means fostering the professional development of the people they manage that show potential for leadership.
“A good leader cares about their people, and tries to find a way to bring educated and passionate people to their team,” Danilova said. “They look for good leaders in their team, and they try to develop new levels of leaders, so they’re not afraid to be outshined or replaced. If it’s about tomorrow, the organization should not suffer any hiccup in operations.”
Henry Ford is quoted as having said, “The only thing worse than training your employees and having them leave is not training them and having them stay.” More recently (and affirmatively), the same concept was framed by Richard Branson as, “Train people well enough so they can leave; treat them well enough so they don’t want to.” Danilova sees the wisdom of both quotes as it applies to managing people.
“I always tell my partners, we need to raise the right people who will take care of us,” she said. “The bottom line is, we’re people. We’re getting older; we’re going to retire. We’re going to have MRIs and CTs and X-rays, and when you go to the hospital, how do you want to be treated? Do you want to have artists in their field, or people who want to do a job and go home?”
Suzieann Bass, associate professor and program director for radiography, management and education at the University of Texas MD Anderson Cancer Center, said it’s important for leadership hopefuls to identify positive examples of leaders in their lives, and learn from those examples. At an academic institution like hers, there’s no shortage of standout professionals in the field, and two of them – Aziz Benamar, executive director of operations for diagnostic imaging; and William Undie, professor and associate dean of academic affairs — she cites as servant leaders who set clear expectations and never stop improving.
“Aziz is a visionary,” Bass said. “He’s a really big proponent of how education can change; how to advance the imaging department through students. He’s passionate about the department; he looks at every avenue to develop his people.”
Bass described how Benamar and Undie established STARS, a talent pathway program at MD Anderson, whereby students working for the division as assistants can then transition into CT and MR technologist roles upon graduation. That way, they roll seamlessly into employment already knowing the institutional culture, the ins and outs of their departments, and the equipment used in their roles.
In working with Undie, Bass said she’s grown tremendously by following the example set by the behavior he models in the workplace. Watching how Undie handled volatile situations with a calm demeanor inspired Bass to fortify her emotional intelligence, and to realize that the concept of servant leadership requires a holistic appraisal of the impact of individual attitudes within the workplace.
“Now I’m in a leadership role, and now I get it,” she said. “It’s ‘we,’ not ‘me,’ and there’s some times that I have to step back and say, ‘How is it going to impact everybody?’ The students, my team – everybody’s under stress. I have to think about the other people in the program.”
“When students go through our program, they’re getting those servant leadership skills,” Bass said. “They’re getting different types of leadership. They’re saying, ‘This is not the type of leader I want to be,’ or ‘This is the type of leader I want to be.’ We know the education is reliable and valid because it’s what the managers and leaders are doing in their everyday life.”
Bass also said she’s picked up valuable leadership insights from past AHRA (the Association for Medical Imaging Management) CEO Edward J. Cronin Jr. Her participation in AHRA over the years was guided by Cronin’s efforts to empower medical imaging professionals to take steps into leadership roles within their institutions through the AHRA basic leadership academy.
“For me that was what was needed so you can see what the leaders go through; so that you can see that having an education and getting your bachelor’s degree has an impact later on,” Bass said. “Just having the experience is not all it is anymore. You have to have that education piece behind it.”
Finally, Bass pointed out that getting the best out of a leader also means fostering an institutional culture of psychological safety and preventing burnout.
“When you have someplace where they really look at making sure that your workplace is positive, and they make sure you’re safe, they work at eliminating unconscious bias and emphasizing inclusivity, it really makes a difference in how happy you are when you come to work every day,” she said. “It is essential for fostering that sense of pride and ownership. I love where I work.”
Nicole Dhanraj, chief strategist of the 424 Business Group, warned that without institutional cultural shifts to create psychologically safe and welcoming workplaces, she deeply doubts those same institutions can develop the next generation of leaders.
Health care senior leaders must reevaluate their understanding of leadership obligations in a post-COVID-19 world, learning from the Great Resignation and embracing that healthy workplaces are built on qualitative values, not quantitative ones.
“There should not be an expectation that as a leader, you’re going to work 80 hours a week,” Dhanraj said. “You don’t get a gold star for going on four hours of sleep. We need to move away from that mindset, and establish healthy work-life boundaries for our team and their leaders.”
“So many of my colleagues are having Sunday evening anxieties because of the dumpster fires they have to deal with on Monday,” she said. “You’re not supposed to conquer the world by yourself. We need to approach our operation through incremental steps aligned with the organizational strategic vision.”
Part of the same process by which strategic vision is developed involves regarding moves into different leadership roles along a similar, incremental process. Dhanraj spoke about the “huge leap” that she took in transitioning from a technologist role to a director position, and the high stakes associated with the prospect of failure therein if someone is not fully prepared to meet the demands of their job.
“We’re so broken in health care,” she said. “If a new leader makes mistakes, and they’re really drowning due to the high workload, they’re going to look less competent and be less successful. Instead, we should ensure our next generation leaders have a better career plan, and formalize that plan. Especially with today’s generation and work options, why is it that we cannot be flexible, or adjust positions to what employees want? We need to consider a new work culture if we want to attract the next generation of leaders.”
“We’re supposed to be allowing experimentation and failure, but organizations are not open to having people learn and make mistakes,” Dhanraj continued. “Organizations promote Just Culture; a majority of organizations actually follow Just Culture. Yet at the end of the day, many employees in Just Culture settings face disciplinary action for their mistakes. Nobody wants to go into leadership because they don’t want to get the blame when something goes wrong, and they certainly don’t want the level of stress associated with the leadership position.”
Dhanraj also believes part of the problem is inherent to the do-it-all attitude that underpins the values of a successful imaging professional.
“If your senior leaders tell you to do something, imaging leaders are of the mindset to get it done at whatever cost,” she said. “We get the work done because we’re known to do what it takes to make things work.”
“We are groomed to be very reactive, jumping to perform the exam in front of us,” Dhanraj said. “When front-line staff are put into leadership positions, they quickly jump into activities, as opposed to strategically thinking about a course of action. We’re all so gung-ho in doing things that nobody’s really pausing to strategically think about things, or question our senior leaders.”
One possible antidote to that mindset is a concept of provocative curiosity, an approach that Dhanraj said inspires leaders to look beyond what’s going on and question what could be instead. Employees who believe that their concerns won’t be addressed eventually stop alerting managers to issues that could be intercepted before they worsen; the cumulative cost of that discouragement means that staff disengage and withdraw altogether.
Instead, she believes that the medical imaging space should develop formalized, industry-specific mentorship programs to position the next generation of leaders for practical effectiveness in such roles.
“You already have the next generation of leaders, but nobody’s willing to give them a chance, or spend ample time to train them,” she said. “We need to proactively help our newer leaders navigate their own thinking and recognize opportunities to grow their mindset and overall knowledge. That’s how you develop leaders who will want to stay and lead radiology into tomorrow.” •
