ORIGINAL ARTICLE

Ineffective Leadership
Jason N. Itri, MD, PhD a , Leslie M. Lawson, MHA a

Abstract
Radiology leaders can have a profound impact on the success and working environment of a radiology department, promoting core
values and inspiring staff members to achieve the organization’s mission. On the other hand, ineffective leaders can have a devastating
effect on a radiology department by impairing communication among members, undermining staff commitment to the organization’s
success, and stifling the development of other staff members and leaders in the organization. One of the most important investments a
radiology department can make is in identifying, cultivating, and promoting new leaders. The authors describe 13 habits and char-
acteristics of new leaders that lead these individuals to address situations in both ineffective and counterproductive ways, impeding the
performance of a radiology department and its capacity to play a meaningful role in shaping the future of radiology. New leaders must
continually learn and improve their leadership skills if they are to avoid the destructive habits of ineffective leaders and successfully
overcome the challenges facing radiology today. Senior leaders may also benefit from understanding the pitfalls that make leaders
ineffective and should strive to continually improve their leadership skills given the critical role of leadership in the success of radiology
departments.
Key Words: Leadership, management, communication, teamwork
J Am Coll Radiol 2016;-:---. Copyright
2016 American College of Radiology

INTRODUCTION and organizational failure. This article describes 13

The quality of a leader can have a substantial impact on
the performance of a radiology department. An effective
leader is able to attract and retain top talent, create an
environment in which staff members are engaged and
proud of their work, and successfully navigate challenges
to move the organization forward [1]. On the other hand,
ineffective leaders can have a devastating effect on a
radiology department by impairing communication
among members, undermining staff members’
commitment to the organization’s success, and stifling
the development of other staff members and leaders in
the organization [2]. One of the most important
investments a radiology department can make is in
identifying, cultivating, and promoting its leaders, yet
new leaders are often promoted without adequate
training or experience, creating situations in which
previously high-achieving individuals struggle to identify
and correct destructive habits that can result in personal
a
University of Cincinnati, UC Health, Cincinnati, Ohio.
Corresponding author and reprints: Jason N. Itri, MD, PhD, University of
Cincinnati, UC Health, 234 Goodman Street, ML 0761, Cincinnati, OH
45267-0761; e-mail: jason.itri@uchealth.com.
The authors have no conflicts of interest related to the material discussed in
this article.
habits and characteristics of new leaders that lead these
individuals to address situations in both ineffective and
counterproductive ways, impeding the performance of a
radiology department and its capacity to play a mean-
ingful role in shaping the future of radiology [2]. It is our
hope that all leaders may benefit from the following
discussion about leadership pitfalls.
INADEQUATE TRAINING
Leadership development programs for physicians typically
aim to strengthen physicians’ leadership competencies,
improve organizational performance, and promote
key functions such as organizational change, quality
improvement, and interdisciplinary collaboration [3-5]. A
systematic review of leadership development programs for
physicians found that these programs are associated with
increased self-awareness and leadership expertise,
although there are few studies that examine the impact of
these programs on important health and system-level
outcomes [3]. In the academic medical center
environment, physician leadership training programs
have had a modest impact on outcomes important to
academic medical centers [6]. A meta-analysis of studies
on the effectiveness of leadership training in various fields

ª 2016 American College of Radiology

1546-1440/16/$36.00 n http://dx.doi.org/10.1016/j.jacr.2016.02.008 1
such as education, government, business, and the military
found that whereas some development programs were
tremendously effective, others failed miserably [4].
Important gaps remain regarding the impact and
effectiveness of physician leadership development
programs, though it is generally believed that formal
management and leadership training is beneficial,
particularly for new leaders.
According to Gunderman [7], one of the primary
reasons radiology leaders fail is a lack of training in
management and leadership. Excellence in clinical
work, teaching, or research does not make a radiologist
an effective leader [8]. Despite this fact, many newly
promoted leaders ascend to their positions through
strong academic credentials and high personal
achievement—activities that do not require the
development of key leadership competencies such as
communication, organizational thinking, team building,
and nurturing the development of others [7,8].
Sometimes the need for such people for personal
achievement may override their commitment to the
best interests of the organization [9]. Despite the recent
development of leadership training programs for
radiologists, most radiologists receive little or no formal
leadership training, and it is inevitable that future
leaders are drawn from the ranks of the less qualified
[1]. New leaders may recognize the need to cultivate
their leadership competencies only after they assume
leadership positions, when it may be too late [7]. It is
important to invest in the development of future
leaders before they assume key positions and support
continued development through formal training and
service opportunities [7,10,11].
FAILURE TO COMMUNICATE
Effective communication is a critical skill for leaders in
any organization, and sharing knowledge plays an
important role [8]. First and foremost, it shows that a
leader is open and transparent; this encourages other
members of the organization to share information with
leaders. Bidirectional information sharing is essential for
leaders to benefit from the insights and experience of
staff members on the frontline. Second, it allows
members throughout the organization to collaborate
and respond to challenges more effectively. New leaders
may choose to actively withhold information, although
more often they fail to communicate unintentionally
because they are too busy, forget, or delegate the
task to staff members without showing them how the
2 Journal of the American College of Radiology
information should be communicated [12]. Regardless
of the cause, over time, failure to communicate is
interpreted as actively withholding information, which
breeds mistrust and conflict. New leaders must
recognize the importance of communication and
make information sharing a high priority, working
continuously to keep staff members up to date on
important issues facing the department and providing
opportunities for staff members to share ideas and
perspectives [8,13]. Leaders should also work to create
and maintain an environment in which staff members
feel comfortable expressing their opinions without fear
of recourse or retribution.
INABILITY TO DELEGATE IMPORTANT TASKS
Another important skill for a new leader is the ability to
successfully, and frequently, delegate. This skill is essen-
tial to decrease the workload of the leader and develop
the skills of those working under the leader. When direct
reports become responsible for delegated tasks, they
develop the critical-thinking and problem-solving skills
necessary to accomplish that task, teamwork skills
necessary to identify collaborative solutions, and auton-
omy that promotes ownership of the problem and
motivation to succeed. Development of junior leaders is a
key component of succession planning (more on that
later). Although nearly all leaders agree that delegation is
one of the most important skills they can master, at least
half believe they have opportunities to improve in this
area, and another half of those do not seek any kind of
formal training on how to successfully delegate [14].
There are six tips new leaders can use to improve their
ability to delegate important tasks:
1. Watch for warning signs that you are not delegating an
appropriate amount of your workload. If you are
overwhelmed with your responsibilities, working very
long hours, or feel like you are the only person on the
team that is vested in the task, you are probably not
delegating enough.
2. Hire people to whom you are comfortable delegating
high-level tasks. Trusting that your employees will
successfully complete an important task independently
is a powerful motivator and relationship builder.
3. Recognize your own reasons for not delegating as a
first step toward moving past those reasons. Some
people do not delegate because they are perfectionists.
Others do not delegate because they are concerned
about being less indispensable or important to their
organizations.
Volume - n Number - n Month 2016
4. Use delegation as a way to enhance your employees’
skills and leadership abilities.
5. Ask others to hold you accountable for delegating.
Encourage your direct reports to call you out when
you do not delegate a task that should be delegated.
6. Once you delegate a task, let it go. Do not dictate
how your direct reports should accomplish tasks
(ie, micromanage). Explain the desired outcome, not
the steps you would take to get there [15].
Lack of Organizational Thinking
Ideally, all members of an organization should understand
the roles they play in pursuing the organization’s mission
[8]. An experienced leader determines the organizational
structure and assigns roles to staff members in the
department to carry out the organization’s strategies
and solve problems. New leaders may mistakenly assume
the leader-as-commander role, believing that they know
what needs to be done and how to do it because this is
their area of expertise and how they became leaders.
When the desired outcomes are not achieved, the new
leader mistakenly believes, “If I want something done
right, I have to do it myself!” There are several major
problems with this leader-as-commander model: radiology
departments are simply too complex for one individual
to understand in depth, particularly at an academic
department with multiple competing missions [16]; an
organization cannot function properly without
hierarchies of responsibility and authority [2]; and this
model deprives other leaders and staff members in the
department of opportunities to own the work,
experience their personal contributions making a
difference in the outcome, and feel trusted and respected
[9,15,17]. New leaders in a radiology department can
significantly increase their effectiveness by establishing
the organizational structure with clearly defined roles
and responsibilities for each staff member [7,18].
four quadrants for effective prioritization (Table 1) [19].
Important tasks often help leaders achieve organizational
goals, whereas urgent tasks often result in the leader
helping someone else achieve their goals. New leaders
have a natural tendency to focus on unimportant but
urgent tasks, better known as “firefighting.”
n Important and urgent tasks: These are sometimes
avoidable and may be related to procrastination. For
optimal time management, eliminate as many of these
tasks as possible, and keep tasks out of this quadrant.
n Important and not urgent tasks: This is the most
important quadrant and where leaders should spend
the most time to achieve personal and organizational
goals. Leaders should allocate enough time in their
daily schedules to work on these so that they do not
shift to the urgent quadrant.
n Not important and urgent tasks: These items should
be delegated whenever possible. If one person tends to
be a source of a large number of these tasks, arrange
regular meetings with that person to address everything
at once.
n Not important and not urgent tasks: These are dis-
tractions and should be avoided whenever possible.
These often lead to high levels of stress and only add to
poor time management. It should be noted that
“pleasant activities” in this context does not include
activities that can be helpful in building teams and
solidarity within a group.
Radiologists who assume leadership roles often have
other demands on their time, such as service in local,
Table 1. Time management matrix developed by Dwight
D. Eisenhower in the 1950s
Urgent Not Urgent
Important Quadrant I Quadrant II
n Crises n Relationship
n Pressing problems building
n Deadline-driven projects n Finding new

n Tasks from quadrant opportunities

POOR TIME MANAGEMENT
II that were postponed n Strategic
Efficient time management skills are essential for leaders planning
who must manage competing priorities, constant meetings, n Personal growth

and unexpected emergencies, often without sufficient time n Recreation

to accomplish everything they need to do. Poor time man- Not Quadrant III Quadrant IV
agement can cripple new leaders, leading to bad decisions, Important n Interruptions n Trivial busywork

n E-mail, phone calls n Time wasters

poor performance, and burnout. Prioritization and creating
n Some meetings n Some calls and
attainable “to-do” lists are two actionable steps a leader can
n Popular activities e-mail
take to manage an ever growing list of responsibilities.
n Pleasant
President Dwight D. Eisenhower’s time management ma- activities
trix is a valuable tool that can be used to categorize tasks into

Journal of the American College of Radiology 3

Itri, Lawson n Ineffective Leadership
state, and national organizations; practicing clinical radi-
ology; teaching; and research activities. These other in-
terests can divert time and energy away from leading
the organization and become overwhelming for new
leaders if not managed [7]. Radiology leaders should ask
themselves whether they are leading effectively within
their own departments before taking on additional
extradepartmental activities and responsibilities.
FAILING TO GIVE RECOGNITION OR EXPRESS
GRATITUDE
Receiving recognition for contributions and efforts has
been identified as an activity that correlates positively
with staff retention and productivity [15]. Conversely,
withholding recognition of others’ contributions not
only treats them unfairly, it deprives them of the
emotional payoff that comes with success, which can be
a powerful motivator [12]. Failure to give recognition
is a common problem for new leaders because often
they become great achievers by intensely focusing on
themselves, with a high degree of self-motivation. High
achievers become effective leaders when they learn to
shift the focus from themselves to others by regularly
showing appreciation for the contributions of staff
members in their organization. Providing recognition is
one of the easier habits to improve; one approach is to
make a list of all the important people you interact with,
review the list of names at least once a week, and ask
the question “Did someone on this page do something
that I should recognize?” If the answer is yes, provide
recognition. Leaders are role models who set the tone for
respect and recognition that extends throughout their
organizations [20].
PASSING JUDGMENT
This pervasive habit often plagues inexperienced but
energetic new leaders, as these individuals can be eager to
show others what they can do and that they are well
suited for the leadership position. Passing judgment refers
to encountering a problem and quickly choosing a solu-
tion without fully investigating the problem to under-
stand all perspectives and contributing factors. For
example, a staff member or colleague will complain about
a workflow problem, and the new leader will decide on an
appropriate course of action without discussing the issue
with other staff members involved or trying to obtain
data to evaluate the problem objectively. This habit can
be particularly destructive when it comes to mediating
interpersonal conflicts. Issues and complaints brought
4 Journal of the American College of Radiology
forward by staff members are described and interpreted
through the lens of those individuals and often do not
include all relevant factors needed to make good de-
cisions. In their haste to resolve issues that are deceptively
simple, new leaders will jump to conclusions on the basis
of assumptions about cause and effect and promptly
decide on a course of action, only to realize that their
assumptions were incorrect. Experience shows that when
individuals bring problems to leaders, the initial discus-
sion reflects only one perspective; deeper discussion and
investigation is required for good decision making.
ADDING TOO MUCH VALUE
It is difficult for high achievers to listen to other people
tell them something without communicating that they
already know it or that they know a better way, a
destructive habit called adding too much value [12].
Many new leaders do not feel as though they are valued
members of meetings or conversations unless they add
value, which is not only frustrating for the people
communicating information but can also decrease their
enthusiasm for working on projects or implementing
ideas because the leader adding value has now taken
ownership. There are many times when a good idea
could be made slightly better with a leader’s input;
however, the consequences may be that the person who
came up with the idea will no longer feel vested or
motivated to carry it out [12]. To overcome the desire
to add too much value, new leaders can pause and ask
themselves, “Is this something I really need to say?”
Another approach is to ask questions to get more clarity
around the current idea and acknowledge that there are
often several ways to accomplish tasks. Once leaders
assume their positions within organizations, one of their
primary goals is to help build up the skills and abilities
of the people around them by allowing them to take
ownership of ideas and work.
REFUSING TO ADMIT PERSONAL FAILURE
A ship is safe in harbor, but that’s not what ships
are for.
—William G. T. Shedd
If a leader only makes safe moves that are carefully
planned and articulated, that are sure to avoid rocking the
boat, then that leader might not ever have to admit to
failure. However, that leader also may not be able to
address challenges in the most effective manner, boldly
invest in technology and research, or make innovative
Volume - n Number - n Month 2016
business decisions. More can be learned from a single
failure than multiple successes. Yet the inability of a
leader to admit failure is an ineffective way to lead and
creates a culture of people afraid to fail. When leaders
take risks and something goes wrong, the best response is
to “fail forward,” or learn from what went wrong to make
a better decision next time. A successful leader is not
someone who never fails; successful leaders take risks and
might fail but can articulate why they failed and use that
to better themselves and their departments.
OVERUSE OF THE COMPETING MODE
Leaders often manage conflict, the condition when one
person’s concerns are different or incompatible with
another person’s concerns. The Thomas-Kilmann model
characterizes five conflict-handling modes (Fig. 1) [21]:
n Competing: You try to satisfy your own concerns at
the other person’s expense.
n Collaborating: You try to find a win-win solution that
completely satisfies both people’s concerns.
n Compromising: You try to find an acceptable settle-
ment that only partially satisfies both people’s concerns.
n Avoiding: You sidestep the conflict without trying to
satisfy either person’s concerns.
Fig 1. Two-dimensional model of conflict-handling behavior.
Adapted from “Conflict and Conflict Management” by
Kenneth Thomas in The Handbook of Industrial and Organi-
zational Psychology. Reprinted from the Thomas-Kilmann
Conflict Mode Instrument with permission from the pub-
lisher, CPP, Inc, ª 1974, 2002, 2007. All rights reserved.
Journal of the American College of Radiology
Itri, Lawson n Ineffective Leadership
n Accommodating: You attempt to satisfy the other
person’s concerns at the expense of your own.
Each conflict-handling mode can be highly effective
when used in the correct circumstance by someone
who has the skills to use the mode. However, when the
circumstances are not appropriate or the user does not
have the skills to use the mode, the conflict situation is
not managed effectively. There is one mode in particular
that new leaders have a tendency to overuse without
recognizing the potentially devastating consequences:
competing. Overuse of the competing mode can result in
losers of the conflict (staff members and direct reports)
feeling resentful and exploited, possible win-win solutions
being overlooked, and others being less committed to
decisions that are imposed [21].
New leaders may feel the need to be vocal and decisive
on key issues to prove to themselves and others that they are
competent and worthy of leading. When dealing with
others in positions of power throughout the organization,
new leaders may fear that using the accommodating or
compromising mode means that they can be pressured
or “bullied” into decisions that compromise their depart-
ment or staff. New leadership positions often come with
increased responsibilities that, coupled with underdevel-
oped time management skills, force leaders into making
quick decisions to avoid being overwhelmed. Prior experi-
ences may predispose a new leader to believe that “the only
way to get something done right is to do it myself,”
perpetuating a destructive behavior that limits the man-
agement and leadership capabilities of staff members and
junior leaders. It is also possible that new leaders were
chosen because of their ability and effectiveness using the
competing mode, reinforcing the misguided notion that
this mode is preferred to manage conflict regardless of cir-
cumstances and skill. Ineffective leaders overuse the conflict
mode to try to bend everyone to their own wills; effective
leaders are consensus builders who spend a considerable
amount of time listening to their staff members [7].
INABILITY TO MANAGE DISRUPTIVE STAFF
MEMBERS
Managing disruptive staff members is a difficult skill
regardless of experience and aptitude, making this partic-
ularly challenging for new leaders. There is a unique skill
set required to effectively manage disruptive staff members
that new leaders often do not possess. Many leaders in
radiology hope that rationality and goodwill are all it takes
to lead and subsequently avoid conflict [22]. New leaders
may believe that they need the support of all faculty and
5
staff members in their departments to be successful,
particularly if they are in interim positions. There may be
complicating factors, such as a new leader being junior to
a disruptive staff member, possibly even trained by that
staff member earlier in his or her career. Regardless of the
reasons, when leaders do not manage disruptive staff
members effectively, colleagues and subordinates will
determine that leaders do not deserve their trust and
respect, and the leader’s authority will be lost [20].
Effective leaders must be ready and willing to fire
staff members who will not or cannot be good citizens
[17]. Without accountability, a superior performance
culture cannot be attained, and having to work with a
disruptive staff member can be one of the most potent
demotivating factors in a work environment [15].
LACK OF INSIGHT
A lack of insight can be the most devastating of all the
characteristics described in this article, as it prevents a
new leader from acknowledging and improving destruc-
tive behaviors. They often have no idea how these
behaviors are coming across to the people in their orga-
nization [12]. One warning sign is inflexibility and
inability to change course as a leader asserts his or her
position as an authority. Another sign is insecurity,
which results in a leader’s inability to delegate
important responsibilities, which subsequently prevents
an effective governance structure and impedes the
development of junior leaders [9]. An ominous sign is
an arrogant leader who does not listen to others or
take responsibility for mistakes, damaging morale
throughout the department and driving away some of
its best people. Leaders using their position and prestige
to promote their own success and self-interests is
another indication that there is a lack of insight. Candi-
dates considered for an important leadership position
should demonstrate self-mastery and a commitment to
lifelong learning that includes honest self-reflection,
acknowledging mistakes, accepting responsibility for de-
cisions, identifying opportunities for improvement, and a
commitment to the organization and its mission. Leaders
need to identify and correct bad habits if they are to
perform at their full potential [2].
HELPING NEW LEADERS SUCCEED
The first step toward helping new leaders succeed is to
thoroughly evaluate them before hiring or promoting.
Candidates for important leadership positions should have
some formal leadership and management training, as well as
6 Journal of the American College of Radiology
experience in relevant service-related roles. Organizations
choosing new leaders can assess difficult-to-measure skills
by asking candidates to describe situations in which the
candidates made mistakes, dealt with disruptive staff
members or colleagues, worked on teams, solved difficult
problems, or served as mentors or coaches. In discussing
these situations, candidates can be evaluated for character-
istics of self-mastery, the ability to learn from past setbacks,
communication and interpersonal skills, and the capacity
to work collaboratively to make important decisions [1].
Although there are benefits and risks associated with
both promoting from within and recruiting from outside
an organization, all radiology departments should engage
in succession planning to ensure leadership continuity
and avoid the vacuum left by unexpected leadership
changes. Succession planning can involve various posi-
tions within the organization, such as section chiefs,
modality chiefs, medical directors, residency program
directors, vice chairs, and chairpersons. Recommended
steps include gaining buy-in from the members of the
group or department, distributing leadership tasks to a
select group of individuals with potential, giving people
incremental amounts of responsibility to assess their
abilities, and incorporating mentoring to develop future
leaders [23]. Despite the importance and potential
benefits of succession planning, a survey of practice
leaders in 2010 revealed that fewer than half of the
practices represented had plans for succession [23].
After assuming leadership positions, organizations
should support their new leaders by regularly providing
time, feedback, mentoring, and opportunities for formal
training. Leaders should have protected time to work on
important tasks and responsibilities, meet with staff
members, network with other leaders, meet with mentors
and coaches, and participate in leadership training [10].
Regular feedback from a variety of sources is
particularly important to help new leaders identify and
correct destructive habits, as well as build on strengths.
Mentors can help guide and assist new leaders,
counseling them when necessary and providing critical
feedback on self-mastery skills. Many resources are
available for formal leadership training either synchro-
nously or asynchronously [10,11,24].
CONCLUSIONS
Leaders aren’t born, they are made. And they are made
just like anything else, through hard work.
This quotation, from Hall of Fame football coach
Vince Lombardi, is as relevant to radiology organizations
Volume - n Number - n Month 2016
as it is to professional football teams. It tells us that there
is a set of leadership skills and behaviors that need to be
developed through formal training and experience. We
should not be choosing leaders in radiology simply
because they are outstanding clinicians, educators, or
researchers. Candidates for important leadership positions
should be evaluated before being hired or promoted to
ensure that they possess the necessary leadership skills to
be effective in their new roles. Moreover, leaders should
be supported if they are to be successful in meeting the
challenges and opportunities that lie ahead. Leaders who
are not continually learning and improving their leader-
ship skills will cease to grow and adapt, at the expense of
the entire organization. The future of radiology and the
welfare of the patients it serves hinge on the quality of
the people who lead it [1].
TAKE-HOME POINTS
- An effective leader is able to attract and retain top
talent, create an environment in which staff mem-
bers are engaged and proud of their work, and
successfully navigate challenges to move the orga-
nization forward.
- Ineffective leaders can impair communication
among staff members, undermine their commit-
ment to the organization’s success, and stifle the
development of other staff members and leaders in
the organization.
- Leaders should be thoroughly evaluated for leader-
ship positions before hiring or promoting.
- Radiology departments should engage in succession
planning to ensure leadership continuity and avoid
the vacuum left by unexpected leadership changes.
- After assuming leadership positions, organizations
should support their new leaders by providing
protected time, feedback from multiple sources,
mentoring, and opportunities for additional lead-
ership and management training.
Journal of the American College of Radiology
Itri, Lawson n Ineffective Leadership
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