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    Tiffinee Swanson
    Tiffinee Swanson, MHA, ACC, CNMT, RT(R)
    Ronald Menaker
    Ronald Menaker, EdD, MBA, FACMPE
    Jeffrey R. Leland
    Jeffrey R. Leland, MA
    Kathryn E. Naumann
    Kathryn E. Naumann, MS, FACMPE
    Nicole L. Fischer
    Nicole L. Fischer, MS

    By Tiffinee N. Swanson, MHA, staff development coordinator – radiology education, Mayo Clinic; Ronald Menaker, EdD, MBA, CPA, FACMPE, MGMA member, operations administrator, Mayo Clinic; Jeffrey R. Leland, MA, manager – radiology value creation and project management, Mayo Clinic; Kathryn E. Naumann, MS, operations manager, Mayo Clinic; and Nicole L. Fischer, MS, program manager – radiology education and staff development, Mayo Clinic, Rochester, Minn.



    The American healthcare system faces substantial challenges such as lower reimbursements, staff shortages, technology changes, information security, staff burnout, regulatory burdens, legislative uncertainty and the rapid application of artificial intelligence. These complexities require leaders who possess capabilities and strategies to successfully carry organizations through these challenging times.1 To ensure effective leadership capabilities, healthcare organizations need to think futuristically about the process in which they develop their leaders.

    Mayo Clinic’s very large radiology department has experienced these challenges and recognized the need to strategically invest in talent so that processes can be optimized to deliver the highest-value care and mission-advancing financial performance.2 Mayo Clinic strives to live by its mission and values, which is exemplified in the institutional leadership model. This model provides a culture that encourages development of leaders who exhibit four leadership capabilities: inspiring values, engaging colleagues, bold and forward thinking, and driving results.3 To align with this model, Radiology felt a strong need to develop an application-based program for emerging and current allied health leaders, which would develop the capabilities necessary to lead a large academic medical practice. Central to this model, our institution recognizes that success is driven by the continued interest of every staff member in the professional progress of every other member.4

    The Radiology leadership team created a new leadership development program called LeaDeR based on the result of a leadership needs assessment that showed the existing program did not accomplish all objectives. This new approach aligns with leadership capabilities for the institution and ensures opportunities to apply these capabilities. This competency-based program is individualized for each learner considering his or her developmental needs of leading self, opportunity, people and strategy. It also includes a measurement instrument to assess the results of the program.

    Needs assessment for program change

    The initial career development program in Radiology consisted of five core components:

    1. Foundations of radiology management: presentations on management topics in a face-to-face lecture format over three consecutive years
    2. Opportunities: an experiential learning assignment to focus on growth of leadership tasks
    3. Mentorship
    4. Job shadowing
    5. Rotational lead: a two- to three-year advanced assignment focused on growth and development of leadership skills.


    A needs assessment to understand the extent to which the original career development offerings were meeting the needs of allied health staff was conducted via a survey and focus groups. The survey (n = 387) identified that 66% of those surveyed expressed interest in developing their leadership competencies. However, the survey revealed a disconnect between the components perceived as most beneficial in comparison to those most frequently utilized. 

    Focus groups were conducted with volunteers (n = 65) from the aforementioned survey cohort to further identify what promoted success or created barriers for career development of allied health staff. Common themes emerged, including the desirable characteristics of effective leaders, the need for networking and mentorship experiences, and growth opportunities outside their current role. Barriers to professional development included a lack of awareness of leadership opportunities and roles, and difficulty getting time away from primary work duties.

    A backward design educational model was utilized to redesign the program. This approach began with identification of desired outcomes, followed by development of assessments as measurable evidence of learning. Finally, learning experiences were designed to support the intended outcomes.5

    Identifying desired behaviors

    To identify desired behaviors, a core team of operations managers and education leaders gathered to review data from the needs assessment. The core team also aligned the department’s five-year strategic and operational plan to characteristics needed for future leaders, recognizing the need to adapt to a continuously changing leadership landscape. As a result, 10 leadership competencies were identified as necessary for future department leaders (Figure 1). In addition, the core team recognized that developing these competencies would require infinite learning, or a propensity for learning driven by a continuous need to acquire new skills.6 Thus, four leadership domains were developed to represent a continuum of learning for leaders using a multi-level approach, consistent with shared leadership theory.7 The domains of leadership include: self, opportunity, people and strategic, representing a successive approach to developing leadership capacity.

    The LeaDeR leadership development program

    The LeaDeR program that was developed following the needs assessment follows through the four leadership domains:

    • Self-leadership focuses on building individual leadership capacity, as leaders must take responsibility to develop their skills and behaviors before they can lead others.8
    • Once an individual demonstrates competence in self-leadership, additional opportunities are offered to further develop leadership capacity through projects, stretch assignments or other opportunity leadership. These experiences support the transfer of learning into practice to increase effectiveness.9
    • People leadership focuses on building the interpersonal skills necessary for leading people and teams.
    • Finally, at the top of the continuum is strategic leadership, in which leaders focus on building a vision and influence needed for success.


    Objectives were created within each domain to characterize the behaviors needed that demonstrate competence for each of the 10 leadership competencies. These behaviors include actions supported in literature such as network development, social and interpersonal relations and organizational understanding.10,11 These leadership behaviors influence the tool utilized to assess the current leadership capacity for each participant in the LeaDeR program.

    Assessment methods

    An initial assessment of an individual’s current leadership capabilities is completed by both the participant and supervisor. This 360-degree assessment, which specifically aligns with the desired behaviors within each leadership domain, is utilized to identify both strengths and opportunities for further development. A discussion between the participant, supervisor and a member of the education team is conducted to reconcile discrepancies in the assessment data. With this feedback, individualized leadership development plans are established to recommend a learning path within the LeaDeR program.

    Program offerings    

    A curriculum has been established to target and support the desired behaviors for each leadership domain (Figure 2) and also address deficiencies identified from the needs assessment. Leadership offerings available within the institution were inventoried to determine existing resources that could meet the learning objectives and identify gaps where new coursework was necessary. To increase the likelihood participants would transfer learning into practice, the program emphasized experiential learning versus traditional face-to-face lecture. In addition, it was determined that participants needed to gain fundamental knowledge regarding leadership principles prior to effectively engaging in their application experiences. Thus, the curriculum includes both a knowledge component and application of knowledge.

    The knowledge component occurs via several means to target all types of learning preferences. In some instances, this reduces the time needed for individuals to be away from primary work duties, as many opportunities are available on demand. Information is provided via online modules, reading an article or book, watching a video and face-to-face lecture format.

    Application of knowledge includes both self-directed and facilitated methods. For facilitated sessions, participants are brought together to actively participate in activities such as workshops, journal and book club discussions, and other behavior-based application sessions. For self-directed learning, experiential learning activities such as delivering a presentation, facilitating a meeting, championing a quality improvement project or external benchmarking are recommended.

    To assist with the application and transfer of knowledge, current departmental leaders are encouraged to submit experiential learning opportunities for participants. Individuals are recommended to participate in opportunities that align with their individual gaps in leadership development. Recognizing that many of the application components require partnership with a mentor or supervisor to complete, a formal mentor program has been initiated. Existing department leaders are paired with LeaDeR participants based on their career goals and characteristics to promote a successful mentoring relationship. LeaDeR participants are expected to drive the mentoring relationship and their professional development. 

    This participant-driven development approach has been implemented to ensure the experience is adaptable and tailored to individual needs and commitment, as employees engaged in self-directed development are expected to be more productive and effective.12 As participants achieve the outcomes of their current leadership development plan, participants are reassessed via the baseline leadership competency assessment. This reassessment demonstrates growth in the desired leader behaviors from the current domain and identifies opportunities in next-level domains.

    Evaluation methods

    The LeaDeR program content and approach are routinely evaluated for effectiveness using the Kirkpatrick model of evaluation. Knowles, et al., describe the use of a Level 1 evaluation to garner participants’ reaction to a learning experience either immediately or soon after the learning experience.13 LeaDeR program participants are surveyed to seek their feedback and level of satisfaction with the relevance of the course content, preparatory materials and effectiveness of the instructor for each learning experience. Additional survey questions seek feedback on the helpfulness of group activities used during the course to increase their ability to apply the tools and concepts to their job. Open-ended questions in the survey instrument seek feedback and suggestions for any improvements to the learning experience. Results are tabulated by the software tool and the summary report is sent to the respective presenter(s)/facilitator(s) of the learning experience.

    Further LeaDeR program content evaluation is conducted by distributing a second evaluation to LeaDeR participants approximately 90 days after the learning experience. According to Knowles, et al., Level 2 and Level 3 evaluations are conducted to evaluate learning and behavior changes among those who participated in the learning experience.14 Kirkpatrick’s Level 2 evaluation seeks to understand the degree to which participants acquired the intended knowledge, skills, attitude, confidence and commitment based on their participation in the training. The Level 3 evaluation, in contrast, assesses the degree to which participants apply what they learned during training when they are back on the job.15 Survey questions are specifically designed to elicit participant feedback as to the application of behaviors, presented during the learning experience, to their current job role and the consistency with which they have applied them. Level 3 evaluations are also encouraged through participant-driven self-reflection, using an electronic journal and dialogue with their mentor or supervisor. Reflection questions are provided to participants to facilitate this individual evaluation component. Results from the Level 1, 2 and 3 evaluations are reviewed by the program directors and faculty members for improvement.  

    LeaDeR program initial results

    The progress of the LeaDeR program is encouraging. Physician and administrative leaders at Mayo Clinic and within Radiology are supportive. There is active engagement by enrollees in the program representing all modalities across the department. Initial assessments of the curriculum have been very high as measured by satisfaction with each component of the curriculum. 

    Staff satisfaction measurements have been in place for an extended period of time with specific questions regarding career development conversations, development of talents and behaviors, and continuous learning that will provide baseline and ongoing metrics on allied health perceptions of leadership development. Human Resources is an active partner incorporating LeaDeR program components in succession planning discussions. A continued measure of success will be the opportunity to fill positions within Radiology with a robust pool of ready-now, emerging and future watch leaders. In 1931, a founder of Mayo Clinic stated, “If we excel in anything, it is in our capacity for translating idealism into action.”16 The LeaDeR program is an essential strategy as part of the leadership developments efforts within Radiology.

    Conclusion

    Through the development of the LeaDeR program and the four leadership domains of self, opportunity, people and strategic, Radiology is now in a better position to support, nurture and encourage internal growth within the department utilizing a systematic and structured approach to secure Mayo Clinic’s future through excellence in leadership.

    Acknowledgements

    The authors wish to acknowledge Sonia Watson, PhD, for her assistance in editing the manuscript; Kevin Seisler and Kim Chandler for their early work in helping to develop the program; and our department leaders who have provided knowledge and support throughout this endeavor.

    Notes:

    1. Menaker R. “Leadership Strategies: Achieving Personal and Professional Success.” J Med Pract Manage. 2016;31(6):336-339.
    2. Kaplan RS, Norton DP. The strategy-focused organization: How balanced scorecard companies thrive in the new business environment. Boston: Harvard Business School Press; 2001. 
    3. Swensen S, Gorringe G, Caviness J, Peters D. “Leadership by design: intentional organization development of physician leaders.” J Manag Dev. 2016;35(4):549-570. doi: 10.1108/Jmd-08-2014-0080.
    4. Mayo WJ. Remarks at faculty meeting regarding reorganization of Board of Governors. Rochester, Minn.: Mayo Clinic Historical Unit, 1932.
    5. Wiggins GP, McTighe J. Understanding by design. Expanded, 2nd ed. Alexandria, VA: Association for Supervision and Curriculum Development, 2005.
    6. Hoffman R, Yeh C, Casnocha B. “Learn from People, Not Classes.” Harvard Business Review. 2019;97(2):50-51.
    7. Pearce CL. “The future of leadership development: The importance of identity, multi-level approaches, self-leadership, physical fitness, shared leadership, networking, creativity, emotions, spirituality and on-boarding processes.” Human Resource Management Review. 2007;17(4):355-359. doi: 10.1016/j.hrmr.2007.08.006.
    8. Boyce LA, Zaccaro, S.J., Wisecarver, Michelle Zazanis. “Propensity for self-development of leadership attributes: Understanding, predicting, and supporting performance of leader self-development.” Leadersh Q. 2010;21(1):159-178. doi: 10.1016/j.leaqua.2009.10.012.
    9. Ibid.
    10. Pearce.
    11. Garman AN, Standish MP, Wainio JA. “Bridging worldviews: Toward a common model of leadership across the health professions.” Health Care Manage Rev. 2019. doi: 10.1097/HMR.0000000000000243.
    12. Boyce.
    13. Knowles MS, Holton EF, Swanson RA. The adult learner: The definitive classic in adult education and human resource development, 8th ed. London; New York: Routledge, 2015, 387.
    14. Ibid.
    15. Kirkpatrick J, Kirkpatrick W. An Introduction to the New World Kirkpatrick® Model; Kirkpatrick Partners, LLC; 2019 [Accessed June 3, 2019]. Available from: bit.ly/2P2wPLk.
    16. Mayo CH. “International Medical Progress.” Collected Papers in Mayo Clinic & Mayo Foundation. 1931;23:1020-1024.

    Tiffinee Swanson

    Written By

    Tiffinee Swanson, MHA, ACC, CNMT, RT(R)

    Tiffinee Swanson MHA, ACC, CNMT, RT(R), Workforce Learning Advisor, Human Resources, Mayo Clinic, Rochester, Minn., can be reached at swanson.tiffinee@mayo.edu.

    Ronald Menaker

    Written By

    Ronald Menaker, EdD, MBA, FACMPE

    Ronald Menaker can be reached at menaker.ronald@mayo.edu.

    Jeffrey R. Leland

    Written By

    Jeffrey R. Leland, MA

    Jeffrey R. Leland, MA, is a former operations manager, Mayo Clinic, Rochester, Minn.

    Nicole L. Fischer

    Written By

    Nicole L. Fischer, MS

    Nicole L. Fischer, MS, program manager – radiology education and staff development, Mayo Clinic, Rochester, Minn.


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