HealthManagement, Volume 12 - Issue 5, 2012

Getting Ahead by Getting Along

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Managing Challenging Conversations in the Radiology Department

Many guides to effective leadership in radiology and other disciplines in medicine concentrate on structure. How the department should be organised and how authority should be delegated are frequently addressed. Other advice dispensers rightly focus on the formation and implementation of the realisation of your mission. Their purpose is to provide helpful suggestions to formulate goals and objectives that derive the most benefit for the department in general as well as to meet the aspirations of faculty, the education of trainees and the care of patients.


These suggestions and directives are often overarching,elevated at a metaphorical height above daily activities.They are unconcerned with the constant daily hubbub happening on the 'ground'. There the chair will be confronted with a continual stream of conversations, some trivial,others more significant and a few others surprisingly crucial even if they are informal and ad hoc in presentation.


But it is just these colloquies in which your mettle as a leader can and will be tested. How to proceed without deflecting from your aims and how to frame these encounters are just as much a part of the job as the planning for and the effectuating of grand strategic initiatives.

Keeping Control

First, a word of caution. Your effectiveness as chair depends on the maintenance of control. It is established and perpetuated not so much by maintaining an ironclad monopoly on agenda, because in a seemingly casual conversation, the agenda is provided by the supplicant or the critic who beseeches you. But, very soon in any exchange, you must project and protect your ethos or you will lose control and as such your capability to manage the situation will erode.


An example: a faculty member or a resident accosts you with the complaint “I have been placed on duty during the afternoon of the annual picnic held on Monday afternoon.It is unfair!” You could acquiesce and find a weaker person to switch with him. Or you could inform him otherwise, by saying, “It is not unfair - no-one is at fault for your being unable to attend. It is merely unfortunate.“ No redress is required. “Next time someone else will be assigned”.Making clear the unfair-unfortunate dichotomy provides you with a position on the high road. The complainer is then seen as selfish not only by you but also by him. Next time he will take into account that distinctive disjunction before challenging you because his complaint no longer has moral heft.

Coping with Exaggeration

Another problem to parry is the use of hyperbole as a persuasive device. You are told, “The situation I have been placed in is a ‘disaster’. If you allow that word to define the discussion, you will be manipulated by the exaggeration. It is then incumbent on you to restore the advantage by saying, “Wait a minute, that is not a disaster. Chernobyl and the Northern Japan tsunami and flood were each disasters. Rather, you are telling me about a difficulty not a cataclysm. Let’s try to resolve or ameliorate it by placing it in the proper context.” It is often amazing how the tenor of the conversation can become less strident when you have set the appropriate terms.


In that regard, one of the underemphasised but requisite capabilities that make a leader successful is his or her skill in metaphor management. In the first presidential campaign of George Bush, the Republican Party framed the economic debate in terms of ‘tax relief ’. As Steven Pinker in The Stuff of Thought has pointed out, the tax then was portrayed as a disease, the relief the cure. The Democrats only responded within the context of Bush’s metaphor and thus could not convince the electorate that the purpose of taxes is not always punitive but rather a necessary way to supply services, more often a boon than a bane.

Receiving Suggestions

As a leader, you must listen not only to complaints but also, at times, to suggestions to improve things. Typically, they are presented as putatively well-reasoned, seemingly reasonable offerings to make things better. Often they are stated as conferring no special advantage to the author of the remarks, even though you know that most of the time hidden somewhere in the proposal, the promoter of the supposed opportunity is not entirely altruistic.


Many of these suggestions are hare-brained or at least unrealistic while a few are truly beneficial if implemented. You know too that very often the unintended consequences will be more profound than the of the stated objective. Yet those insidious and frequently counterproductive happenstances will not immediately disclose themselves. What to do?


Should you summarily dismiss the idea and then have to deal with the hurt feelings of the idea’s promoter? Should you uncritically accept it, swayed by the power and earnestness of the suggestion or the enthusiasm of the staff member who articulated it? Or should you ponder it for a while?


After that, when you have allowed yourself to think it through somewhat you might follow this protocol of engagement by channelling the dialogue according to a programmatic schedule of tenses.


First, ask him (or her) to recast the idea not in declarative terms, but rather in the subjunctive, “if this, then that”, instead of permitting him to declare it without qualification forcing you to accept it or reject it without qualification.With a subjunctively offered proposal, you can perceive and discuss apparent consequences hypothetically.


And those consequences are more likely to emerge when it is no longer a take it or leave it proposition. If the ill effects of the idea become prominent at this stage it is likely that the proposer will go away disappointed, but he will not go away mad.


If on the other hand there seems to be merit in the notion, continue the analysis by now invoking the conditional tense allowing for further consideration without necessarily giving your assent. The dialogue may then be “if this would occur, then that would happen, would it not?” At this stage you can still reject it without fomenting ill feelings.And if you then decide to proceed further, move to a  formulation, such as, “Let us now do the following to test it out.” No decision is rendered even at this stage. However, along the way you have respected the enthusiasm of the proposer but you have not yet agreed to embrace the proposal. And by the concern and consideration you have shown you have established a congenial relationship you can then build upon to heighten the esteem by which you wish and need to be held.


Learning to manage the conversation then is not merely an option. For your success it is an obligation and a skill you can acquire by thinking tactically, listening and speaking tactfully and deciding cautiously.

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Managing Challenging Conversations in the Radiology Department Many guides to effective leadership in radiology and other disciplines in medicine concen...

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