Author’s Accepted Manuscript image

The Nine Habits of Highly Effective Radiologists

Timothy Alves, Monica Kalume-Brigido, Corrie

Yablon, Puneet Bhargava, David Fessell

www.elsevier.com/locate/bios

PII: S0363-0188(18)30064-1
DOI: https://doi.org/10.1067/j.cpradiol.2018.03.001
Reference: YMDR614
To appear in: Current Problems in Diagnostic Radiology
Cite this article as: Timothy Alves, Monica Kalume-Brigido, Corrie Yablon,
Puneet Bhargava and David Fessell, The Nine Habits of Highly Effective
R a d i o l o g i s t s , Current Problems in Diagnostic
Radiology,doi:10.1067/j.cpradiol.2018.03.001
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Title: The Nine Habits of Highly Effective Radiologists

Authors: Timothy Alves MD1, Monica Kalume-Brigido MD1, Corrie Yablon MD1, Puneet Bhargava

MD2, David Fessell MD1

Author affiliations:

1- University of Michigan

2- University of Washington

Corresponding Author:

Timothy Alves MD

talves@med.umich.edu

1500 E Medical Center Drive, TC B1 140A

Ann Arbor, MI 48109

Acknowledgements: None.

Disclosures: None.
Abstract:

Stephen R. Covey’s landmark work in the field of effectiveness and professional

development delineated first seven, then ultimately eight, habits of highly effective people with

applicability to all professions.1 This article describes the eight habits in specific relation to the

radiologist, and proposes a ninth habit to help one bring a positive and centered approach

during the journey to effectiveness and beyond.

Introduction:

Effectiveness is the degree to which something, or someone, is capable of producing a

desired result. In radiology, our desired result is of our choosing and includes goals such as

providing excellent clinical care, having a successful practice, teaching effectively, advancing

scientific knowledge, and finding meaning in one’s work.

Covey’s first three habits are designed for the individual to achieve independence in

one’s quest for effectiveness. Covey’s habits four through six focus on cultivating beneficial

interdependence. Covey’s seventh habit is about continual improvement and the eighth habit is

to make the leap from effectiveness to greatness. We propose a ninth habit, ‘Cultivate

gratitude and mindfulness,’ which supports the eight habits by helping one bring a positive and

centered approach during the journey to effectiveness and beyond.

Below, we tackle the habits one by one, with special emphasis on how they relate to the

life of a radiologist.
Habit 1 - Be proactive:

Often we are in a reactive state, bouncing from urgent task to urgent task. Habit 1

encourages us to be proactive – to anticipate and solve problems before they arise, to act with

conscious intention rather than to react. As the first habit, the idea of acting with purpose,

rather than taking a defensive reactionary stance, sets the tone for the approach to the

remainder of the habits and how they can be implemented into one’s professional and personal

life.

For example, one can plan ahead and create a daily and weekly schedule to help

maximize effectiveness. One can anticipate issues with tomorrow’s procedural cases by

previewing them the day before. When writing a manuscript or grant, one can anticipate

reviewers’ concerns and address them up front. When making management or leadership

decisions, one can anticipate possible opposition and discuss plans with the potential

stakeholders to gain their input and buy-in.

Imagine a scenario in which a procedural ‘near-miss’ almost harms a patient and one

believes there are system factors at fault. Applying habit 1, one could proactively address the

situation by warning others in the group about the potential hazard and designing a quality

improvement project to investigate and address the issue. In radiology we rely on many

systems to keep our patients safe. A pro-active review of such systems, such as radiation dose

monitoring during CT procedures, benefits not only patients but our respective institutions and

our field as a whole.

Habit 2- Begin with the end in mind:

Habit 2 is about setting goals, both big and small. It can be helpful to divide goals into

different facets of one’s life (professional, personal, physical, financial, etc.) and create short,

medium, and long-term goals. iSMART (important, Specific, Measurable, Actionable, Realistic,

Time limited) goals can aid effectiveness and ideally focus on important topics, rather than goal

setting around trivial topics to give the illusion of progress.2 Writing these goals down and

having a system to periodically track & review them and celebrate successes can aid success.

Keeping such goals in a visible place can serve as a constant reminder of what one hopes to

accomplish, and why.

For example, a radiologist’s goal may be to learn more about certain subject matter

through CME courses, or to roll out a new service line such as 3D printing. Such goals serve not

only the individual but also his or her practice group, institution, and of course patients and

their families. Similarly, one can obtain a certificate in leadership through the RLI or AAPL or in

the business aspects of radiology such as finance. By having specific learning and networking

goals in mind, one can also maximize the value of attending national meetings.

A young radiologist in their first job, no matter the setting, will often be overwhelmed

by the myriad possibilities for their career. Applying habit 2 and setting appropriate goals can

help the junior radiologist make decisions about how they spend their non-clinical time, be it

learning the business of radiology to become a practice leader, developing a research niche,

developing a novel area of clinical expertise, or improving their skills as an educator.

Habit 3 - Put first things first:

Are “first things” the most urgent or the most important? Who decides? Covey proposes

a 2 x 2 table of prioritization, distinguishing tasks based on ‘important vs. unimportant’ and

‘urgent vs non-urgent’ (Figure 1). It is easy for much of our time to be wasted on tasks which

are urgent but unimportant – many emails, phone calls, and other interruptions. Urgent and

important tasks often need to come first, but it is most effective to spend the bulk of our time

on important but non-urgent tasks (quadrant II).

Where one spends one’s energy and time should align with the goals set with habit 2.

Which tasks in a practice could one delegate to support staff in order to increase efficiency and

maximize the time and energy expended? This is important for all radiologists, who may have

different roles (clinical, administrative, educational, etc.) and multiple demands on their time.

Applying habit 3, one could categorize their to-do list based on the four quadrants, focus on

quadrants 1 and 2, and delegate quadrants 3 and 4.

Habit 4 - Think Win/Win:

The first habit for cultivating interdependence reminds us that life is not a zero-sum

game. It is possible, and preferable, that both parties see the outcome of an interaction or a

solution to a problem as a win. In order to ‘think win/win,’ one must be able to put one’s self

into other people’s shoes and learn what winning means to them. This ties in to habit 5,

described below. Adopting a win/win attitude can be particularly helpful in quality

improvement projects when trying to get ‘buy-in’ from multiple groups of stakeholders or when

proposing a change in the call or rotation schedule with colleagues. The goal in working with
others should be to find mutually beneficial solutions that ultimately advance patient care.

Adopting a win/win mindset will lead to better outcomes for all parties involved, and also make

the process of finding solutions easier for all involved.

Habit 5- Seek first to understand, then to be understood:

Habit 5 is a fundamental rule of communication that prioritizes understanding others’

viewpoints as a requisite for creating mutually beneficial relationships. This can be useful in

discussions with clinical colleagues, support staff, and with our patients. Seeking to understand

the other first, and checking in with them to be sure we have it right (reflective listening), can

go a long way toward increasing mutual understanding and mutually beneficial relationships.

This principle is important to remember in conversations with referring physicians and support

staff, especially during stressful interactions where emotions may run high. This is a

fundamental approach for all interactions. After deeply and fully listening to another, one can

then communicate back with consideration and kindness.

Suppose the emergency department is increasingly pressuring one’s radiology group to

improve turn-around times. Until one fully understands why they would make such a request

and the pressures they face, one cannot begin to address the issue and find a mutually

beneficial solution. In order to think win/win, one needs to understand what winning means to

and for the other party.

Habit 6 – Synergize:

Habit 6 is based on the principle that the whole can be greater than the sum of its parts.

When working together as a team, we can achieve results we could never reach working

independently. The goal is to create an environment of creative cooperation amongst all levels

of staff in a practice. How amazing does it feel when things flow smoothly, with each person

doing his or her part for the greater good? If we recognize and appreciate individual

contributions to the team when things work effortlessly, it creates momentum and positive

energy for even greater cooperation and success.

For example, if one were tackling a quality improvement project to decrease MRI wait

times, one could address the problem in an interdisciplinary manner involving referring

clinicians, technologists, and clerical staff in a way that would accomplish more than any one

person ever could. This approach likely will take longer and involve more short term

frustrations. However, the payoffs can be larger, more sustainable, and ultimately serve more

individuals as well as the greater good.

Habit 7 - Sharpen the Saw:

Effectiveness is not a state to be achieved, but rather a goal to be pursued. Habit 7

reinforces the concept of continuous and never ending self-improvement through the analogy

of a saw. Blades dull and rust over time, as do our skills. By periodically ‘sharpening the saw,’

we can stay sharp and effective in reaching our goals. In addition to maintaining clinical skills

with continuing medical education (CME) courses and participation in interdisciplinary

conferences, one can continually hone their non-interpretive skills through participation in
leadership and personal development courses, Lean and process improvement methodologies,

and Maintenance of Certification (MOC) projects. One can seek mentorship and ultimately

mentor others as a way to ensure accountability and promote progress in one’s career

development.

Habit 8 - Find your voice and inspire others to find theirs:

Effectiveness is about producing results, but true greatness lies in the impact we have

on others. Covey later added this 8th habit to encourage people to find their passion, to which

they could then apply their newfound effectiveness. The most important point about finding

one’s voice is not so much that the voice has to be unique or powerful, but that it is truly and

authentically one’s own. What is your voice as a radiologist? Is it being a practice leader? An

outstanding clinician? A quality and safety expert? Teacher? Researcher? Knowing and

nurturing one’s voice taps into the energy and excitement felt while learning, growing, and

contributing, and helping others do the same. Paying it forward by mentoring others and

helping them to find their voice is equally important to achieving greatness. Mentoring can be

formal or informal, temporary or permanent. Ideally it always leads to growth and

development for both parties (win-win).

Habit 9 - Cultivate gratitude and mindfulness:

We propose this ninth habit as a method to stay grounded and positive during our never-

ending quests for professional and personal success. Gratitude represents “a life orientation

towards noticing and appreciating the positive in life.”3 Studies have shown that gratitude is

related to adaptive personality characteristics, positive social relationships, and physical health
(especially stress and sleep).3 When cases are piling up and the phone is ringing off the hook,

how much better could your day be if you took a moment to express and really feel gratitude?

Studies have shown that simply writing down three things you are grateful for 2-3 times a week

can significantly impact one’s happiness and well-being.4

The concept of mindfulness can be thought of as “maintaining a moment-by-moment

awareness of our thoughts, feelings, bodily sensations, and surrounding environment with an

attitude of acceptance without judgment.”5 Mindfulness has been shown to increase positive

emotions, decrease stress, improve memory and attention skills, and enhance relationships. 5

Mindfulness has been specifically shown to help health care professionals cope with stress,

connect with their patients, and improve their general quality of life.5 A common mindfulness

practice is focused-breathing, in which one’s attention is focused on deep breathing while

accepting whatever thoughts and feelings arise and letting them pass without judgment. This is

simple enough to be done right at the workstation.

Much has been written recently about the epidemic of physician burnout, and

radiology is no exception. Cultivating gratitude and practicing mindfulness are simple ways a

radiologist can help prevent or counteract burnout.

Conclusion

Stephen R. Covey’s eight habits of highly effective people, and our proposed ninth habit,

focus on principles that aid personal and interpersonal effectiveness and mastery both at work

and at home. From independence to interdependence to greatness, raising awareness of these

principles and consistently incorporating them into our everyday lives can pay big dividends for

our patients, colleagues, and families.

References

1. Covey SR. The 7 Habits of Highly Effective People: Powerful Lessons in Personal Change.

New York (NY): Free Press. 1989.

2. Duhigg C. Smarter Faster Better: The Secrets of Being Productive in Life and Business.

New York (NY): Random House. 2016.

3. Wood AM. Gratitude and well-being: a review and theoretical integration. Clin Psychol

Rev. 2010 Nov;30(7):890-905.

4. Emmons RA and McCullough ME. Counting blessings versus burdens: An experimental

investigation of gratitude and subjective well-being in daily life. J Pers Soc Psychol. 2003

Feb; 84(2): 377-89.

5. Greater Good: The Science of a Meaningful Life. Available at:

http://greatergood.berkeley.edu/topic/mindfulness. Accessed April 11, 2016.

Figure 1. Time management matrix