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Possessing a high emotional intelligence (EQ) is essential for any leader. Cheri L. Canon, MD, FACR, professor and chair, The University of Alabama at Birmingham, Department of Radiology, discusses the important topic of EQ and why practice makes perfect as you strive to develop higher EQ skills. She also talks about the importance of EQ for being an effective leader, recognizing burnout and building a better practice.
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Scott: Hello and welcome to another episode of the “Leadership Insider Podcast”. This is Scott Pearce with the American College of Radiology and today we are talking about emotional intelligence or emotional quotient with Dr. Cheri Canon, professor and chair of radiology at the University of Alabama in Birmingham School of Medicine. Dr. Canon, thank you very much for joining us today to talk about this wonderful topic. [00:00:30]
Dr. Canon: Oh, thanks for having me.
Scott: So first, can we just maybe set the stage a little bit and discuss what exactly is emotional intelligence or emotional quotient?
Dr. Canon: Sure. I…you know, first of all, I wanna be clear I am not an expert on emotional intelligence. I started learning about it I guess a few years back in part or entirely because I realized mine needed a little work, [00:01:00] and as I learned more about the concept and actually as I took different EQ inventories, I really realized the power that emotional intelligence provides for a leader. And initially my understanding of emotional intelligence was very constrained. It was…I thought it was just controlling one's emotions. But it's really a lot more than that, and so for me it's been a journey of self-growth [00:01:30] but there's a long ways to go, I'm afraid. In fact, a couple of years ago I actually was going on a trip to speak on the topic and my teenage daughter commented about it and asked me what I was going to talk about, and I told her emotional intelligence. And her response to me was, “You are giving a talk on emotional intelligence?” She was dumbfounded by that.
So I think my family would probably be the first [00:02:00] to suggest that maybe I am not the best candidate to discuss this topic. So that's my disclaimer. The emotional…
Scott: Nothing like children to keep you humble, right?
Dr. Canon: Right, exactly. You know, most of my leadership development stories are grounded in comments or experiences with my family, so you're right. So emotional intelligence or as some people refer to it, EQ, it's an attempt to quantify how we engage [00:02:30] and interact with one another. On the surface, it's a reflection of our interpersonal communication skills. As I mentioned before, it's really so much more than that. It's a construct of how we manage our emotions, but importantly and this is the part that really pertains to leaders, it's how we motivate and lead others in a productive way. And you hear the term EQ a lot. Many people [00:03:00] don't like that term because emotional intelligence, unlike IQ actually can be developed and can improve, fortunately for all of us. It really is the cornerstone of good leadership. In fact, when I'm asked what I think the most important skill is for a leader, I answer emotional intelligence. But I would say even the key for successful happy life is probably emotional intelligence. But the base of it, [00:03:30] developing and [inaudible 00:03:34] empathy. So I think emotional intelligence just makes you a good person.
Scott: Yeah, it's interesting. You mentioned several comments in there. So Daniel Goleman, Richard Boyatziz and Annie McKee have done kinda much of the seminal work of the research on emotional intelligence. In fact, they may have even coined the term emotional intelligence. And within some of their writings they talk about the fact…I was actually just reading recently from Daniel Goleman where [00:04:00] they look at some of the most successful leaders and it wasn't IQ, it wasn't necessarily business acumen or even educational background that set the most effective leaders apart. It really was just as you underscored, their level of emotional intelligence and their ability to understand the emotional comings and goings of their group, but also the ability to motivate and tap into what actually gets their employees and their team members out and going and performing at their best. [00:04:30] And what's interesting…the other thing that you just mentioned is that this is actually something that can be developed. And within their…the book that the three researchers talked about…and it's called, “Primal Leadership” and in it it's interesting because they mention this fact that kind of took me by surprise a little bit to really consider what they're saying. You know, athletes, musicians and world class performers spend a vast majority of their time practicing, but really very little time actually performing, whereas executives and leaders spend nearly all of their time performing [00:05:00] and little to none actually practicing these skills. And so EQ is so critical to really being the most effective leader you can be whether that is personal or professional. Could you just please offer some tips that you've learned along the way of how do you go about developing these EQ…these skillsets?
Dr. Canon: Yeah, you know, it's definitely not a one size fits all. There are different ways to go about it. I think the key though is prescriptive. And if [00:05:30] you look at emotional intelligence, you can kind of break it down into four categories and they build on each other. The first one's kind of the entry level emotional intelligence and it's referred to as self-awareness. And it really simply stated, it's being aware of your triggers. You know, what sets you off. And it's a very inward facing…it's opportunities for us to be aware of our [00:06:00] emotions that have an impact on physiology. I mean, we all know examples of where a certain person, a certain statement kinda sets us off. We feel our heart pounding, we feel our pulse race. So that's kinda step one. Step two is a big step because it's managing that piece and trying not to have that emotional response. And then almost as we move up the pyramid and evolve in emotional intelligence, [00:06:30] the next step is empathy and that's really at the core. So it's not only understanding your triggers and managing those, but it's actually understanding another person's triggers and then finally taking all of those and managing people and motivating them and that's…so those are kind of the four steps.
And so really to do this, you really just have to inculcate it in your daily [00:07:00] activities. And in your management activities at work and your leadership of groups and your interactions with friends and family. And you just have to start out step-wise, being aware of yourself and then becoming aware of others and their feelings.
Scott: Great. Now one of the things that they also talk about in the book is a dissonant leader versus a resonant leader. Can you provide some insights into [00:07:30] the differences between the two and how one might become a more resonant and effective leader?
Dr. Canon: Sure. Dissonant leaders are probably more of the historical leaders we think of. And there was probably and may still be times that call for dissonant leaders. And these are authoritarian leaders. They have a very commanding approach. It's very top down. [00:08:00] And again there are times that maybe that's appropriate. But I would say in modern day just because of the complexity of not just medicine, but complexity of the world, it really takes matrix organizations to solve problems and those organizations really can only function with resonant leaders. And resonant leaders, they take time to [00:08:30] understand individuals on a team. They connect those individuals, they build those individuals to function as a team, and so building relationships is really at the core of their activities. And as a leader they build these relationships around a vision and they take the time for those team members to understand the vision and have buy-in in the vision. So again you can see at the core of that is empathy, [00:09:00] and so to be a resonant leader you must have emotional intelligence. And probably now more than ever with the rapidly changing healthcare. Change management is, you know, it's a daily activity for most leaders. And, you know, one of the steps in change management is, you know, initially describing why we are doing something, why are we making a change but then gaining people's trust [00:09:30] so they can move in that direction, and to gain that trust again, you have to have emotional intelligence and you have to have a common sense of purpose.
Scott: So in terms of what you just talked about there with change management and really understanding culture and there's an interesting case that the book, “Primal Leadership” actually points out about organizations. They talk about them thriving on routine and status quo but they say, you know, there are good news. Even toxic organizations can in fact change. [00:10:00] But the example they give is of a hospital in the late 1990s that was facing increasing demands from patients for quality care and from insurance companies and government agencies for lower costs. Demands obviously in conflict with each other, you know, which honestly…I mean, how much has really changed since then, right? But at any rate, the hospital's leadership's answer was to craft a five-year strategy to overhaul almost every aspect of how it led and managed the institutions. They commissioned the design of complicated software to manage financial data and outsource functions that [00:10:30] could be managed better elsewhere and they moved people in and out with an eye toward efficiency, but again the leadership forgot about the primary foundations for change as you were just talking about, which is the attention to the emotional reality and to the culture. And they failed to recognize how staff actually felt about the change process. They did what a lot of organizations do. They imposed change from above with rational goals, clear mandates, logical processes, and within two years the hospital was on the brink of a total downward spiral but they were able to turn it around by, you know, creating what they called an ideal [00:11:00] organization with the right culture. And so kind of what you were just talking about with change management, what are some ways that you've been able to see to build toward that ideal practice or the ideal department to one that is…has a resonant emotionally intelligent and effective culture?
Dr. Canon: Well, you know, that's difficult and that's probably something that I work on every day in my department and still have a long ways to go. And, you know, emotional intelligence is [00:11:30] a way of life. I mean, it requires daily intentional practice. In some ways it's like meditation or mindfulness, and the more we use this mechanism of leadership, it becomes more natural. And leaders…you know, we have to model this behavior so that other sees this. So that's what establishes the culture. And then once that happens, you have a [00:12:00] community of emotionally intelligent individuals or those who are striving to become more emotionally intelligent. And with that community, then when you have someone that joins that's an outlier, they're seen as such and there's, you know, a natural attempt to conform. So I think it's a very organic process and although change management in many cases has to be rapid and the example you discuss…sometimes you have the burning platform that you need to move quickly because of a [00:12:30] failing organization.
The reality is most emotionally intelligent cultures develop slowly over time and then again it's that community. There's a key piece of emotional intelligence that initially when you look at some of the literature, it wasn't apparent to me. It wasn't really stressed but I realized later how important it is and that's actually motivation. [00:13:00] And it was interesting some years back, you know, I was…you know, I had I guess improved my emotional intelligence and I think most people at work would describe me as being, you know, at least average emotional intelligence if not a little more. But when I would go home, my family would be a completely different person and hence the response by my daughter. And I was sharing that with one of our…we have a faculty [00:13:30] leadership development officer and I shared this with her and she kinda chuckled and she said, you know, “You have to really be motivated.” And again, this is not always a natural or reflexive behavior, particularly initially. So you have to be motivated to stick with it. Again, it's like exercise. It's a great analogy.
And she said, you know, “At home we're probably more comfortable. We're with people that we love and that we trust and we don't feel like we have to be on [00:14:00] all the time. And so we may…” And so I developed the term. I'm sure it's not original but I started referring to this as emotional intelligence laziness. And I felt like at work I was on point all day and then when I went home it was time to relax, but the reality is we really need to continue to practice it at home as well.
Scott: Yeah. Excellent points. And just kinda what you were saying it's really, really, very easy to be comfortable at home and [00:14:30] you get used to the familiar relationships of being able to kinda, you know, show some of the, you know, other sides of yourself. You don't have to “be on”. A couple other things you just talked about there…I think I wanted to talk about and circle back to on the topics of one, mentorship and then burnout. You know, I have talked to quite a few residents and young physicians coming up and your name has come up more than a few times in terms of them having you as a mentor. And I'd just kinda like to get your perspective [00:15:00] if I could on the importance of being a mentor and how that actually impacts EI growth for both you and also the mentee.
Dr. Canon: Well, you know, mentoring is one of those things that most of us can share a story of one or more mentors that in effect changed our lives. I mean, they helped us move into a direction that led to either [00:15:30] success at work, success at home, whatever that is but we can point to those mentors. And at some point, I realized that that was one of the ways that I wanted to give back was to actively engage in mentoring. In an academic setting where I am, mentoring happens really all day, every day in various forms but I wanted to be very prescriptive about it and particularly mentoring young women [00:16:00] or aspiring women leaders. You know, I can't say that I've ever purposefully tried to incorporate emotional intelligence into my mentoring, but I think that all mentors do a lot of that just by role modeling in how we behave. So hopefully as long as they don't see me at home, they can see someone behaving in an emotionally intelligent way. [00:16:30] But, you know, asking that makes me realize that perhaps that's something I should actually discuss very explicitly in conversations with my mentees because again…and I know I keep harping on this, emotional intelligence is really practice. You have to practice, practice, practice. So I guess that's my kind of winding answer.
Scott: No, that's great. And in…you know, for example, [00:17:00] you know, Dr. Amy Patel has mentioned a lot of EQ and her work with you actually as being mentored by you. And so that's kinda where that question had to come to my mind and wanted to ask you about that. So sometimes even if it's not deliberate, you know, if you do as you just said, get into the practice of doing it on a consistent basis, it will seep through into what you're doing regardless. I also would like to probably point out that I think that you're probably being much harder on yourself in terms of your home life and I don't want people to get the wrong picture that you're [00:17:30] painting there about that as far as that's concerned, you know.
Dr. Canon: Fair enough. Fair enough.
Scott: But I would like to talk about EQ and burnout. You know, physician burnout is at an all-time high as we know and according to one of the leading experts on physician burnout and wellbeing, Tait Shanafelt, who's at Stanford now, well over 50% of physicians experience at least one symptom of burnout and that's pretty staggering actually. And according to Dr. Shanafelt, he says, “The rising tide of [00:18:00] burnout coupled with its effects on quality of care and access make burnout a major threat to the healthcare delivery system.” And in fact, I think it's becoming so critical that Stanford…he was Stanford's first chief wellness officer which also makes Stanford the first medical center in the country to create a chief wellness officer position. And so from your perspective and especially considering the burnout within radiology and some of the unique aspects of what the…kind of what the practice is going through right now leading to [00:18:30] some of those increased instances of burnout for radiologists, can you discuss how increased EQ and EQ in action can help radiologists recognize and address burnout symptoms?
Dr. Canon: Sure. Before I answer that I wanna share something. I was so fortunate to actually spend some time with Tait Shanafelt. He was a visiting professor at UAB and he attended a chair's breakfast and so I had [00:19:00] the opportunity to have a very casual conversation with him and really pick his brain and try to get some of his insights. And he said something that really resonated with me and he's actually published and he was nice enough to send me the publication and…but it's this very simple concept about burnout and that we need to do what we love, and that in fact one of the best ways to mitigate against burnout is [00:19:30] really determine what our passion is and then spend a certain amount of time doing that. And he challenged me and he said, “Most physicians are unable to articulate very granularly what they love.” And he used the example of an oncologist's passion was taking care of men with prostate cancer. And in their research…and again this is a publication, it said that if you're able to engage in whatever this activity is for 20% of your [00:20:00] professional time, that that was one of the biggest mitigators against burnout, and interestingly if you increase that time, it doesn't necessarily linearly decrease burnout. You just have to achieve that threshold of one day a week doing what you love and that is incredibly helpful. And he said that because, you know, 20% to most of us, that's manageable, you know. We can do that. And so that gave me hope, but back to your [00:20:30] original question.
So how can we use EQ to recognize and address burnout? Another study actually was in Harvard Business Review looked at healthcare CEOs. And I think it was also chief medical officers as well. And they looked at this group of people who self-reported that this was the most stressful time of their career, yet very few of them demonstrated any signs of burnout. And so when they [00:21:00] did an inventory of these people, the one thing that they had in common was that they had a very high emotional intelligence or EQ. And really at the core of that again is empathy. Burnout is a very inward facing activity. You become withdrawn, you become disengaged, you lose the passion to help others whereas empathy is the exact opposite. You really take the time to consider the other person's situation. [00:21:30] So really if you think about it, EQ not only mitigates against burnout. The activity of demonstrating emotional intelligence is completely counter to burnout. And then linking back with our discussion about a resonant leader, if you lead with resonance and develop your team, then you've developed a sense of purpose and it's that sense of purpose, again that passion that has also helped [00:22:00] us address burnout. So they're really kind of all inextricably linked.
Scott: Yeah. I read that article. It was very fascinating. And the other aspects I was looking at and reading about this as well is…so that's individual focused and, you know, Tait Shanafelt also looked at this as a systemic issue as well and there was a “New England Journal of Medicine” article where he says, you know, “We tell physicians to get more sleep and eat more granola, do yoga and take better care of yourself [00:22:30] and while these efforts are well intentioned, the message to physicians however is that you are the problem and you need to toughen up.” And I thought that that was an interesting insight in terms of that, that there's a more systemic approach to this that actually needs to take place in order to truly address the larger issues of burnout and what that actually means for the health system and patient care. Do you have any ideas in terms of more systemic things that can be done to address burnout on an organizational level as opposed to just the individual? [00:23:00]
Dr. Canon: Yeah. You know, that's a tough one. And particularly now with constrained resources. In general when you're talking about the system issues, it's not creating…at least moving us towards burnout. These are typically big, complex problems but they all do a similar thing. They cause friction. So that [00:23:30] in an environment where physicians are having to do more with less, anything that adds a layer of friction is a contributor to burnout. So let me give you an example. And this is always kind of, you know, the poor punching bag is the electronic medical record. You know, this was a legally mandated instrument for healthcare, the medical record and it was [00:24:00] really initially touted as being an efficiency tool for physicians. But at most physicians…at most institutions physicians really think of it as just another layer of burden or bureaucracy on their daily activities that actually takes them away from taking care of their patients. The challenges with the EMR, there are ways to make it work for physicians but sometimes those are so expensive that health systems [00:24:30] are unable, unwilling to invest in this. So, you know, that's just one big example but anywhere that you can reduce friction on a system level, that's a movement to help physicians and hopefully mitigate against some burnout.
Scott: Well, that actually is perfect because that leads me to a question that I really wanted to ask as well. And to set this up a little, you know. Neural [00:25:00] scientists call our limbic system which is our emotional center and open loop system, which means that it depends largely on external sources to manage itself. So in other words, we rely upon our external connections and our relationships for our own emotional stability which underscores how critical healthy working relationships are. And that coupled with also other scientific studies that show how moods impact cognitive abilities. So in other words, if you're in a bad mood, that may actually impact how well you are able to read and [00:25:30] do your core job of diagnosing. And moods are contagious. And oftentimes an emotional leader isn't necessarily the one that has the title of president or chair for example. And so…and kind of…you know, and you talked about friction and a lot of…obviously those moods and some of those things all lead to increased friction and dissatisfaction. And so when someone…in your experience, what have been some of the best ways to foster meaningful working relationships for a better practice environment? [00:26:00]
Dr. Canon: Yeah. That's tough. And, you know, a concept in there that I'm actually learning more about now and you mentioned it kind of obliquely is the concept of scarcity. And so we tend to concentrate on certain negative things and particularly things we don't have, things that are scarce, and we concentrate to a point that actually research shows that cognitive functioning declines. [00:26:30] And so the great example is kind of the extreme example is when you take a group of individuals and you withhold food to the point they're significantly malnourished and all they can think about is eating. And so when you give them cognitive tests in that environment, they actually perform not as well as other individuals. And more so when you give them a test in that environment [00:27:00] and then somehow integrate food or the concept of food, they're completely distracted and perform even worse. So you really have to concentrate on the positive and I think this gets to the concept of cognitive behavioral therapy, mindfulness. We have to invest time into developing meaningful relationships and [00:27:30] most of us again…feel like we're so busy that we don't have time to do these…as some refer to, these softer skills. But the reality is it's probably worth the time investment up front to do this. And again, we have to take pause, develop relationships. And, you know, the other thing that I see sometimes with colleagues that are perhaps not burned out, but they're [00:28:00] clearly in a time of stress. Perhaps, you know, either physically exhausted or emotionally exhausted. And they're not particularly kind to one another or they're less tolerant than they normally would be, and there's this interesting concept in leadership literature exercise called, you know, think about a back story. So an example, you know, you're walking down a busy sidewalk and someone roughly bumps into you and of course [00:28:30] your immediate response is get defensive, perhaps even say something ugly. But instead of doing that just think of a back story, think of a reason why that person would have done that in such a way, you know, as an example. They're rushing to the hospital where their loved one is dying. You know, that's an extreme example. But it puts you in that mindset of giving others the benefit of the doubt, being positive and again…you know, 10 years ago I really didn't pay as much attention to some of these thoughts or as I refer to [00:29:00] squishy things. But it's amazing how mindset can impact their day and these stories, these tapes that run in our head really can demonstrate themselves in our daily engagement, interactions either in very positive or very negative ways. So I think we really have to find what we're passionate about. We have to make every opportunity to spend time doing that and we have to be more [00:29:30] empathetic towards others and we have to be more generous.
Scott: That's phenomenal advice and it's something I try to remind myself whenever I'm in traffic because I do the same thing whenever I'm in traffic. I've gotta be able to focus on some of those back stories for folks because I'm not a very patient driver myself but…I just wanted to be very mindful of your time here. I know we're running out of time and the last one I…question I really wanted to get to is EQ and artificial intelligence. You know, there's a great quote [00:30:00] that I love from Albert Einstein where he says, “We should take care not to make intellect our God. It has of course powerful muscles but no personality. It cannot lead. Only serve.” And so we're on the cusp of what is seemingly going to be this proliferation of AI within radiology or within healthcare. So why is it so important for a deliberate focus on developing higher IQ particularly in relation to the onset sort of, of increasing AI within radiology and the workflow? [00:30:30]
Dr. Canon: You know, I think you could look at this at several different perspectives. Two that come to mind, you know…one is that artificial intelligence clearly is a paradigm shift in how we will work in the future. And none of us knows exactly how that's gonna play out. Regardless, it will be a case study in change management. I think on the optimistic side, it will be an extremely helpful tool [00:31:00] for radiologists and it may even replace some of the more rote tasks that we engage in so that we can then spend time doing those other things that bring us more passion, more fulfillment. You know, making the difficult diagnosis in the challenging, complex patient, engaging with our clinical colleagues etc. You know, but that being said, there are some people that are, [00:31:30] you know, convinced that machines will take over the world and they have this great fear of that. You know, I think that's unrealistic and unfounded, but you could argue if that were true, that emotional intelligence may be the one thing that sets us apart from the machine.
Scott: Yeah, absolutely. I think that that's a sound argument that I don't think really has a counter argument to be honest with you. Dr. Canon, thank you absolutely so much for being able to take [00:32:00] the time today to talk to us. So thank you once again, Dr. Canon. We really appreciate it.
Dr. Canon: Oh, you're welcome. Thank you.
Scott: Thank you for joining us for another episode of the “Leadership Insider”. If you are looking for more resources on emotional intelligence, the RLI will host sessions devoted to this very important topic. The RLI leadership summit this year will feature a session titled “Leading with social and emotional competence” where we will examine how those leaders with high EQ created an overall positive [00:32:30] environment and how that leads to more productive and more successful practices. In addition the skills that you will learn during this session will even help you improve recruitment and retention of millennials as well as deal effectively with burnout and help resolve disruptive behavior in your environments. This year, the leadership summit will be held September 7th through the 9th at Babson College in Wellesley, Massachusetts which is just outside of Boston. For more information on the leadership summit please visit www.radiologyleaders.org/ [00:33:00] leadership-summit.
Cheri L. Canon, MD, FACR, professor and chair, The University of Alabama at Birmingham, Department of Radiology
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