July 25, 2019

McGinty Discusses Old Power, New Power and Their Relevance for Radiology

You have to sometimes think outside the box to find out what’s inside. That’s exactly the approach American College of Radiology (ACR) Board of Chancellors Chair Geraldine McGinty, MD, MBA, FACR, took Monday, July 22, during her ACR Grand Rounds presentation before nearly 200 members of ACR staff.

The box in question was laid out as a four-square matrix to define four types of personalities and how they fit the milieu of “new power” and “old power,” as defined by social philosophers Henry Timms and Jeremy Heimans and in their popular book, “New Power: How It’s Changing the 21st Century – and Why You Need to Know.”

In some ways, the ACR seems to exemplify old power in its hierarchical organizational structure, its penchant for excellence, expertise, exclusivity and testing to determine if candidates for fellowship qualify for recognition by the group, McGinty explained. “There is an expectation of loyalty and long-term commitment. You get to be a leader through your commitment to the organization and its leader and your willingness to become part of and shape the culture,” she said.

New power may not always play by the rules that govern professional societies, but it has a lot to say about the creativity, inclusivity, mass appeal and the strengths and shortcomings of some of this century’s most successful corporations and mass movements. “Based on the values of new power, you don’t have to be an expert to participate,” McGinty said. “You don’t have to come up through the ranks and pay your dues to be part of the conversation. Knowledge is readily shared, and a consensus may form around one issue but not necessarily around others.”

New power is relevant to the ACR, according to McGinty, because of the insights it brings to the personality types in Timms’ and Heiman’s four-square models and their implications for the creative energy and commitment the College can expect from its future leaders and members.

Situated in one quadrant are “Castles,” symbolizing those old-school radiologists and ACR volunteers who rely upon the ACR’s hierarchical structure, traditions and rules to contribute to the College’s status and success.

In another quadrant, “Cheerleaders” are people who have a leadership role to play in a traditional sense but are also amenable to change and know how to engage a crowd in the spirit of other cheerleaders, such as companies like outdoor clothing and gear purveyor Patagonia.

“Crowds” gravitate to new power. They like informality and operate most effectively when there are few barriers to joining organizations, rules are not codified and ideas are readily shared. The Occupy movement was based on this model, which can be credited for its decentralized leadership and broad reach. However, despite its members’ strong allegiance to the movement, it was ultimately not sustainable in the long term, which is a risk to be addressed in pursuing such models.

And “Co-opters,” such as Uber’s Travis Kalanick, prefer working in a top-down organizational structure and using the rules and the strength of their personality to reach objectives. The rideshare company he founded, Uber, is an example of a co-optive company as evidenced by its disruptive business model and fractious employee relations.

So how do leaders attain a proper balance of old and new power to achieve success? That quest can go awry, as illustrated by the example of the British Royal Navy’s attempt to enlist public participation in the naming of a new arctic exploration vessel. The Navy was forced to abruptly change course when the British public showed an ironically comical preference for “HMS Boaty McBoatFace.” Those who voted were disappointed when their engagement was set aside, and the ship was instead christened in honor of renowned naturalist Sir David Attenborough.

But a commitment to customer engagement can lead to new markets and sales growth with the help of creative marketing and competent market research. Toymaker Lego confirmed that many adults play with its toys by connecting with audiences attending events that were organized, not by the company, but by its adult fans. Recognizing that these customers, known as Adult Fans of Lego or AFOL, were outspending the “traditional” customer 20 to one, Lego set out to cultivate this group. From crowdsourcing ideas for new kits to inviting the community to submit scenes for the blockbuster Lego movie Lego developed legitimacy with its customer base that turned into profits. McGinty highlighted a project led by pediatric radiologist Ben Taragin, MD, to develop an MRI Lego kit designed to help children undergoing MRI deal with anxiety that leveraged Lego’s crowdsourcing design process.

Even organizations as highly structured as England’s National Health Service can be fertile ground for self-described rebels like Helen Bevan, creator of the NHS School for Change Agents. Bevan was attracted to the new power principles advocated by Timms and Heimans to find creative ways to provide quality health care despite chronic underfunding and stifling bureaucracy.

Bevan found that small acts of civil disobedience can be effective for bringing chronic problems to the attention of higher-ups at NHS. One such example, cited by McGinty, was #EndPJParalysis, an effort to bring normalcy to elderly patients stuck in acute care because of long-term care facility shortages. Bevan and her colleagues were troubled seeing these patients lying in their pajamas all day, so they all arrived at work one morning wearing pajamas to focus attention on the problem.

Though the ACR has thrived as an old power organization, with its emphasize on structured governance, expertise and credibility, McGinty argued that it is a new power organization as well.

“The idea for the mentorship program at the 2019 ACR Annual Meeting originated with staff members Darlene Poucher and Catherine Herse. It opened up the meeting to first-time attendees in a way that was quite unlike my first experience when I didn’t know where I was supposed to sit and which sessions I was allowed to attend,” McGinty remembered.

There is more work to do, she admitted, especially in adjusting to the preferences and values of younger radiologists. McGinty stressed the ACR is not assuming that the organization that has served its members well and has gained the loyalty of many radiologists over the years will have the same appeal for the next generation. In fact, the College’s research suggests that some younger members think the organization is “old” and too “ivory tower.”

“When it comes to diagnosing a brain tumor, I want an ‘ivory tower’ expertise, but for an organization that is in large part about advocacy and shaping the way we practice, we really want to make sure young people feel that this is where they can come and be part of the decision-making process,” she said.

McGinty identified principles that summarize what she’s learned about new power. It is important to think about stakeholders, their perspectives and how they can help or hinder your pursuit of goals. After you believe you fully understand the stakeholder, think again to find what you have yet to learn.

Do the necessary work to educate and build consensus, making sure people really understand what you are trying to accomplish and why. Welcome diverse options, build diverse teams and encourage diversity in the medical imaging profession. Don’t marginalize rebels, but invite them to the table, channel their energy and challenge them to find innovative solutions.

“At the end of the day, it’s going to be a balance,” McGinty said, “but we’re in a great place to move forward.”